Nursing Matters

Nursingmatters May 2015 • Volume 26, Number 5

www.nursingmattersonline.com

INSIDE: New “What If?” column

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Opinion page

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Heard it through the Grapevine

PAID

MADISON WI PERMIT NO. 1723

PRST STD US POSTAGE

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Wisconsin awarded second grant The Robert Wood Johnson Foundation recently announced that the Wisconsin Action Coalition, co-led by the Wisconsin Center for Nursing Inc. and the Rural Wisconsin Health Cooperative, has been awarded a second two-year grant through the Future of Nursing State Implementation Program. The $7.65 million initiative is helping states prepare the nursing profession to address our nation’s most pressing healthcare challenges — access, quality and cost.

This award follows a successful first grant, “Taking the LEAD for Nursing in Wisconsin: Leadership, Educational Advancement and Diversity.”

The Wisconsin Action Coalition is part of the “Future of Nursing: Campaign for Action,” a nationwide movement to improve health and healthcare through nursing. An initiative of AARP and the Robert Wood Johnson Foundation, the campaign includes Action Coalitions in 50 states and the District of Columbia working to implement the Institute of Medicine’s Future of Nursing recommendations.

Match funding for the Wisconsin award was made possible by contributions from multiple stakeholders.

“We are tremendously proud to be continuing with this program and look forward to doing even more to implement the Institute of Medicine Future of Nursing recommendations here in Wisconsin,” stated Judith Hansen, MS, BSN, and Wisconsin Center for Nursing executive director. “The work we are doing to transform nursing improves healthcare for everyone. We are grateful to the Robert Wood Johnson Foundation and our many partners here in Wisconsin for this generous support.”

The funding will support the next twoyear project, “Wisconsin Nursing LEADs the PACC – Partners in Action for Community Care,” which began Feb. 1. The PACC grant addresses two of the Institute of Medicine report’s key recommendations: “Increase proportion of nurses with a baccalaureate degree to 80 percent by 2020,” and “Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.”

Diversity will again be infused into all grant activities.

Activities to advance academic progression will include annual surveys of Wisconsin nursing programs to monitor Bachelor of

CONTRIBUTED

Managing the grant program will be, from left, Carol Sabel, PhD, RN, project manager; Judith Hansen, MS, RN, Wisconsin Center for Nursing executive director; Carolyn Krause, PhD, RN, Wisconsin Center for Nursing Board president; and Barbara Nichols, DNSc, MS,RN, FAAN, diversity coordinator.

Science in Nursing completion enrollment, and development of a plan to retain associate degree students to graduate. The goal is to increase associate-degree completion by 10 percent and overall enrollment of bachelor’s-degree-completion students by 18 percent, to include 5 percent from groups that are traditionally underrepresented in nursing. A statewide media campaign will be created to promote bachelor’s-degree completion and Wisconsin nursing-education programs.

To support life-long learning for nurses, the PACC project will advance previous activities with additional board-service training, and new offerings on philanthropy education. The goal for this part of the project is to provide educational sessions for no less than 50 participants, with 10 percent from minority groups. Web-based modules for board-service training and a mentor repository on the Wisconsin Center for Nursing website will also be developed.

A new focus area in PACC will be the facilitation of team-based inter-professional collaboration for community-based models of care. This will include the establishment of employer-educator partnerships to develop these models. Key strategies include an employer-educator summit, provision

of educational offerings on regionally identified needs, and development of a community team-based care model for dissemination. A statewide conference on care coordination is scheduled June 12 at the Richard T. Anderson Conference Center on the Waukesha Technical College campus.

Visit www.wisconsinnurses.org/education/ conferences/wcn for more information.

Wisconsin has been recognized as a national leader in diversity initiatives and these initiatives will continue within this project. The PACC project has also set a goal to double the number of American Assembly of Men in Nursing chapters in the state.

The PACC project will be guided by an Advisory Council for both the grant workplan and the Wisconsin Action Coalition, which will also serve to vet other related projects in Wisconsin.

Leadership will be provided for the project by Judith Hansen, Wisconsin Center for Nursing executive director and project director; Carol Sabel, PhD, RN, CNE, project manager; and Barbara Nichols, DNSc (hon), MS, RN, FAAN, diversity coordinator. Molly Gottfried will serve as the administrative assistant.

Contact Carol Sabel at carol@wicenter fornursing.org if interested in participating.

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Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713 Editor........................................... Kaye Lillesand, MSN 608-222-4774 • kayelillesand@gmail.com Managing Editor................................... Julie Belschner 608-250-4320 • jbelschner@madison.com Advertising Representative...................Andrew Butzine 608-252-6263 • abutzine@madison.com Recruitment Sales Manager.......................Sheryl Barry 608-252-6379 • sbarry@madison.com Publications Division Manager.................. Matt Meyers 608-252-6235 • mmeyers@madison.com Nursingmatters is dedicated to supporting and fostering the growth of professional nursing. Your comments are encouraged and appreciated. Email editorial submissions to klillesand@sbcglobal.net.

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Every precaution is taken to ensure accuracy, but the publisher cannot accept responsibility for the correctness or accuracy of information herein or for any opinion expressed. The publisher will return material submitted when requested; however, we cannot guarantee the safety of artwork, photographs or manuscripts while in transit or while in our possession.

EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NURSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at UW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor UW-Eau Claire School of Nursing, Eau Claire, WI © 2015 Capital Newspapers

Nursingmatters

What if there is more to healthcare?

Brenda Zarth

Editor’s note

For Nursing Matters‌

I’ve been a nurse for 28 years and I think I’ve seen a lot. I went into nursing because I love people; I want to see them smile. I’ve always prided myself on being a good nurse and given it my best. I have often wondered, though, if there isn’t more to healthcare when I listen to my patients say they don’t feel good but their lab work comes back normal. They tell me they have had stomach pain for more than 20 years and no one can figure out why.

We have accepted medications with side effects that can be severely debilitating and even cause death. I wonder about the state of healthcare; is this really the best we can do?

Sandy made me think.

Sandy was 29 years old; she had been admitted to the hospital for pain management and generalized weakness. After hospitalization, home healthcare was ordered to give her Physical Therapy and walker training due to severe weakness. She had burning pain associated with a rash on her arms and legs. No one knew where the rash had come from or how to treat it. Most of her lab tests came back normal.

She was diagnosed with rash unknown etiology, uncontrolled pain, unsteadiness of gait, narcolepsy, hypothyroidism, depression, anxiety and gastro-esophageal reflex.

She was discharged from the hospital with a Fentanyl patch, Percocet, Flexeril, Naprosyn, Dextroamphetamine, Effexor, Synthroid, Topamax, Prevacid and Zomig. She had been seen by the departments of Dermatology, Rheumatology and Infectious Diseases, but none of them could come up with a diagnosis. The final decision, she was told, was that it must be all in her head; the hospitalist ordered a Neuropsychology evaluation.

I was to be her Home Health RN Case Manager, but I didn’t have any nursing visits approved by the insurance company because they didn’t have a clear diagnosis or need for teaching. My role was just to case-manage her chart. I was intrigued

by Sandy’s case, so I called her on the phone weekly to discuss her pain, rash and symptoms, and to case-manage her care.

She was determined to find the cause of her pain. She had two young children and a disabled husband who depended on her, and she was not going to let them down.

She thought there must be something negative written in her chart that made her doctors not want to listen to her, or maybe they thought she was crazy. She said they were tired of trying to figure out what was wrong with her.

Because Sandy didn’t have faith in her current doctor, I helped her find a new primary physician. But still, the only significant finding on her initial

More than 22 doctors say there is nothing wrong with a woman deathly ill.

nursing assessment was that she had not had a bowel movement in three weeks. I questioned her about this, but she said when she did have a bowel movement it took three hours of sitting on the toilet; it was painful and there was a lot of bleeding, until she finally passed a hard black rock. She didn’t want a bowel movement more frequently because of the pain. She had tried every laxative on the market and nothing worked. She did not like talking about it; she had been constipated for as long as she could remember.

