Within REACH Fall 2021

Volume 12│Issue 3│Fall 2021 Carilion Clinic, 1906 Belleview Ave, Roanoke, VA 24014 https://www.insidecarilion.org/hub/nursing -research-evidence-based-practice nursingresearch@carilionclinic.org (540)266 -6216

The Power Within Reach of Nurses Deirdre Rea, DNP, MSNCNS, PMHRN-BC - Connect Director & Within REACH Editorial Board Member The arrival of the novel Coronavirus-19 pandemic turned healthcare – and nursing- upside down. The spread seemed unstoppable. There were not enough beds, ventilators, PCR tests, PPE or nurses to care for the tsunami of patients arriving on our units daily. Every discharge was to be celebrated because we were unable to stop the rising death toll. If there was ever a time when we, as nurses, felt powerless to effect change, this was it. And the fallout has been an exodus of people from the nursing profession. 1 While we may have felt powerless, I would strongly argue that we are not. According to the American Association of Colleges of Nursing in its 2019 Nursing Fact Sheet2, there are more than 3.8 million registered nurses throughout the United States comprising the largest segment of the healthcare workforce. There is potential power in our numbers. Nurses again topped the Gallup Poll list of the most trusted professions in the country.3 There is potential power in being trusted. Abood4 identifies this as referent power and states this is an important asset that puts us in a position to foster change. As a Magnet© recognized organization with an emphasis on a nursing education, we are recognized for our knowledge and skill. Abood defines this as expert power. But this power remains in the realm of ‘potential’ if we do not employ those strengths.

The articles in this issue of WithinREACH offer different methods to turn that potential power into active power. When we search the literature, critically analyzing and comparing outcomes from multiple studies to identify best practices for our patients, we are utilizing our expertise. When we direct those 3.8 million, most -trusted healthcare voices – and votes- toward the legislative process, we are exercising our referent power and numbers. Fortunately, we can empower ourselves with exploring evidence-based practice at any time.

Legislation is somewhat different. Longest 5 describes the opportune time for policy change as being in the ‘window of opportunity’ when problems, possible solutions and political circumstances come together at the same time. This year in Virginia, we are at just such a place. In November, the Commonwealth will vote for a new Governor, Lieutenant Governor, Attorney General and for every seat in the House of Delegates.

Use your power! Write, call or speak directly to the candidates. Ask their positions on healthcare. Educate them on the problems you see on the frontline and offer possible solutions. BE HEARD- and advocate for both our patients and our profession. ~ Deirdre References 1.

2.

3.

4.

5.

Kalter L. Survey: 2/3 of critical care nurses consider quitting due to Covid-19. https://www.webmd.com/lung/news/20210920/ survey-critical-care-nurses-consider-quitting-due-covid. Published September 20, 2021. Accessed October 6, 2021.

Nursing Fact Sheet. American Association of Colleges of Nursing website. https://www.aacnnursing.org/news-Information/factsheets/nursing-fact-sheet Published April 1, 2019. Accessed October 6, 2021.

Nurses top list of most honest and ethical professionals: Gallup. Staffing Industry Analysts. https://www2.staffingindustry.com/ row/Editorial/Healthcare-Staffing-Report/Jan.-14-2021/Nurses-top-list-of-most-honest-and-ethical-professionals-Gallup Published January 14, 2021. Accessed October 6, 2021.

Abood S. Influencing Health Care in the Legislative Arena. OJIN: The Online Journal of Issues in Nursing. 2007; 12(1), Manuscript 2. Accessed October 6, 2021.

Longest BB. Health policymaking in the United States. Ann Arbor, MI: Association of University Programs in Health Administration (AUPHA) Press/Health Administration Press;2010.

Carilion Clinic Roanoke Campus

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ARTICLES/NOTIFICATIONS 1 The Power Within REACH of Nurses 3 4

Deirdre Rea, DNP, MSNCNS, PMHRN-BC American Academy of Nursing - 2021 Class of New Fellows Announcement

Best Practice for Measuring Body Temperature Kim Carter, PhD, RN, NEA-BC 9 Nursing Legislation Summary - Nurse Staffing for Hospital Patient Safety and Quality Brittany Spence, BSN, RN, CEN 11 A Day in the Life of Diabetes: Perspectives from a Provider Vanessa Hedge, MSN, CPNP-AC

RECOGNITION/EVENTS 12 Recognitions 16 Virtual Journal Club 17 18 20 23 24 25

Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Carilion Nursing Research Classes - end of year update Citations & Recognitions Carilion Nursing Research Virtual Conference Information Nursing Research Hub Information See Where Our Nurses Have Presented Their Work 2021-2022 National Virtual Nursing Conference Information

**If you are interested in becoming a member of the Carilion Nursing Research Editorial Board, please email your CV or Resume to Chris Fish-Huson (cdhuson@carilionclinic.org) for review!**

Carilion Nursing Research Editorial Board: Deirdre Rea, DNP, RN-BC, PMH-CNS - Interim Editor-in-Chief Reviewers Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCRN, CCNS Ann Beheler, ADN, RN Sarah Browning, DNP, RN-BC Charles Bullins, DNP, RN, AGACNP-BC Monica Coles, DNP, RN-BC, ACNS -BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, PhD, RN, CNE

Donna Goyer, BSN, RN, CPAN, CAPA Cindy W. Hodges, BSHS, RNC, FCN James Ingrassia, MSN, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Laura Reiter, MSN, RN, CCRN, CNRN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC

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CONGRATULATIONS! American Academy of Nursing Announces 2021 Class of New Fellows

Join us in congratulating our very own Phyllis Whitehead, PhD, APRN, ACHPN, PMGT-BC, FNAP - Clinical Ethicist who has been inducted by the American Academy of Nursing into the 2021 Class of Fellows.

The inductees will be recognized for their significant contributions to health and health care at the Academy’s annual Health Policy Conference on October 7-9, 2021.

The newest fellows represent 39 states, the District of Columbia, and 17 countries. Through a competitive, rigorous application process, the Academy’s Fellow Selection Committee, which is comprised of current fellows, reviewed hundreds of applications to select the 2021 Fellows based on their contributions to advance the public’s health.

Induction into the Academy is a significant milestone in a nurse’s career, in which their accomplishments are honored by their colleagues within and outside the profession.

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Best Practice for Measuring Body Temperatures

Kim Carter, PhD, RN, NEA-BC - Senior Director Nursing Research Purpose of Review The purpose of this review was to examine the literature to identify best practice for non-invasive body temperature measurement for adult hospital inpatients, with a specific focus on axillary temperature.

Background Core body temperature (CBT) reflects overall health and endurance. The gold standard location for measuring core body temperature is the pulmonary artery; however, accessing this location is invasive and risky15,21. The esophagus and rectum are also recognized as accurate, but with some risk, inconvenience, and are not practical for many situations21. Therefore, other measurement locations and devices, including contact-type (sublingual mouth, rectum, axillary, and base of urethra) and non-contact-type infrared (IRT) thermometers (tympanic and forehead) are options5. Forehead thermometry includes a thermistor probe, a liquid crystal strip, and an IR thermometer5. There are two types of infrared techniques for surface temperature: point estimation (tympanic IRT or forehead IRT) and IR thermal imaging5.

What constitutes “normal” in core and peripheral temperature measurement further complicates the situation. Variations in core body temperatures between rectal (37.04 ͦ C) and urine (36.61 ͦC) are a result of a fundamental problem with how urine core body temperature was measured in the 1970s and 1980s22. Following an analysis of 36 articles reflecting 9227 measurement sites from 7636 subjects in a systematic review of papers published from 1935 to 2017, Geneva and colleagues defined “calculated ranges (mean + standard deviations) were 36.32-37.76 (rectal), 35.76-37.52 (tympanic), 35.61-37.61 (urine) 35.73-37.41 (oral), and 35.01-36.93 (axillary)” (p. 1).

Many studies grapple with determining “normal” for each of the methods of measuring body temperature5.

The complexity of body temperature measurement is also affected by a variety of influences.

Normal oral adult temperature has decreased in Japan24 and in the U.S. at a rate of 0.03 C ͦ per birth decade since 186023. Geneva, et al.’s findings22 are consistent with a normal body temperature lower than the currently accepted normothermia cutpoint of 36.8 ͦC, but not to a level of clinical impact. It is important to consider the patient’s age, blood pressure, pulse rate, time of day, and site of measurement when assessing body temperature 22, 24. Compared to younger adults, healthy older adults have lower body temperatures (an average of 0.23 ͦC) due to slowing metabolism and decline in internal temperature regulation mechanisms, which is clinically important as people aged 60+ may not exhibit a temperature in the traditional fever range22.

The ideal device for measuring core temperature in critical care patients would be continuous, noninvasive, and accurate18. This review followed the evidence-based practice review process outlined by the Ohio State University Fuld Institute to analyze and synthesize the current evidence related to thermometry options.

Approach Search Process. The following data bases were searched: 1. HERO: “axillary temperature adult”, published since 2016, English 2. CINAHL: “body temperature” AND “axillary” OR “oral” AND “adult”, 2016, English 3. Google Scholar: “body temperature measurement”, English 4. TRIP: “temperature measurement” 5. Ancestry search yielded Singh, 2000; Jensen 2000 After screening, 21 papers were ultimately included in the analysis. Papers were not included if

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they were pediatric or did not compare temperature to a referent method. Further, papers were excluded if the focus of the work was to determine “normal” core and/or peripheral body temperature. The literature review in Chen, Chen, & Chen (2020)5 was used to further augment the synthesis table, citing their literature as secondary sources in this review.

Synthesis and Analysis Following the process from the Ohio State University Fuld Institute of EBP, analysis and synthesis tables were developed (Table 1).

Findings The literature is relatively weak in identifying best practice for measuring body temperature peripherally. Studies are limited in sample size, design, and many do not compare the peripheral approach being studied to a core body temperature measurement. Systematic reviews and meta-analyses either did not use established meta-analytic methods or were narrow in scope to select populations15. Not all studies identified the specific device brand or device type (such as infrared or electronic) that was used.

No approach for measuring peripheral body temperature stands out as best practice from this review (See synthesis table on page 6).

Axillary: Of the 9 studies reported, 4 do not recommend use of the axilla, and 2 note use with caution. The Agency for Clinical Innovation (2014) identifies some support for the axillary approach1, and Pei (2018) found that axillary thermometry using the iThermonitor WT701 was suitable for clinical use with noncardiac surgical patients17.