So her new primary MD did a thorough workup, but all her laboratory tests came back normal. We sent her to every specialist we could find looking for answers to why she had the rash and severe pain. A total of 22 doctors said she was within normal limits. The neuropsychologist said she was not crazy, that there was something physically wrong causing her rash, and to go back to her primary MD. After two months of calling her my time was up but I wanted to lay eyes on this woman for myself and see if she looked sick. I went to see her to discharge her from my care and say goodbye. She was thin, her legs were purple and cold, she looked like a concentration camp victim and we cried. She said I was the only one who had listened to her and now there was no one else.

I had nightmares of guilt and desertion for a month. I had no one I could think of to call or follow up with her care, and she was obviously dying. Then I watched the movie “The Passion of the Christ” and decided if Jesus Christ could die for me, I could make sacrifices for this woman. I couldn’t live with the guilt of desertion.

This month we are starting a new food for thought column entitled “What If.” Brenda Zarth, with 28-plus years of nursing experience, will share her stories and convictions about how to improve the healthcare system by using nurses to the full extent of their education. Zarth will demonstrate how the essence of nursing – looking at the total patient, body, mind and spirit – fosters healing, is more effective and less expensive.

We welcome comments and ideas.

I called Sandy the day after Easter and asked how she was doing. She said she hadn’t had a bowel movement in five weeks.

If a Twinkie was unwrapped she would eat it, but she was too tired to open it. She was urinating once a day. Her family was waiting for her to die; every night her husband came home wondering if she would be alive.

I asked if she would let me take her to a naturopathic doctor and she said yes.

I called a naturopathic doctor who had been referred by a friend of a friend, and literally carried this girl to the appointment. She couldn’t remember the names and birthdates of her children; she couldn’t write her address. The naturopathic doctor looked at her and then yelled at me. As a healthcare provider, how dare I let someone sink into this state?

They gave her colon hydrotherapy for a few hours and she passed a couple of large black rocks followed by a large amount of blood. After the session she did feel better.

Her color was improved and she was able to walk with the walker and help. She wanted to continue. She was given a list of vitamins and herbs to take every two hours. One set was to detoxify and clean her out, and then two hours later she took supplements to build her up.

She had colon hydrotherapy every day for a week; it was like watching her come back from the dead. The first day she was so weak she couldn’t think or walk by herself. The third day she talked non-stop like a cork had been pulled out of her brain. The seventh day she walked without her walker and we all cried again. It was like Lazarus coming back from the dead.

Today she is happy, healthy and raising her children. Her problem was constipation, which was not seen as significant but nearly killed her. Had I taken her to the ER she most likely would have required surgery – and given her debilitated state I don’t think she could have tolerated it. She could have had IV fluids, which she may have been able to tolerate, but her kidneys were shutting down. Our healthcare system had let her down and she had no faith

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Book Review Stopping by the Side of the Road: A Tale about Dying By the Rev. Jody Whelden Reading this unique, powerful, heartwarming – and sometimes heart-wrenching – tale of dying transported me back to my days as a bedside nurse. It is a MUST-read for every nurse. But more than that, it is a must-read for anyone wishing for a beautiful, peaceful death.

— Kaye Lillesand, RN, MSN, Editor of NURSINGmatters

What if

continued from page 2 in it. Since her constipation was chronic, her body had learned to adapt and she was stooling through the second largest organ of elimination – her skin.

What was the cause of her illness?

Her body was missing the lubrication she needed to move waste through her bowels.

She now takes Aloe Vera capsules daily and has a frequent regular bowel movement.

Due to her overall weakness and illness, she couldn’t work and was on Social Security Disability and Medical Assistance; her medications alone were more than $500/ mo. Medical assistance paid for her to see 22 doctors who were not able to find the problem, but tried to the best of their ability with the tools they had. I would estimate the federal government easily paid more than $100,000, not including Social Security benefits, lost wages and stress on her family.

Sandy’s naturopathic treatments cost $2,000, which I privately paid for, and she now spends about $15 per month for Aloe Vera capsules. What I learned from this case about healthcare alternatives made me nearly quit nursing. I felt like I had been in a closet my whole nursing career and someone opened the door.

First I was disgusted and angry – angry with my nursing education that I didn’t know about Natural Medicine, angry that I was told it was quackery, angry with the American Medical Association and the limited education her doctors had received, and angry with pharmaceuticals that nearly contributed to her death.

Sandy wanted to sue her doctors. The lawyer said he sympathized, but because 22 doctors told my patient she was fine, he

would need to find a doctor to go against 22 colleagues. The lawyer also told her he had gone to Europe for his knee procedure because he could have a much better recovery time there, rather than having a knee replacement in the United States. He even said that following the procedure on his knee, he was so excited he approached an Orthopedic Surgeon in the United States to suggest we do the procedure here; the surgeon didn’t want to hear it.

Doing surgery provides income and support for hospitals, and counteracts the financial drain of the chronically ill medical population admitted to hospitals. The reality is our healthcare system would not survive without money-making surgeries we perform.

I realized we have a systems problem and we need an upgrade. Because Sandy did not have nausea, vomiting and abdominal distention, her constipation was not seen as significant by the physicians that evaluated her.

As an infant Sandy was constipated and routinely had a bowel movement only once a week. So she didn’t see the significance of her slow bowels; she thought she must have some horrible disease. It wasn’t until her mid-20s that her system began to be unable to cope with inadequate colon function. As her body filled with toxins and waste, she developed severe burning pain.

She started on narcotic pain medications, further decreasing her bowel function and increasing her constipation. Her ability to cope was overloaded.

How can we stop this from happening again? Who are the Sandys in your life?

Please email BrendaZarth@gmail.com or visit brendashealthplan.blogspot.com to send stories or comments.

Alverno/Advantage Media Services; 2 x 12.5; Color; 2310998; Nursingmatters

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Mission changes lives – both volunteers and students

Thank you.

To our nurses: When we promise parents that their children are in the very best hands, it’s often your hands that we’re talking about. From all of us at Children’s Hospital of Wisconsin, thank you for your hard work, passion and unwavering dedication to the patients and families you see every day.

Happy Nurses Week! chw.org

Nursingmatters

Karen Klemp, RN, and Cheryl Manning, RN

Crossing the International Date Line can be confusing. At a precise moment, today becomes tomorrow and yesterday is two days ago. Fortunately, the rest of our group’s trip from Madison to Manila, Philippines, was more understandable.

There were seven volunteers in the Philippines to teach and to be taught – Karen Klemp, Carolyn Terry, Nancy Comello, Jane Krogstad, Cheryl Manning, Dr. Jamie Limjoco and her 10-year-old daughter Caiden, and Limjoco’s mother, Edna Limjoco, a retired NICU RN. We were to roll out for the first time in the Philippines the American Academy of Pediatrics global initiatives of “Helping Babies Breathe” and “Essential Care for Every Baby.” We had been invited by Vicki Penwell of Mercy in Action, a birthing center in Olongapo City. Penwell was already committed to giving mothers and babies healthy life experiences at her clinic.

Penwell’s well-trained Filipino midwives were quick to pick up information to add to their practices. They were evaluating for abnormal birth conditions and starting resuscitation efforts, using mannequins and practice equipment in the neo-Natalie kits that our group had brought along in our suitcases. The midwives then taught the same information to five healthcare workers from the local community.

Those students enthusiastically received the training. Just what the American Academy of Pediatrics

CONTRIBUTED

had hoped would happen, happened. The information on how to decrease maternal and infant mortality is being shared across the Philippines.