Infrared or electronic Tympanic: Of the 14 studies reported, 10 do not recommend use for fever detection. Mogensen (2018, as cited in Chen, Chen, & Chen, 2020 5) determined that IRT was adequate for screening. When compared to IR TA, IR tympanic was most accurate compared to nasopharyngeal. A combined screening approach is recommended with tympanic and oral 12 and with IR forehead5.

Oral: Of the 8 studies examining oral approaches, 3 did not support use 3,10,15. Some support for oral thermometry was yielded by the Agency for Clinical Innovation 1. The disposable oral electronic thermometer had some degree of support from studies 4,7 and the Emergency Nurses Association (as noted by Hafizi, 20199). A combination approach for detection of fever between oral and tympanic was recommended by others12.

Forehead: Of the 22 studies, infrared forehead temporal artery measurement was not recommended by 14 studies of contact-type, liquid crystalline strip, non-contact IRT, and the Exergen TAT-5000, especially with medications used for anesthesia1-5,8-9,11,14-16. The contact-type forehead with and without ear tap approach was supported by Blake (2019). Chen, Chen, & Chen (2020) recommended a combined screening with IR forehead and then confirmed with tympanic thermometry. Cautious use was suggested by Fitzwater (2019), Hafizi (2019), and Hsiao (2020, as cited in Chen et al, 20205) suggests two readings with using forehead thermometry. However, a summary of 7 studies between 1969 and 20025 found that contact type deep skin forehead thermometry was accurate and suitable for clinical use.

Other: The infrared wrist approach was not recommended5. The Zero Heat Flux was found to be comparable to rectal and bladder thermometry and recommended for medical, surgical and neurologically injured ICU patients18, but another did not recommend it6, based on findings from 2 studies. However, one study6 did not identify the product tested for zero heat flux in the 2 studies, while Schell-Chaple (2018)6 used the SpotOn thermometry system (3M Healthcare). It is possible that different brands were examined. The Vital-SCOPE thermopile contactless temperature sensor was found to be promising20. Jensen (2000) noted that the electronic rectal temperature compared

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Table 1: Synthesis Table

Practical Applications of Nursing Inquiry

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most closely to rectal mercury10; although many new products have emerged in the 21 years since this paper was published.

References 1. Agency for Clinical Innovation. 2014. Temperature measurement for critically ill adults clinical practice guideline. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/240178/ACI14_Temperature-1 -4.pdf 2. Aykanat, V., Broadbent, E., & Peyton, P. 2021. Reliability of alternative devices for postoperative patient temperature measurement: two prospective, observational studies. Anaesthesia, 76, 514-519. doi:10.1111/anae.15248 3. Bijur, P., Shah, P., & Esses, D. 2016. Temperature measurement in the adult emergency department: oral, tympanic membrane and temporal artery temperatures versus rectal temperature. Emergency Medicine Journal, 33, 843-847. Doi: 10.1136/ememed-2015-205122 4. Blake, S., Fries, K., Higginbotham, L., et al. 2019. Evaluation of noninvasive thermometers in an endoscopy setting. Gastroenterology Nursing, 42(2),123-131. DOI: 10.1097/SGA.0000000000000367.

5. Chen, H., Chen, A., & Chen, C. 2020. Investigation of the impact of infrared sensors on core body temperature monitoring by comparing measurement sites. Sensors, 20, doi: 10.3390/s20102885.

6. Cutili, S., See, E., Osawa, E., Ancona, P., Marshall, D., Eastwood, G., Glassford, N., & Bellomo, F. 2021. Accuracy of non-invasive body temperature measurement methods in adult patients admitted to the intensive care unit: A systematic review and meta-analysis. Critical Care and Resuscitation, 23(1), 6-13.

7. Fitzwater, J., Johnstone, C., Schippers, M., Cordoza, M., & Norman, B. 2019. A comparison of oral, axillary, and temporal artery temperature measuring devices in adult acute care. MEDSURG Nursing, 28(1), 35-41. NLM UID: 9300545 8. Gates, D, Horner, V., Bradley, L., Sheperd, T., John, O., & Higgins, M. 2018. Temperature Measurements: Comparison of different thermometer types for patients with cancer. Clinical Journal of Oncology Nursing, 22(6), 611-617. Doi: 10.1188/18.CJON.611-617 9. Hafizi, D. & McCormack, S. 2019. Infrared tympanic thermometers for measurement of temperature in adults and children: clinical effectiveness, diagnostic accuracy, and guidelines. Ottawa: CADTH Rapid Response Report, Apr. 10. Jensen, B., Jensen, F., Madsen, S., & Lossi, K. 2000. Accuracy of digital tympanic, oral, axillary, and rectal thermometers compared with standard rectal mercury thermometers. European Journal of Surgery, 166, 848-851. DOI: 10.1080/110241500447218

11. Kiekkas, P., Stefanopoulos, N., Bakalis, N., Kefaliakos, A., Karanikolas, M. 2016. Agreement of infrared temporal artery thermometry with other thermometry methods in adults: systematic review. Journal of Clinical Nursing, 25, 894-905, doi: 10.1111/jocn.13117 12. Martin, D., Das, P., Friedman, M., & Rahman, M. 2019. Assessing performance of multiple methods for measurement of body temperature, Bangladesh. Poster Abstracts, Open Forum Infectious Diseases (OFID), 6, (Suppl 2). S614.

13. Marui, S., Misawa, A.,Tanaka, Y., & Nagashima, K. 2017. Assessment of axillary temperature for the evaluation of normal body temperature of healthy young adults at rest in a thermoneutral environment.

Journal of Physiological Anthropology, 36(18), doi: 10.1186/s40101-017-0133-y 14. Mason, T., Boubekri, A., Lalau, J., Patterson, A., Hartranft, S., & Sutton, S. 2017. Equivalence study of two temperature-measurement methods in febrile adult patients with cancer. Oncology Nursing Forum, 44(2), E82-E87. doi: 10.1188/17.ONF.E82-E87

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References continued: 15.

Niven, D., Gaudet, J., Laupland, K., Mrklas, K., Roberts, D., & Stelfox, H. 2015. Accuracy of peripheral thermometers for estimating temperature: A systematic review and meta-analysis. Annals of Internal Medicine, 163, 768-777. Doi: 10.7326/M15-1150 16.

Paik, G., Henker, H., Sereika, S., Alexander, S., Piotrowski, K., Appel, N. Meng, L., Bircher, N., & Henker, R. 2019. Accuracy of temporal artery thermometry as an indicator of core body temperature in patients receiving general anesthesia. Journal of PeriAnesthesia Nursing, 34(2), 330-337.

17.

Pei, L., Huang, Y., Mao, Guangmei, & Sessler, D. 2018. Axillary temperature, as recorded by the iThermonito WT701, well represents core temperature in adults having noncardiac surgery. Anesth Analg, 126, 833-838. DOI: 10.1213/ANE.0000000000002706

18.

Schell-Chaple, H., Liu, K., Matthay, M., & Puntillo, K. 2918. Rectal and bladder temperatures vs forehead core temperatures measured with SpotOn Monitoring System. American Journal of Critical Care, 27(1), 43-50.

19.

Singh, V., Sharma, A., Khandelwal, R., & Kothari, K. 2000. Variation of axillary temperature and its correlation with oral temperature. Journal of Association of Physicians in India, 48(9), 898-900.

PMID: 11198790

20.

Sun, G., Matsui, T., Watai, Y., Kim, S., Kirimoto, T., Suzuki, S., & Hakozaki, Y. 2018. Vital-SCOPE: design and evaluation of a smart vital sign monitor for simultaneous measurement of pulse rate, respiratory rate, and body temperature for patient monitoring. Journal of Sensors, 2018. Https:// doi.org/10.1155/2018/4371872

21.

Yeoh, W., Lee, J., Gan, C., Liang, W., & Tan, K. 2017. Re-visiting the tympanic membrane vicinity as core body temperature measurement site. PLoS ONE, 12(4), e)174120. https://doi.org/10.1371/ journal.pone.0174120.

Other papers cited, but not included in analysis and synthesis: Geneva, I., Cuzzo, B., Fazili, T., & Waleed, J. 2019. Normal body temperature: A systematic review.

Open Forum Infectious Diseases, DOI: 10.1093/ofid/ofz032 Protsiv, M., Ley, C., Lankester, J., Hastie, T., & Parsonnet, J. 2020. Decreasing human body temperature in the United States since the Industrial Revolution. Elife, 9(e49555. DOI: https://doi.org/10.7554 eLife.49555.

Yoshihara, T., Zaitsu, M., Ito, K., et al. 2021. Statistical analysis of the axillary temperatures measured by a predictive electronic thermometer in healthy Japanese adults. International Journal of Environmental Research and Public Health, 18, 5096. doi.org/10.3390/ijerph18105096

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Nursing Legislation Summary: Nurse Staffing for Hospital Patient Safety and Quality Care Act Brittany Spence, BSN, RN, CEN - CRMH Emergency Department

Legislation can make a difference to address the nurse staffing crisis. As of 2019, only 15 states have legislation in place to address nurse staffing ratios (American Nurses Association, 2019).

Though helpful, “in 13 of those states, the laws only require there to be a general plan in place to manage the ratio as opposed to regulate it” (King University Online, 2019). The American Nurses Association, Emergency Nurses Association, and The American Academy of Emergency Medicine agree that states should require hospitals to formulate staffing plans for all nursing areas (Eales, 2019). The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2392, Schakowsky, 2017), sponsored by Illinois Representative Jan Schakowsky and Ohio Senator Sherrod Brown, focused on nurse-to-patient ratios to improve the safety and quality of patient care.

Prior to this bill, there were no federal guidelines describing the appropriate number of patients a nurse could safely care for in all areas (National Nurses United, 2021). This paper explores the need for specific nurse-to-patient ratios within hospitals from a legislative perspective.

The higher the number of patients a nurse is required to care for at one time, the higher the rate of burnout, risk of errors, and inappropriate care for these patients (National Nurses United, 2021).