Penwell in turn taught the seven of us disaster preparedness for mother and infant, because the Philippines experience more natural disasters than most of the rest of the world. On average the country has 24 typhoons each year. There was an earthquake while we were there; floods are common. Philippine volcanoes have changed the country’s landscape and weather around the world. This will be knowledge we will share in the future.

Besides leaving a part of our hearts there, we also left medical supplies — such as syringes, needles, gloves for the clinic and many kits for newborns and their mothers.

After crossing the International Date Line on the way home, we once again weren’t sure if we were coming or going. But we were sure that we had been and went on a life-changing mission.

CONTRIBUTED

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Nurses admired — five traits Kaye Lillisand Nursing Matters editor‌

At the recent NURSINGmatters Career EXPO, we showed a film produced by Carolyn Jones. Carolyn followed several nurses at work for a year. When she spoke at lunch, she listed five characteristics of nurses that she observed and admired. I would like to share them with you and give you a nurse’s perspective of them.

• ‌No façade – an ability to be present A huge part of nursing is being present for the patient and family. It emanates from a deep caring about the individual and the knowledge that people know when it is real and respond accordingly. Being present helps nurses know when to be gentle or tough, patient or energetic, nutty or sweet, or whatever the situation demands. If a nurse tries to be someone he or she is not or to force a patient to be someone he or she is not, it does not work. Integrity and caring are crucial to good nursing care. Without it there is no satisfaction in our work and no satisfaction and healing for the patient.

• ‌Extremely well-educated

The essence of nursing is based on healing the whole person – body, mind and spirit.

So a nurse’s education includes physiology, pathophysiology, mental health and illness, and spiritual health and illness. The unique gift we offer to patients is to help learn how these three parts – body, mind and spirit – are influencing one another in the healing process. Physicians are the experts in curing the body. Psychiatrists are the experts in working with the mind. The clergy are experts in working with the spirit. It is only nurses who are educated to look at all three at once so that patients can heal or have a peaceful death.

• ‌Ability to work without judgment Nurses believe in the inherent worth and dignity of human beings. The American Nurses Association’s “Code of Ethics for Nurses states,” “The need for healthcare is universal, transcending all individual differences. The nurse establishes relationships and delivers nursing services with respect for

LETTERS TO THE EDITOR Letter to the editor

The Home Health Planning and Improvement Act 2015 – S. 578, H.R 1342 – has been introduced for consideration by the 114th Congress. Thanks to the support from Sen. Susan Collins(R-ME) and Sen. Chuck Schumer (D-NY), along with Rep. Greg Walden (R-OR), Rep. Ron Kind (D-WI), and Rep. Danny Davis (D-IL), this bill if approved will amend a section of Medicare law that has kept advanced-practice nurses – a group that includes nurse practitioners, clinical nurse specialists and certified nurse midwives – from signing home-health plans of care and certifying Medicare patients for home-health benefits.

These healthcare professionals coordinate the majority of skilled care for homehealth patients and this outdated prohibition has led to delays in healthcare delivery.

These delays in care not only inconvenience patients and their families, they result in increased cost to the Medicare system when patients are unnecessarily left in more expensive institutional settings. The Home Health Planning and Improvement Act would eliminate this barrier, permitting advanced-practice nurses to be recognized for services they are currently providing without added physician intervention.

We need your help! We need you to take action and contact your member of Congress to ask them to cosponsor the Home Health Care Planning Improvement Act of 2015. Thanks for your continued support.

Ruling good for nurses

The U.S. Supreme Court’s Feb. 25 decision in a state dental board anti-competition case has far-reaching implications beyond dentistry and will have a significant, positive impact for nursing practice. It ensures nurses can work to the full extent of their education and training, unrestricted by unlawful anti-competitive interference.

The American Nurses Association, which joined an amicus – friend of the court – brief in the case, is pleased the court ruled that the actions of the North Carolina Board of Dental Examiners to prevent non-dentists from offering teeth-whitening services were an unlawful attempt to suppress competition. Though the case pertained to dentistry, the association contends anti-competitive practices that restrict advanced-practice registered nurses or other healthcare professionals from practicing to the full extent of their education and training diminishes access to care for patients, increases healthcare costs and reduces healthcare quality.

(The American Nurses Association) believes the court’s decision benefits consumers. (The American Nurses Association,) along with others who joined in the amicus brief, expressed concern that unsupervised state regulatory boards comprised largely of professionals practicing in the field they are regulating may be prone to act in their own economic self-interest by protecting their economic markets through methods that run counter to state policy and principles of competition.

(The American Nurses Association) commends the (Federal Trade Commission’s) vigilance and pursuit of enforcement initiatives to ensure fair economic competition benefits all Americans in the healthcare sector.

human needs and values, and without prejudice. An individual’s lifestyle, value system and religious beliefs should be considered in planning healthcare with and for each patient. Such consideration does not suggest that the nurse necessarily agrees with or condones certain individual choices, but that the nurse respects that patient as a person.”

• ‌Ability to use personal experience to make life better for others Our personal experiences help us to be empathetic rather than just sympathetic.

I can immediately think of two personal experiences that reflect this. First when I was in labor with my first child thinking that if some nurse comes in here and tells me to relax – like I had suggested to women in labor – I think I’ll scream. I learned that there are many other ways to help someone in labor relax. “Would you like a backrub?” or “Can you take a few deep breaths?” are much more effective. Second, in my Pediatrics Nursing class we were taught never to take a child from a parent when admitting the child. We were to wait until the parent handed the child to us. I always did that because I trusted our instructor. It wasn’t

until I needed to admit my child that I really felt what a parent would feel like if a nurse just took the child from the parent.

• ‌Brave Whether it is working with high-tech machines, powerful drugs, mentally ill or confused patients, spiritually deprived patients, home-health patients, public-health situations, or anywhere nurses practice, it takes courage because the quality of someone’s life is dependent on the nurse’s skills and knowledge. Besides taking care of patients, advocating for them also takes courage. I know nurses who have taken on judges, attorneys, physicians, administrators, legislators and many others in positions of power in order to protect and advocate for a patient. Nurses are courageous because they believe in what they are doing and who they are doing it for!

The film is being shown in some public venues and is available at americannurseproject.com – I urge everyone to see it.

Veterans bill supported by ANA SILVER SPRING, MD – The American Nurses Association applauds Rep. Sam Graves (R-MO) and Rep. Jan Schakowsky (D-IL) for their leadership in introducing the “Improving Veterans Access to Quality Healthcare Act of 2015.” The bill, H.R. 1247, allows Advanced Practice Registered Nurses who work in Veterans Health Administration facilities “full practice authority.” Full practice authority means allowing Advanced Practice Registered Nurses to practice to the full extent of their education and training, and provides a common-sense solution to the challenges associated with ensuring U.S. veterans have access to high-quality healthcare services.

“This legislation will make a big difference in meeting the healthcare needs of our nation’s veterans,” said American Nurses Association President Pamela Cipriano, PhD, RN, NEA-BC, FAAN. “As the Veterans Administration works to address staff shortages that have contributed to delays in veterans’ access to care, an important first step is to remove barriers that prevent Advanced Practice Registered Nurses from providing a full range of services.”

Advanced Practice Registered Nurses are advanced-practice registered nurses who have completed formal graduate education leading to at least a master’s degree in nursing, and increasingly to a doctor of nursing practice degree, in one of four Advanced Practice Registered Nurses roles that provide primary,

preventive and chronic care – nurse practitioners, certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists.

Currently, Advanced Practice Registered Nurses who work in Veterans Health Administration facilities are subject to the laws of the state in which the facility is located. While some states have removed restrictive practice regulations, in other states Advanced Practice Registered Nurses face regulations that limit their scope of practice, with veterans’ access to care suffering as a result.