According to National Nurses United (2021), each patient beyond recommended ratio limits increases the risk of adverse patient outcomes by 7 percent. There are several factors to consider when determining an appropriate nurse to patient ratio which include, but are not limited to, acuity, staff numbers, department volume, type and location of the facility, individual staff ability and experience, area of care (American Nurses Association, 2019). H.R. 2392 identified recommended patient to nurse ratios for specific care areas, including trauma emergency (1:1), operating room (1:1), critical care (1:2), emergency room /pediatric /stepdown /telemetry /antepartum /combined labor and delivery and postpartum (1:3), medical-surgical units/intermediate care nursery /acute care psychiatric /other specialty care (1:4), rehabilitation and skilled nursing (1:5), and postpartum/ well-baby nursery (1:6). This bill required hospitals to create and maintain plans for staffing each year to ensure that the minimum ratio requirements were met. It also required that hospitals maintain detailed records of how these ratios were maintained. The bill included protection for staff who reported unsafe ratios.

I have worked in 5 different emergency departments and have clearly seen how staffing ratios affect patient care and nurse wellbeing. When nurses get behind because they have more patients than is safe, the care of all patients suffer, and stress and burnout increases for the staff (Vuong, 2020). When the expectation is to take as many patients as necessary to fill the needs, care feels unsafe and nurses are discouraged to not be able to attend to their patients’ needs. The American Academy of Emergency Medicine advocate for a maximum ratio of 1 nurse per 3 patients in emergency departments (Eales, 2019), and in my experience I agree that this would allow for sustainable, safe and effective patient care with less stress for staff. Safe ratios also lead to decreased nursing errors, departmental efficiency, and lower nursing turnover (Eales, 2019; National Nurses United, 2021).

A bill that addresses safe staffing ratios is necessary to ensure that patient and staff safety are maintained in all hospitals. However, H.R. 2392 was never made into a law. However, bill

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co-sponsor Senator Sherrod Brown has proposed a similar bill entitled Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021. Currently, California is the only state that has a law passed specifically addressing nurse-to-patient ratios on specific hospital units (Eales, 2019; National Nurses United, 2021). Clearly, other states have a lot of work to do to pass similar laws to improve patient safety and nurse burnout.

In conclusion, nurses in the remaining states should advocate for best practices in safe patient care by working with their hospital safety committees and state nursing associations. Additionally, nurses can increase their political activism and awareness. One way is for nurses to contact legislators to provide testimony and helpful information to be used to develop legislation.

References American Nurses Association. (2019, July). Nurse Staffing Advocacy. Nursingworld.Org. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy/ Eales, T. (2019, April 8). Unsafe Nursing Ratios Incapacitate EDs, Endanger Patients.

Emergency Medicine Residents’ Association. https://www.emra.org/emresident/article/nursingratios/#:~:text=The%20American%Academy%20of%20Emergency,roles%20for%20higher%ac ity%320departments.

King University Online. (2019, March 12). Nurse-to-Patient Ratio: How Many is Too Many?

Nursing Center. https://www.nursingcenter.com/ncblog/december-2019/nurse-patient-ratio National Nurses United. (2021, April 29). Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Sponsored by Senator Sherrod Brown Representative Jan Schakowsky. nationalnursesunited.org/sites/default/files/nnu/documents/0421_Ratios_Federal_FactSheet.pdf

Schakowsky, J. (2017, May 4). H.R. 2392 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. In govtrack. Retrieved June 29, 2021, from https://www.govinfo.gov/content/pkg/BILLS-115hr2392ih/pdf/BILLS-115hr2392ih.pdf Vuong, L. (2020). Staffing Ratios and Burnout. American Journal of Nursing, 120(5), 13. https://doi.org/10.1097/01.NAJ.0000662724.83879.81

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A Day in the Life of Diabetes: Perspectives from a Provider

Vanessa Hedge, MSN, CPNP-AC - Carilion Children’s Pediatric Endocrinology Several years ago, I transitioned from working as a Pediatric Nurse Practitioner in the inpatient setting to an outpatient position in Pediatric Endocrinology. If you do not know anyone with type 1 diabetes, you may not be aware of how difficult it can be, particularly for children or adolescents.

Being a parent of a child diagnosed with diabetes is also highly challenging and frustrating. Many advances in diabetes management help those with diabetes achieve their day-to-day activities; however, the disease persists in the lives of the individual and family.

To gain expertise in diabetes technologies, such as continuous glucose monitoring monitors and insulin pumps, I chose to wear each device myself. While I do not have diabetes, choosing to live "a day in the life with diabetes" opened my eyes to the tremendous amount of dedication and commitment required by patients to manage this disease. While wearing the continuous glucose monitor (CGM), I was able to keep a constant watch on my glucose levels and even received alerts on my cell phone if my levels were out of range.

While going for a run one day, my CGM alerted me that my glucose was low. Since I do not have diabetes, this likely was normal during strenuous activity; however, I wanted to confirm with a blood sample. Upon returning to my vehicle to check my blood glucose using a standard fingerstick, I suddenly realized the battery on the glucometer was dead. It hit me right then that THIS is "real-life diabetes."

For just a moment, suppose I did have type 1 diabetes. During that moment, while trying to maintain a healthy lifestyle with exercise, my glucose became dangerously low, requiring quick-acting glucose to keep me from passing out. But I did not plan for low glucose, so I was unprepared. I did not have glucose tabs to quickly bring my blood glucose up to a safe range, nor did I have an emergency glucagon kit. What if I had passed out? What if I had a hypoglycemic seizure? I was alone, with no one around me knowing why I was on the ground. From the outside, nobody "looks" like they have diabetes.

I realized through this experience and all the associated questions it brought that individuals with type 1 diabetes and their family members are constantly burdened by these types of events.

While the purpose of "living a day in the life of diabetes" was to gain knowledge in prescribing and recommending diabetes technologies to my patients, I gained much more than that. I realized that having diabetes is a constant and nagging reminder that I had a chronic disease. A disease that I did not ask for and from which I cannot take a break. A disease that has no cure. This experience has allowed me to understand better how difficult it is for children, adolescents, and families to manage diabetes. After my experience of "living with diabetes," interactions with patients have shifted to being more understanding, empathic, and compassionate. As a result, my patients are more open and honest in discussing their care and responsive to finding ways to improve their health.

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Curiosity & Collaboration!

CRMH 9M ICU & CRMH 8M ICU CELEBRATING SUCCESS!

9M ICU

In 2019, both units had some of the highest rates of hospital acquired infections (HAIs). Decreasing HAIs, which can be caused by different conditions, including the use of Foley catheters and central lines, is one way of improving patient outcomes. 8M ICU was used as a COVID unit for 17months, and nearly 100% of their patients had Foley catheters and central lines for weeks. Yet, both 8M ICU and 9M ICU are leading the pack in best overall improvements. Each unit had 8 HAIs in 2020, but none in 2021. The staff came together and pushed each other to redefine how they approached ICU care.

8M ICU

Collaboration!

Ellen Harvey, DNP, RN, ACNS-BC, CCRN, TCRN, FCCM Carilion Roanoke Memorial Hospital - Trauma Services Radford University School of Nursing & Teaching Excellence Academy for Collaborative Healthcare Congratulations to Ellen Harvey for being appointed Associate Faculty status at Radford University School of Nursing, as well as receiving an appointment to the Teaching Excellence Academy for Collaborative Healthcare (TEACH) Skilled member. The mission of TEACH is to promote learning excellence at Carilion Clinic, the Virginia Tech Carilion School of Medicine, and Radford University Carilion by creating a community of educators and fostering their development as teachers, learners, and education researchers.

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Compassion!

Kelly Epperly, RN - Nurse Navigator CNRVMC Radiology Administration 2021 Vision Award Congratulations to Kelly Epperly, RN at CNRVMC for receiving the Vision Award for displaying compassion and care to a patient and their family. Kelly upheld our core values by demostrating Collaboration, Commitment and Compassion. Her passion for our patients’ health is appreciated every day!

Commitment!

Monica Coles, DNP, RN-BC, ACNS-BC CRMH 10W - Geriatrics CIRCAA Completion Sending congratulations to Clinical Nurse Specialist Monica Coles for completing CIRCAA (Creating Interprofessional Readiness for Complex and Aging Adults). CIRCAA is a comprehensive interprofessional training program designed to improve knowledge, skills, and practice in the care of older adults. Her participation and professional perspective were valuable additions to another successful program year.

Completing CIRCAA is a testament of commitment to the highest standards of age-friendly, person-centered, interprofessional geriatrics care.

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Commitment!

4th from left: Betty Robertson

Betty Robertson, BSN, RN Community Health Educator Community Health & Outreach at Carilion Franklin Memorial Hospital 2020 United Way of the Roanoke Valley’s Distinguished Service Award Congratulations to Betty for being the recipient of the 2020 United Way of the Roanoke Valley Distinguished Service Award. The United Way of the Roanoke Valley states the most non-renewable resource that we can give is time. The Distinguished Service Award recipient is someone who gives support, gives a voice and gives their time to the needs of United Way and their community.

Collaboration!

CRMH Nursing Staff American Heart Association Get With the Guidelines® - Stroke GOLD PLUS with Honor Roll (National Recognition) The American Heart Association and American Stroke Association proudly recognizes Carilion Roanoke Memorial Hospital for it’s continued success in using the 2021 Get With The Guidelines®- Stroke, Target: Stroke Advanced Therapy.This demonstrates that CRMH is applying the most up-to-date evidence-based treatment guidelines to improve patient care and outcomes in the community they serve. Great job to all nursing staff that work on a daily basis to improve outcomes for our stroke patients!

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Compassion!

CRMH 10S Palliative Care Unit Legacy Shawl Project (est. 2016) Carilion’s Legacy Shawl Project began in 2016. Phyllis Whitehead - Carilion Clinical Ethics and others helped create Project Legacy Shawl as part of the Dr. L.A. Keeley Healing Arts Program. A lifelong hobby for some, took on a new meaning. The shawls and lap blankets are crocheted and knitted by members of our community for the patients and families in our Palliative Care unit. Beautiful, brightness, and warmth for people who are spending their last days on earth. And for their families, the legacy shawls are a constant reminder of their loved ones. **If you can knit or crochet and are interested in participating, just bring your shawls and lap blankets to the front desk at CRMH and the volunteers/staff will bring them to the unit. Please label the bag for 10S Palliative Care.

The only requirement is that the yarn be soft and washable if possible.

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Compassion!