By recognizing these nurses to their full practice authority, the Veterans Health Administration can make the fullest use of these critical members of their healthcare workforce, maximize care delivery, and minimize waits and delays for care. The bill is consistent with the recommendations of the Institute of Medicine report “The Future of Nursing: Leading Change, Advancing Health,” and with proposals under consideration in the Veterans Health Administration.

Additionally, Veterans Health Administration recognition of Advanced Practice Registered Nurses full practice authority would make the Veterans Health Administration consistent with the models already practiced by the U.S. Armed Forces, Indian Health Service and Public Health Service systems

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Nursingmatters

Reprint in a series written by Signe Cooper and introduced by Laurie Glass in Nursingmatters

Josephine Balaty

Remembering a WWII hero This column originally appeared in Nursing Matters in August 1992 Marcia Gates 1915-1970 Two scrapbooks and other memorabilia relating to the World War II nursing career of Marcia Gates are in the archives of the Wisconsin State Historical Society. She was one of 67 nurses held as prisoners of war by the Japanese in the Philippines during the war. Gates, from Janesville, was one of five Wisconsin women held at Santo Tomas Camp in Manila; the others were Winiferd Madden of Montello and Alice Hahn of Cleveland, both nurses, and physical therapist Brunetta Keulthau of West Bend and Red Cross worker Marie Adams of Milwaukee.

A graduate of Milwaukee Hospital School of Nursing, Gates entered the Army Nurse Corps in February 1941 and was sent to the Philippines – a U.S. dependency – in October of that year. She worked in two

different hospitals, but as the enemy came nearer she was sent to work in the hospital in the Melinta Tunnel in Corregidor.

In spite of efforts to evacuate the nurses, Gates and her colleagues were taken May 9, 1942, by the Japanese and sent to Santo Tomas Internment Camp in Manila, where they were held for nearly three years.

The camp contained more than 3,000 internees, mostly American and British.

With limited supplies and equipment, and few medications, nurse internees cared for the ill in the camp’s hospital. During much of the time, Gates worked in the hospital’s laboratory.

One of the scrapbooks contains an undated clipping from the Milwaukee Journal in which she was quoted as saying, “Santo Tomas was perfect for the first couple of years. We had money and a market... That lasted until the Japanese knew they were losing... Then the military took

over and it was pretty terrible... We lived on a thin rice mash that was mostly water, pigweed and the tops of potato plants for greens, and soybeans once or twice when we all came down with beriberi.

“There were lots of epidemics – diphtheria, chicken pox, tuberculosis, dengue, malaria and amoeba. But I was fortunate.”

After the Philippines were liberated, she returned to this country Feb. 24, 1945.

She and the other nurses who had been interned were awarded the Bronze Star medal and the Presidential Citation with two oak leaf clusters. The citation for the Bronze Star noted that it was presented “for meritorious achievement while in the hands of the enemy, in caring for the sick and the wounded.”

After the war, Gates’ career was in public health nursing. Her last position was on the staff of the Janesville Health Department.

She died of a malignancy June 25, 1970.

Marcia Gates

An educational culture — the right angle priority. “Perhaps the nerds and the geeks need these educational skills, but in our home, they just Guest ‌ editorial: are not that important.”

The basic problem with AmerOur schools face a huge ica’s educational system is not challenge today, because the that college is too expensive. Nor educational message that teachers is the basic problem that pubare trying to inculcate into their lic-school teachers are underpaid Gary Welton students is far too often dismissed or that educators are poorly at home. If you live in a subculture where trained. The basic problem with Amerieducation is not valued, it is unlikely you ca’s educational system today is that far will come to value your own educational too many children are given the implicit message at home that education is not a continued on page 7 Gary L. Welton

Veterans

continued from page 5 where veterans can now use their Veterans Health Administration health benefits under the Veterans Access Choice and Accountability Act of 2014 (P.L. 113-146).

The American Nurses Association joins other national nursing organizations, representing more than 240,000 Advanced Practice Registered Nurses, in calling on members of Congress to support this important legislation. These include the American Association of Nurse Anesthetists, American Association of Colleges of Nursing, American

Association of Nurse Practitioners and the American College of Nurse-Midwives.

The American Nurses Association is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. The American Nurses Association advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public.

May 6, 7, and 8: Labor and Delivery: The Latest Interventions for Childbirth Challenges May 6 – Appleton May 7 – Madison May 8 – Brookfield PESI HealthCare www.pesihealthcare.com or 800-8448260 May 8: Managing Psychotropic Medications for Older Adults University of Wisconsin-Madison Continuing Studies Madison www.continuingstudies.wisc.edu/aging or 608-262-2451 May 11: Pharmacology Updates Seminar Waukesha County Technical College Waukesha www.wctc.edu or 262-691-5578

May 12 and 13: Pediatric Problems, Emergencies and Lab Interpretation PESI Health Care Brookfield www.pesihealthcare.com or 1-800844-8260 May 22: Care That Matters: Providing Person-centered Dementia Care University of Wisconsin-Madison Continuing Studies Madison www.continuingstudies.wisc.edu/aging or 608-262-2451 June 12: Wisconsin Center for Nursing annual conference Wisconsin Center for Nursing Waukesha www.wisconsincenterfornursing.org

www.nursingmattersonline.com

Angle

continued from page 6 opportunities. We cannot expect our schools to inculcate values of learning when there is little to no reinforcement at home.

The reality of life is that education and learning is not always fun. I was, and still am, an eager learner; nevertheless, some topics were uninteresting and seemed pointless when I first learned them. Some things are not intuitive; being sick and missing math class the day we were introduced to right angles, I was totally confused the day I returned to school. I could not figure out whether a right angle was the opposite of a left angle or the opposite of a wrong angle.

That, of course, was an easy fix with a few questions that evening around the dinner table – an easy fix because my parents and my older siblings cared about education.

No college opportunity was available to my father-in-law, but one of his primary goals in life was to enable his children to be college graduates. In order to fund this educational goal, he worked a factory job in addition to farming his own property. He only liked one of these jobs, but he worked them both because he wanted to make sure his children had every educational opportunity.

In “Look Homeward, Angel,” Thomas Wolfe says, “He loved a farm better than anything in the world except a school.” My father-in-law communicated that value to his children.

My father-in-law saw both his children succeed in college and recently celebrated

Page 7

May • 2015 the diplomas of all four of his grandchildren. He fostered an educational culture in which education was important. His children and grandchildren were motivated by his own continuing love of learning.

President Obama has sought to increase the number of college graduates in America, and is currently proposing that federal and state governments pay the tuition for community college students. As Michael Horn recently stated in a CNN column, however, community colleges have not been particularly successful. Only 22 percent of students complete their two-year degree within three years and 28 percent within four years – in spite of the fact that tuition is already heavily subsidized. He concludes that 60 percent of tuition is already covered by federal, state, and local programs, and, for needy students, the remaining 40 percent is entirely covered

by Pell Grants.

Horn argues that providing free tuition will not fix the educational system. Indeed, the problem begins in American homes.

When parents and caregivers communicate that education provides access to jobs and opportunities, and when parents demonstrate that college tuition is high on their list of priorities, students will come to value their educational opportunities.

President Obama’s current proposal will not fix the problem unless the core issue of educational value becomes the focus.

If we want to improve our educational system, creating an educational culture is the essential and right angle.‌

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May • 2015

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Nursingmatters

In celebration of National Nurses Week, the Wisconsin Women’s Health Foundation wants to take the time to recognize our dedicated volunteer nurses of the GrapeVine Project.

Since 2002, GrapeVine nurses have provided free women’s health education to more than 6,000 women in 41 Wisconsin counties. These are women who are not Amanda Verbrick connected to the health resources they need.