CRMH Nursing Staff 2021 Healer’s Circle Art Show Awards

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We celebrate our nursing winners in the Healer’s Circle Art Show! Carilion’s annual employee art show is an initiative of the Dr. Robery L.A. Keeley Healing Arts Program, offered in partnership with the National Arts Program. The theme of this year’s show, “The Healer’s Circle” symbolizes the healing connections within and between us. Participants are Carilion Clinic employees, volunteers and their family members. The art was judged by three professional artists.

1. Caroline Butt, BSN, RN - Care Coordination Manager - Honorable Mention, Amateur for “Lone Bird”.

2. Christine Fimbel, BSN, RN - Pre-Surgical Testing - 3rd place, Amateur for “Legend”.

3. Rachel Heletz, RN, CRNP - Carilion/Hollins University Student Health 2nd place, Intermediate for “Dusk in Tribecca, NYC”.

4. Jennifer Pynn, RN - Carilion St. Albans - 3rd place, Professional for “A Beautiful Sunrise”.

Link to video of all winners - https://www.youtube.com/watch?v=zih8qiIoYmk

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Introducing the Virtual Healthcare Hot Topics Journal Club!

Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Research Council Unit Outreach Subcommittee The Unit Outreach Subcommittee of the Research Council has started a virtual journal club to provide an opportunity to read and discuss issues of concern in healthcare. The journal club is open to any employee. The most exciting thing about the Healthcare Hot Topics Journal Club is that it is virtual! Using the Teams platform will allow participants to post their comments and opinions when it is convenient for them.

A new discussion will be started every one to two months. There will be a channel for each new topic with the article posted in the Files section. Discussion questions for the article will be located in the Wiki.

A separate tab will give access to the evaluation form. Please complete the evaluation to let us know your opinion about the journal club and what future topics you’d like to discuss.

Participation in a journal club can be used to fulfill the Research criteria for RN 2. The subcommittee will discuss ways journal club participation could be added to RN 3 and 4 criteria and make recommendations to the CAP Committee.

Questions? Contact: Cindy Ward - Clinical Nurse Specialist email: cwward@carilionclinic.org phone: 540-224-2508

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CLASSES & EVENTS

UPDATE: All Nursing Research classes for the remainder of 2021 have been cancelled.

This will allow staff time to focus on their wellbeing and the wellbeing of their patients during these unprecedented times.

We will re-evaluate the Nursing Research Class schedule for 2022 and communicate any updates as they become available.

*All classes and events will be virtual once they are resumed.

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June 2021 - October 2021 (& past presentations not noted prior to this edition) Whitehead, P. November 12, 2020. How is the Clinical Nurse Specialist Role Defined in Virginia?

Virginia Association of Clinical Nurse Specialists Virtual Fall Conference Whitehead, P. November 12, 2020. Legislation How Do Laws Work? Virginia Association of Clinical Nurse Specialists Virtual Fall Conference Whitehead, P. April 2021. The Clinical Nurse Specialist in Palliative Medicine: An Under-Utilized APRN Resource. national Hospice Palliative Nurses Association Expert Faculty Enduring Internet ANCC Acredited Educational Activity.

Whitehead, P. June 11, 2021. COVID: What You Need to Know to Manage Symptoms? Virginia Association of Clinical Nurse Specialists Virtual Spring Conference Harvey, E. July 21,2021. Trauma Nurses Recognize and Rescue. 21st Rao Ivatury Trauma Symposium - Virginia Commonwealth University Health - Virtual Event.

Rea, D. August 11-13, 2021. The Effect of Implementing Symptom Feedback into Psychiatric Care at a Non-Profit Clinic. 2021 Fourteenth National Doctors of Nursing Practice Conference, Chicago, IL Whitehead, P. August 19-21. The Patient Preferences About Serious Illness Instrument (PASI): An Innovation in Eliciting Seriously Ill Patients’ Preferences. European Society of Medicine Annual Assembly, Berlin, Germany.

Whitehead, P. August 26-27, 2021. Deconstructing Complicated Ethical Challenges Through the Lens of Implicit Bias. The Hospice Palliative Nurses Associations’s 15th Annual Clinical Practice Forum - Virtual Event.

Whitehead, P. August 27, 2021. The CNS Role in Navigating Ethically Challenging Issues. North Carolina Association of Clinical Nurse Specialists Annual Conference - Virtual Event

Jones, B. October 12, 2021. Creating Purpose Driven Moments as a Healthcare Leader. Texas Womens University, Path to CXO Patient Experience - Virtual Event.

Bath, J. October 28, 2021. Using a Needs Assessment to Determine Nurses Knowledge Gap in Trauma Care. 2021 Virtual TEACH Education Day Poster, Recognition, and Awards Reception, Virtual Ward, C., Mitchell, T. November 11-13, 2021.

Nursing Burnout with Substance-Using Inpatients: A New Hope. ANCC Magnet Conference 2021, Atlanta, GA. (*Accepted but unable to present)

Dampeer, R. October 28, 2021. Implementing Healthy Work Environment Strategies. 2021 INOVA Nursing Research & EBP Symposium Virtual Event.

Hayes, K., Bond, D. October 28, 2021. Time is of the Essence: Decreasing Unplanned Extubations in Critical Care: A follow-up study. 2021 INOVA Nursing Research & EBP Symposium Virtual Event.