Women who participate in the program often live in rural communities, do not have easy access to healthcare information, and might feel stigmatized by their health issues. GrapeVine-Project nurses generously donate their time and expertise by organizing community health-education sessions. They aim to connect women with the information and resources they need to truly impact their health and well-being, as well as motivate them to adopt healthy habits.

Ardyce McMillen, a GrapeVine nurse

from Marquette County, attested GrapeVine to the personalunit topics ized attention the Bone Health program offers – Osteoporosis its audiences.

Breast Cancer “Doctors and Breastfeeding nurses are so busy Diabetes Prevention Domestic Violence that it seems like Gynecologic patients have less Cancers and less time with Healthy Aging Brain them, so it’s nice – prevent Dementia when we are able Heart Health to take the time to Mental Health talk to individuals Oral Health about their health concerns during GrapeVine sessions,” she said. “Sometimes people just need someone to listen to them.”

GrapeVine sessions encourage a dialogue surrounding important health issues.

The program’s volunteer nurses help women make positive lifestyle changes, gain confidence in healthcare providers and understand their own bodies. GrapeVine nurses also affect many more people than just those who attend their sessions, because women most often make healthcare decisions for their families. To reach different communities of women, current nurses

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For more than 160 years, nurses have enjoyed a rewarding career at Columbia St. Mary’s. That includes all the benefits of a strong, stable organization. But our nurses are also part of a team of healthcare providers who receive our full support in delivering the highest quality and most personal care to their patients. And that means we’re not the only ones showing our appreciation for a job well done.

How rewarding can it be to practice nursing at Columbia St. Mary’s?

To begin to find out, visit PA S S I O N F O R PAT I E N T C A R E . O R G

www.nursingmattersonline.com

have talked at churches, hospitals, retirement homes, libraries – and even a hockey rink while moms awaited their sons’ game.

“It makes sense to me to reach women where they’re at,” said Sue Richards, a Dane County GrapeVine nurse. “I admit, the idea of holding a health-education session at a hockey rink sounded odd at first, but it worked! GrapeVine has provided me with some structure so that my clinical experience can translate into healthy behavior changes for women. I love being present with women as they commit to becoming advocates for their own health.”

Get Involved!

Anyone who is a nurse looking to give back, consider joining GrapeVine. The program is currently recruiting nurses and retired nurses to join the team to educate women about health topics that disproportionately affect women. The GrapeVine Project is holding a conference June 1-2 in Madison to train new and existing nurses. Contact Nora Miller at

May • 2015

Page 9

Ardyce McMillen was trained for the GrapeVine Project in April 2008 and has presented nine educational sessions in Reedsburg. She is a Parish Nurse at the Reedsburg Bible Baptist Church.

nmiller@wwhf.org or visit wwhfblog.com for more information.

Amanda Verbrick has a degree from the University of Wisconsin-Madison in Community and Nonprofit Leadership. She currently works at the Wisconsin Women’s Health Foundation as the program assistant to the GrapeVine Project.

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Page 9

May • 2015

Page 10

Nursingmatters

Helen Bader with sons, 1963

Foundation gives grants Thank You,

Nursing Faculty & Staff In the spirit of Nurses Week, the Henry Predolin School of Nursing at Edgewood College thanks its nursing faculty and staff for their outstanding contributions to educating future nurses and nurse leaders.

Margaret Noreuil, Dean Jenna Alsteen Cathy Andrews Ruth Baier Martine Banda-Wolk Mary Elizabeth Bathum Chris Bell Lena Blakeslee Gerrie Bleifuss Mary Brueggeman Jacinda Burdon Nancy Comello Bridget Counts Pamela Crary Carrie Croft Heidi Deininger-Kinney Kathy Dineen Tom Doherty Vicki Evenson Barb Gallogly Taylor Garcia JoAnne Granquist Colleen Gullickson Erika Helmer Julie Hudziak Joan Jacobsen Mary Kelly-Powell Angela Krey

Betsy Laessig-Stary Tish Lafferty Jane Lucht Jeneile Luebke Cleary Kristen Menningen Brenda Merrell Pamela Minden Kim Moreland Tara Morris Lottie Most Quinn Mullikin Nancy Patrick Roberta Pawlak Nancy Pullen Katrina Pycha-Holst Claude Rochon Bethany Saddler Katie Selle Yulia Semeniuk Lori Severtson Beth Strauss Tracy Towne Kimberly Walker Karil Walther Britt Wanta Jennifer Weitzel Elaine Wheeler Maria Yelle

connect.edgewood.edu

Wisconsin League of Nursing Inc., which promotes nursing education to enhance the quality of health and healthcare in Wisconsin, is receiving a two-year $60,000 grant from the Helen Bader Foundation. The grant supports Wisconsin League of Nursing’s efforts to promote advanced nursing studies, with an emphasis on gerontology, in rural areas of Wisconsin.

Based on an extreme shortage of nurses and individuals who are able to care for older adults, particularly in rural Wisconsin, the league will offer tuition support to individuals who will focus on gerontology as they pursue an advanced-practice nursing degree or post-master’s certificate of education degree. The program allows individuals located in rural communities who are currently employed full-time or part-time an opportunity to update their required academic degrees. Applicants are screened for evidence of intended academic enrollment via a structured validated search; tuition support is disbursed directly to the school of nursing of the applicant.

Certification Nursing Scholarships to support post-graduate candidates whose intent is to seek certification in adult gerontology and advanced-practice gerontology through the American Nursing Credentialing Center will also be awarded. These scholarships will be for Generalist Specialty Certification, Clinical Nurse Specialist Certification and Nurse Practitioner Certification, all with an emphasis in Gerontology.

“The (Wisconsin League of Nursing) is committed to making an impact on the future of nursing and healthcare delivery in Wisconsin,” said Maureen Greene, Ph.D., RN, CNS-BC, ACNP-BC, recent past president for the Wisconsin League of Nursing, and Advanced Practice Nurse and Researcher at Wheaton Franciscan Healthcare, Milwaukee. “Through the generous support from the Helen Bader Foundation, (Wisconsin League of Nursing) can increase the number of healthcare professionals in the field to meet the increased needs of Wisconsin’s aging community.”

Visit www.wisconsinwln.org for more information.

The Helen Bader Foundation also, in its fight against Alzheimer’s disease

throughout Wisconsin, recently granted $1.082 million in funding to various Alzheimer’s and aging organizations throughout the state. With an emphasis on enhancing the quality of life for older adults in rural communities, the new grants will help create, expand and bolster a variety of efforts to address various challenges that greatly improve the quality of life of Wisconsin’s aging community.

Since opening its doors in 1992, the foundation has led with Helen Bader’s vision – to play a key role in supporting statewide initiatives and collaborations aimed at finding innovative approaches to assist those affected by Alzheimer’s, dementia and aging. This recent list of grant awardees represents the foundation’s continued commitment to provide an average of $1.5 million annually to support organizations that provide solutions for families struggling with Alzheimer’s disease, as well as creative- and healthy-aging projects, according to foundation officials. To date, they say the foundation has given nearly $43 million in related grants to make it the largest private funder of Alzheimer’s and aging in the state.

“With the rapidly increasing number of older adults, we have been hearing from communities across Wisconsin on how to address the various health, wellness and social needs of Wisconsin’s aging community,” said Helen Ramon, program officer and manager of the foundation’s efforts to address Alzheimer’s and aging. “We at Helen Bader Foundation are continually striving to keep our home state a national leader in how we serve older adults, and we’re impressed by the dedication of individuals and communities that share that vision for an elder-friendly Wisconsin.”

The foundation’s approach to addressing Wisconsin’s aging community involves working with organizations to assure that programs and resources are available to meet the increased demand for services.

Visit hbf.org for more information.

www.nursingmattersonline.com

Page 11

May • 2015

BETTER TOGETHER

SM

Thank you To our nursing and PaTienT Care serviCes sTaff for The suPerb member Care Provided eaCh day.

For a complete and accurate listing of all our patient care career opportunities, visit ghcscw.com

P.O Box 44971 Madison, WI 53717-1962 (608) 251-4156 (800) 605-4327 TDD (608) 828-4815 EOE-Minorities/Females/Disabled/Vets Group Health Cooperative of South Central Wisconsin (GHC-SCW)

A new nursing tool will help school nurses deal with chronic illness.

New tool removes school-nurse isolation MADISON – Lori Anderson, the daughter of an Oconomowoc school nurse, saw the daily challenges of school nurses even as a kid: not enough time, too few resources and isolation from peers.

As a clinical professor at UW-Madison’s School of Nursing, Anderson helped tackle those problems by creating a Web-based tool that school nurses in 30 Wisconsin counties and across West Virginia are now using to treat and better understand kids’ chronic illnesses. Called eSchoolLori Anderson Care, the tool allows school nurses to go online to tap into expertise from the School of Nursing and the American Family Children’s Hospital to help treat children with asthma, diabetes, severe allergies, cancer and mental health disorders. Another module, on caring for kids with epilepsy, is under development.

After graduating from nursing school, Anderson recalls her first job as a school nurse in Mukwonago and the professional isolation she felt.

“That feeling stuck with me, of being out in a school, the only healthcare person and people were counting on me to know a lot of things,” she said. “But I could always pick up my phone and call my mom.”

In a similar – but digital – way, eSchoolCare helps school nurses stay current, confident and connected, with the goal of improving children’s health and their classroom performance. Bolstering academic success is key because children with chronic conditions are three times more likely to miss significant amounts of school and are nearly three times more likely to repeat at least one grade, compared to healthy children.

“School nurses are increasingly asked to take care of kids with complex health problems,” Anderson said. “It’s not just

Band-Aids.”

She said 18 percent of school-aged children have or are at-risk for a chronic health condition.

The mobile-enabled eSchoolCare platform provides updated, research-based guidance on treatments in modules written in each subject area by physicians and advanced-practice nurses at American Family Children’s Hospital. The nursing modules receive independent quality reviews by national experts and are routinely updated with new information.

School nurses using eSchoolCare – which has been endorsed by the National Association of School Nurses – find it a helpful, easy-to-navigate tool for nurses who are often on the move.

“The videos help me teach students how to use their medications as they learn self-management skills,” said Valerie Hon, district nurse in the Portage Community School District. “The tools show how other students, similar in age, are doing. Another benefit is that I can really delve into professional development by using resources identified for each of the topics. If I have questions, I can pose them to others on the community forum, to learn how others are approaching the same topics.”

The effectiveness of eSchoolCare helps remove learning barriers for kids with chronic conditions, Hon added. The program, developed with a 2011 grant from the U.S. Department of Health and Human Services, is now supported by school district subscriptions and gifts. Anderson hopes to expand the use of eSchoolCare. The program was in the inaugural class of Discovery to Product, which helps commercialize UW-Madison innovations.

“We’re nurses, not business people, so we’re trying to figure out a business model so we can make it as successful as possible,” Anderson said. “It’s a great example of using the university’s healthcare expertise and literally taking it out into the state.”

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AP

Angie Stone of HyLife oral care services greets George Schmidt, 88, before caring for his teeth at Huntington Place in Janesville.

Edgerton woman takes aim at dental hygiene His wife, Mary Jane Schmidt, thinks EDGERTON, WI (AP) – Angie Stone has what Stone does is wonderful. an unusual combination of passions.

Growing up in a large family without Her love for the elderly and her backa huge calcium intake, her husband has ground as a dental hygienist has led her to always had problems with his teeth, Mary start HyLife, a caregiving business aimed at addressing a problem most never consider – Jane Schmidt said.

“I think it means a lot to George,” she nursing home residents’ poor oral health. said. “It means a lot to me. It’s very importStone’s new book, “Dying from Dirty Teeth,” outlines the issue: Dependent senior ant.”

Mary Jane Schmidt came into citizens aren’t being given proper contact with Stone through a recoral care, and they’re dying because ommendation from her husband’s of it. Poor oral hygiene can lead Stoughton-based dentist, Richard to heart attacks, lung disease and Albright. As a result, Stone has been strokes, Stone said. seeing George Schmidt every week Though oral care is required since August 2013. for nursing-home residents, staff “She does an amazing job,” Sugmembers don’t have as much Angie Stone den said. “She’s great with the staff training in the area as Stone. Cerhere and other residents. She’s a tified nursing assistants receive huge inspiration to me.” about an hour’s worth of oral care training, Stone and George Schmidt have formed Stone said. a bond. Stone spoke to him throughout the Stone has 30 years of experience. entirety of a recent cleaning, and when he “We do oral care, but obviously staff wasn’t sleeping, he spoke back. aren’t trained to do what needs done,” said After the procedure, Stone rubbed Melissa Sugden, Huntington Place resihis hand and whispered, “You did dent-service coordinator. “She’s very thorgood, George.” ough, and she’s always getting lots of things A passion is born we don’t see.”

Stone had a great experience with an A typical cleaning takes about 15 minutes. Stone brushes and flosses clients’ teeth orthodontist back when her teeth were “all over the place,” she said. It pushed her into and then lines their mouths with xylitol, a natural sugar substitute that makes it harder dental hygientistry.

“That care changed my life,” she said. “I for bacteria to produce plaque. was just fascinated with how having good “It seems so simple, but when you read oral care, a good smile, could affect somemy book, you’ll see why it’s not simple,” one’s life.”

Stone said.

Stone’s inspiration to start HyLife Her eye is trained to pick up potential began with two women: her mother-inproblems, such as the broken teeth she law, Gladys Stone, and her grandmother found in Huntington Place resident George Schmidt’s mouth. With Stone’s help, he was Helen Schrantz.

Gladys Stone entered a nursing home able to have his problems addressed, adding with lung disease. Without a dentist or quality to his life.

www.nursingmattersonline.com

Page 13

May • 2015

Assistant Professor of Nursing The Henry Predolin School of Nursing at Edgewood College announces the opening for two full-time tenure track faculty positions beginning with the academic year 2014-2015.

Responsibilities include teaching at the undergraduate and graduate (MSN and DNP) levels.

Graduate concentrations include Nursing Administration and Leadership.

Qualifications: • Earned PhD in Nursing (preferred), or doctorate in related field with a Master’s degree in Nursing; DNP may be considered • Eligible for RN licensure in the State of Wisconsin • Evidence of teaching, scholarly and community services potential • Knowledge and skills in contemporary practice issues related to the AACN Essentials • Demonstrated commitment to promoting diversity, inclusion, and multicultural competence To Apply: Send a letter of application, resume, and references to: Edgewood College Human Resources – APN1 1000 Edgewood College Drive Madison, WI 53711 www.edgewood.edu E-mail: humanresources@edgewood.edu Equal Opportunity Employer

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May • 2015

Page 14 dental hygienist on staff, Angie Stone watched as plaque built up in her motherin-law’s mouth. Her lung disease continued to worsen at an alarming rate despite the antibiotics she took, Angie Stone said.

“I know her mouth played a role in infecting her lungs,” she said. “When she died, I vowed I was going to do something to help.”

At the time, Angie Stone had no idea what it would be.

Schrantz also entered a nursing home late in life. In two years, she lost 60 percent of her teeth, Stone said.

“I buried her with no front teeth,” Stone recalled, “and as a dental hygienist, that haunts me. It should have never happened.”

At the time, Stone was seeing a client like George Schmidt once a week. In her time with him, the client never had bleeding gums, tooth decay or pneumonia, and his blood sugars were well maintained, Stone said. She said she might leave the nursing home crying if he had a bad day. It can be sad, hard work, she said, but wouldn’t trade it for anything.