Terrell, D., Echevarria, M., Carter, K. November 6-10, 2021. Implicit Bias: Improving Cultural Competency for Nurses Caring for LGBT Individuals. Sigma 46th Biennial Convention, Indianapolis, IN Wilson, V., Lockhart, E., Defilippis, S., Carter, K. November 11-13, 2021. Key Factors for RNBSN Program Enrollment: A State Survey. ANCC Magnet Conference 2021, Atlanta, GA. (*Accepted but unable to present)

Whitehead, P. (2020). Pain Management Interprofessional Case Study. In A. Farinde, and M.Hebdon, (Eds.). Pharmacological Considerations in Gerontology: A Patient-Centered Guide for Advanced Practice Nurses and Related Health Professions (pp. 221-224). Springer Publishing. *Awarded 2nd place in the 2020 AJN Book of the Year Award in the Gerontologic Nursing Catego-

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Whitehead, P., Swope, M., Carter, K. Spring/Fall 2020. Impact of a Team-based, Interprofessional Clinical Ethics Immersion on Moral Resilience.

Teaching Ethics, 20(1/2), 65-74. Doi: 10.5840/ tej202132585 Anderson, R., Eton, D., Camacho, F., Brenin, C., DeGuzman, P., Carter, K., Guterbock, T., Ruddy, K., Cohn, W. January 2021. Impact of comorbidities and treatment burden on general well-being among women cancer survivors. Journal of Patient Reported Outcomes, 5(1), 2. doi:10.1186/s41687020-00264-z.

Rea, D. January/February 2021. Mental Health Impacts from COVID-19 and the Necessary Public Health Measures. Clinical Nurse Specialist, 25(1), 18-22.

Whitehead, P., Carter, K., Garber, J., Epstein, B. June 2021. The nurse manager's experience of moral distress. Journal of Nursing Administration, 51(6), 334-339.

Crandell, I., Rockwell, M., Whitehead, P., Carter, K., Hanlon, A. June 2021. Examination of the Moderating Effect of Race on the Relationship between Vitamin D Status and COVID-19 Test Positivity Using Propensity Score Methods. Journal of the American College of Nutrition. Published online: June 2021 at https: doi.org/10.1080/07315724.2021.1948932 McGinnis, S., Privitera, C., Nunziato, J., Wohlford, S. July 2021. Environmental life cycle assessment (LCA) in medical practice: A User’s Guide. Obstetrical and Gynecological Survey,76 (7), 417-428.

Wooldridge, A., Carter, K. July 2021. Pediatric and neonatal tracheostomy caregiver education with phased simulation to increase competency and enhance coping. Journal of Pediatric Nursing 60, 247-251. https://doi.org/10.1016/ j.pedn.2021.07.011

Contact Chris FishHuson with your ideas so that we can find funders to support you!

Seidel, L., Dane, F., Carter, K. July/August 2021. Brief mindfulness practice course for healthcare providers. The Journal of Nursing Administration, 51(7/8), 395-400.

Whitehead, P., Locklear, T., & Carter, K. July/ August 2021. A Longitudinal Study of the Impact of Schwartz Center Rounds on Moral Distress.

Journal of Nursing Administration, 51(7/8), 409415, doi:10.1097/NNA. 0000000000001037 Ushe, T., Lakhan, S., Locklear, T., Muthukattil, R., Whitehead, P., Benson, Ladak, A., Carter, K. August 2021. Pain management consultation for acute pancreatitis: Impact on length of stay and opioid utilization.

Pain Management. Published Online:23 Aug 2021 at https://doi.org/10.2217/pmt-2021-0012.

Whitehead, P. Aug/Sept/Oct 2021.Tackling mental health stigma in public schools. Virginia Nurses Today, 29(3), 4.

Whitehead, P. September 2021. Caring for Patients with Dementia at End of Life. American Journal of Hospice and Palliative Care.

Published online ahead of print: https:// doi.org/10.1177/10499091211046247 Whitehead, P., Keating, S., Gamaluddin, White, C., Stewart, C., * Kim, K.Y. (2021) Palliative Care for Chronic Cancer Patients in the Community. In M. Silbermann, (Eds), Understanding the Impact of Community-Based Palliative Care (pp. 49-64). Springer Publishing.

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Conference information continued

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Follow us on our Nursing Research & EBP hub at Inside Carilion for updated information about: Login to Inside Carilion/Departments & Services/Nursing Research & Evidence Based Practice/Featured Topics & Top Resources

*STAY TUNED FOR 2022 NURSING RESEARCH INFORMATION!

Need editorial support to publish your work?

Contact Nursing Research & EBP for: • Assistance with writing your abstract • Peer review • Manuscript submission nursingresearch@carilionclinic.org

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“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom

Nottingham

Natl. Harbor, MD Williamsburg

Palm

Anaheim

Greenville

Lake Buena Vista

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2021/2022 NURSING CONFERENCE INFORMATION

Livestream November 2-5,

CONNECT WITH NURSES! INSPIRING NURSE LEADERS!

AACN National Teaching Institute & Critical Care Exposition Date: May 16-18, 2022 Location: Houston, TX

Date: April 11-14, 2022 Location: New Orleans, LA Early Bird fees available through October 31, 2021 31st Annual AMSN Convention Date: September 29-October 2, 2022 Location: San Antonio, TX Speaker abstracts due 10/30/21 Poster abstracts due 5/15/22

Carilion Clinic Roanoke Campus