“I look forward to seeing them (the Schmidts), and they look forward to seeing me,” she said. “You gotta have that connectivity. If it’s in your heart and you love the population, it’s worth it.”

“I love it,” Mary Jane Schmidt said of Stone’s compassion and work. “I love her,

Edgewood College Henry Predolin School of Nursing School of Nursing Simulation Education Specialist Position Description Edgewood College Henry Predolin School of Nursing (SoN) is seeking a .50 FTE nursing faculty member with expertise in clinical practice to serve as Simulation Education Specialist. Faculty member will provide oversight and teaching as well as assessment of students’ learning. The Simulation Education Specialist collaborates with faculty to develop and implement simulation-based educational experiences designed to enhance patient safety and quality in health care delivery. This person reports to the Dean, SoN. Responsibilities: Curriculum • Assumes leadership role in working with faculty and lab manager to develop curriculum for Patient Care Areas which includes health assessment, clinical skills, low, medium and high-fidelity simulation; • Determines the most effective simulation experiences to assist students in developing competencies; • Actively contributes to the development, conducting and evaluation of simulation-based experiences with particular emphasis on creating life-like scenarios for educational purposes; • Leads small group learning sessions and encourages reflection of simulation experiences.

Faculty Partnerships • Collaborates with faculty to integrate simulation experiences (e.g. The Neighborhood software experiences) into the learning environment of theory courses; • Collaborates with faculty in identifying learning needs, and developing and implementing creative learning environments; • Orients new faculty, staff and students to simulation.

• Collaborates with faculty in orienting new faculty to the Patient Care Areas of the SoN as well as the Center for Healthcare Education and Simulation (CHES); Knowledge, skills and abilities • Knowledge of curriculum design and evaluation; • Maintains current expertise in clinical skills and with standards of practice; • Effectively teaches with individuals and small groups; • Works collaboratively with faculty in identifying learning needs, and developing and implementing creative learning environments; • Maintains current expertise in use of equipment including but not limited to simulation models; • Possesses effective written and verbal communication skills; • Organizes, prioritizes and multitasks on a daily basis; and Operations/Management • Establishes and maintains current and long term planning, including expenditures and projected budgetary needs for patient care areas and activities. Submits plan to SoN Dean annually in preparation for budget planning; • Works collaboratively with faculty and staff to maintain safe, current, interactive, equipped learning labs.

Nursingmatters

too. She’s precious. Her personality speaks for itself.”

A growing business HyLife is still in its infancy. The oral-care component of the company began last July; HyLife currently employees 10 caregivers in four Midwestern states and Florida.

Families of nursing-home residents hire HyLife employees to provide oral care, Stone said. Though each of HyLife’s 10 employees is a licensed dental hygienist, they operate as certified caregivers under HyLife. That limits what they can do in terms of using equipment or removing plaque, but being trained dental hygienists gives them a leg up when it comes to thorough oral care.

Should a HyLife caregiver notice a problem with a client’s teeth, he or she will notify the facility’s staff and refer the client to a local dentist, as Stone did when she found George Schmidt’s broken teeth.

George Schmidt’s oral issues aren’t uncommon for people his age. Stone said dependent nursing-home residents suffer the worst oral hygiene and have the worst oral health of any population in the country.

“There’s already a workforce that can handle this problem, and that’s the dental hygienists,” Stone said. “When we’re acting as caregivers, we can help put a dent in that statistic. We can help get rid of that

statistic.”

HyLife hasn’t done any marketing, because its mission right now is to plant seeds and put the word out, Stone said.

“Right now, we’re in education mode to really sound the alarm of what’s going on,” she said.

Besides a dedication to keeping elders’ mouths clean, Stone’s company aims to offer autonomy and extra income to dental hygienists, many of whom don’t work full time, Stone said. HyLife also is a support network of like-minded professionals who can help each other when needed.

Stone’s company might be small right now, but her ambitions are huge.

“My dream is to have a team all over the country acting as caregivers and taking care of this population so they’re not dying from dirty teeth,” she said.

People don’t always understand what Stone’s doing because it’s different.

“I’m in front of the curve, and in front of the curve can be a lonely and scary place sometimes,” she said.

Despite the challenges and enormous task ahead, Stone will keep pushing ahead.

“In the U.S. in 2015, should people die from dirty teeth?” she said. “No. I don’t think so. We’re doing something, and we’re absolutely helping.”

RN Management in Assisted Living LPN opportunities also available

Join an organization that is a recognized leader in the industry.

Qualifications: • A master’s degree in nursing is required; DNP preferred.

• Certified in Simulation Education preferred (Certified Healthcare Simulation Education (CHSE) • Current Wisconsin RN license required.

• Excellent communication and interpersonal skills.

• Leadership and organizational skills.

• Recent teaching experience in clinical and/or nursing simulation/skills laboratory preferred.

• Experience with patient simulations strongly preferred.

• Computer skills in Word, Excel, and online learning systems.

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Considering a change to assisted living? Seeking a management position with a progressive organization that will support your personal development?

Laureate Group, a leading provider of senior housing and assisted living services in the greater Milwaukee area is seeking an energetic RN to join our team. This is a great position for someone who is looking for a good balance of both management responsibilities and care time duties.

Candidates for this hands on position will be organized and results-oriented with prior supervisory/management experience.

Must be able to implement systems, effectively interact with residents and families and have proven problem-solving and leadership skills. Alzheimer’s/Dementia experience preferred. Computer skills essential. This is a Full Time Day Position. Join an organization that is a recognized leader in the industry.

This is a challenging yet rewarding position in a residential setting. We offer a competitive salary and comprehensive benefits package including health and dental insurance as well as matching 401(k) contributions. Apply conveniently online at www.laureategroup.com or send resume to apply@laureategroup.com

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www.nursingmattersonline.com

May • 2015

Page 15

Nurses inducted into 2015 Hall of Fame INDIANAPOLIS – The Honor Society of Nursing, Sigma Theta Tau International, will induct 19 nurse researchers into the International Nurse Researcher Hall of Fame July 23-27, 2015, at Sigma Theta Tau International’s 26th International Nursing Research Congress in Puerto Rico. These 19 individuals, representing the countries of Australia, Belgium, Canada and the United States, will be presented July 25, 2015, with the International Nurse Researcher Hall of Fame award and participate in a conversation with Sigma Theta Tau International President Hester C. Klopper, PhD, MBA, RN, RM, FANSA. Created in 2010, the International Nurse Researcher Hall of Fame recognizes nurse researchers who have achieved significant and sustained national or international recognition and whose research has improved the profession and the people it serves. The honorees’ research projects will be shared through the Virginia Henderson Global Nursing e-Repository, enabling nurses everywhere to benefit from their discoveries and insights. The award presentation is sponsored by Wiley.

“These 19 honorees have achieved life-changing results through their research,” Klopper said. “In keeping with the Sigma Theta Tau International mission to celebrate nursing excellence in scholarship, leadership, and service, I congratulate the 2015 Nurse Researcher Hall of Fame honorees. I look forward to learning more about their contributions and sharing them with our members worldwide.”

Kassie Stovell, Wiley Publishing manager for nursing, said, “We are honored to sponsor Sigma Theta Tau International’s International Nurse Researcher Hall of Fame awards and congratulate each recipient. Wiley recognizes the contributions of these 19 inductees for their outstanding research, leadership and efforts in advancing health around the world. Their insight, expertise and integrity have greatly impacted the profession and improved the lives of the patients they serve.”

Sigma Theta Tau International’s annual international nursing research congress attracts nearly 1,000 nurse researchers, students, clinicians and leaders, who learn from evidence-based research presentations. The theme for the 26th congress is Question Locally, Engage Regionally, Apply Globally. Visit http://congress.nursingsociety.org for more information.

2015 International Nurse Researcher Hall of Fame Honorees Ruth Anderson, PhD, RN, FAAN Virginia Stone Professor of Nursing Duke University School of Nursing Beta Epsilon Chapter #051, Epsilon Theta Chapter #126 USA

Elizabeth R. A. Beattie, PhD, RN, FGSA Professor, Aged and Dementia Care Queensland University of Technology Phi Delta-at-Large Chapter #482 Australia Stijn Blot, PhD, MNSc, RN Research Professor Ghent University Rho Chi-at-Large Chapter #428 Belgium Wendy P. Chaboyer, BSc(Nu), MN, PhD, RN Professor, Griffith University Phi Delta-at-Large Chapter #482 Australia Greta G. Cummings, PhD, RN, FCAHS, FAAN Centennial Professor, University of Alberta Mu Sigma Chapter #304 Canada Susan G. Dorsey, PhD, RN, FAAN Associate Professor and Department Chair Department of Pain and Translational Symptom Science University of Maryland School of Nursing Pi Chapter #015 USA Carol J. Farran, DNSc, RN, FAAN Professor The Nurses Alumni Association Chair in Health and the Aging Process Rush University College of Nursing Gamma Phi Chapter #091 USA Mary Beth Happ, PhD, RN, FAAN, FGSA Distinguished Professor of Critical Care Research Director, Center of Excellence in Critical and Complex Care The Ohio State University College of Nursing Epsilon Chapter #004 USA Diane Holditch-Davis, PhD, RN, FAAN Marcus E. Hobbs Distinguished Professor of Nursing Associate Dean, Research Affairs Duke University School of Nursing Beta Epsilon Chapter #051 USA

Tonda L. Hughes, PhD, RN, FAAN Professor and Associate Dean for Global Health University of Illinois at Chicago College of Nursing Alpha Lambda Chapter #033 USA Christine E. Kasper, PhD, RN, FAAN Professor and Senior Research Scientist Department of Veterans Affairs and Uniformed Services University Nu Beta Chapter #312 USA Gail Melkus, EdD, C-NP, FAAN Professor and Associate Dean for Research New York University College of Nursing Upsilon Chapter #018 USA Christine Miaskowski, PhD, RN, FAAN Professor University of California, San Francisco School of Nursing Alpha Eta Chapter #029 USA Dianne Morrison-Beedy, PhD, FAANP, FNAP, FAAN Dean, University of South Florida College of Nursing Senior Associate Vice President, USF Health University of South Florida Delta Beta-at-Large Chapter #096 USA Karen Frick Pridham, PhD, RN, FAAN Helen Denne Schulte Professor Emerita University of Wisconsin-Madison School of Nursing Beta Eta-at-Large Chapter #053 USA Barbara Resnick, PhD, CRNP, FAAN, FAANP Professor Sonya Ziporkin Gershowitz Chair in Gerontology University of Maryland School of Nursing Pi Chapter #015 USA Barbara Riegel, DNSc, RN, FAHA, FAAN Edith Clemmer Steinbright Professor of Gerontology University of Pennsylvania School of Nursing Xi Chapter #013 USA

Margarete J. Sandelowski, PhD, RN, FAAN Cary C. Boshamer Professor University of North Carolina at Chapel Hill Alpha Alpha Chapter #023 USA Antonia M. Villarruel, PhD, RN, FAAN Professor and Margaret Bond Simon Dean of Nursing University of Pennsylvania School of Nursing Xi Chapter #013 USA The Honor Society of Nursing, Sigma Theta Tau International is a nonprofit organization whose mission is advancing world health and celebrating nursing excellence in scholarship, leadership, and service.

Founded in 1922, it has more than 135,000 active members in more than 85 countries. Members include practicing nurses, instructors, researchers, policymakers, entrepreneurs and others. The organization’s 499 chapters are located at 695 institutions of higher education throughout Armenia, Australia, Botswana, Brazil, Canada, Colombia, England, Ghana, Hong Kong, Japan, Kenya, Lebanon, Malawi, Mexico, the Netherlands, Nigeria, Pakistan, Portugal, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan, Tanzania, Thailand, the United States, and Wales.

Visit www.nursingsociety.org for more information.

Wiley is a global provider of content-enabled solutions that improve outcomes in research, education and professional practice. Its core businesses produce scientific, technical, medical and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services, and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Founded in 1807, John Wiley & Sons Inc. (NYSE: JWa, JWb), has been a source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace.

Wiley’s global headquarters are located in Hoboken, New Jersey, with operations in the United States, Europe, Asia, Canada and Australia. Visit www.wiley.com for more information.

May • 2015

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Academy launches Institute for Nursing Leadership WASHINGTON, D.C. – The American Academy of Nursing has launched an Institute for Nursing Leadership. The institute houses the academy’s work to place more nurses on governing boards, commissions and task forces, with an emphasis on federal and gubernatorial appointments and governing boards of national organizations aligned with the academy’s strategic plan.

The creation of the Institute for Nursing Leadership was made possible in part by Pfizer Inc.’s $50,000 contribution that was matched by academy fellows.

“We are pleased to support the Institute for Nursing Leadership,” said Pfizer Senior Director, Paula R. DeCola, MSc, RN. “Nurses have a unique perspective within our health systems that should be more pervasively channeled to advance policies and regulations that will further support public health. An imperative exists for nurses to be more fully integrated into forums where these impactful discussions are taking place The academy’s institute will increase nurse appointments to national and select state governing boards of health-related

entities, councils, commissions and task forces; prepare academy fellows and emerging nurse leaders for such appointments; and evaluate the impact and value of nurse appointments on the work of the decision-making bodies on which they serve.

“The Institute for Nursing Leadership will serve as a springboard for nurses to drive positive change in healthcare and health policy,” said Academy President Diana J. Mason, PhD, RN, FAAN. “In addition to increasing nursing appointments, the institute will also seek to fill the gaps in development by connecting qualified nurses with opportunities to prepare them for leadership.”

The institute will be led by a National Advisory Council comprised of forward-thinking leaders. The members of the National Advisory Council include: Angela McBride, PhD, RN, FAAN, distinguished professor & University Dean Emerita, Indiana University – Chair Stephanie Ferguson, PhD, RN, FAAN, ICN Leadership For Change Programme consultant, Nursing & Health

Policy, ICN – Co-Chair Sheila Burke, MPA, RN, FAAN, adjunct lecturer, Harvard University Darlene Curley, MS, RN, executive director, Jonas Center for Nursing Excellence Paula R. DeCola, RN, MSC, director, External Medicine Affairs, Pfizer Inc. Patrick DeLeon, PhD, JD, MPH Joanne Disch, PhD, RN, FAAN, Professor ad Honorem, University of Minnesota School of Nursing Alicia Georges, EdD, RN, FAAN, professor and chairperson, Lehman College Department of Nursing Catherine Gilliss, PhD, RN, FAAN, Helene Fuld Health Trust Professor of Nursing, Duke University School of Nursing Jan Heinrich, DrPH, RN, FAAN, associate administrator, Bureau of Health Professions, HRSA Randy Jones, PhD, RN, FAAN, director, Baccalaureate Programs, associate professor, Robert Wood Johnson Foundation Ramon Lavandero, RN, MA, MSN, FAAN, senior director, American Association of Critical-Care Nurses Christopher Lee, PhD, RN, FAHA, FAAN, associate professor of nursing,

Nursingmatters

Oregon Health & Science University School of Nursing Susan Reinhard, PhD, RN, FAAN, senior vice-president, Public Policy Institute, AARP Cory Rieder, EdD, executive director and treasurer, The John A. Hartford Foundation Rita Wray, MBA, RNC, FAAN, CEO, W.E. Inc. Colleen Conway Welch, PhD, CNM, RN, FAAN, FACNM, Dean Emeritus, Vanderbilt University School of Nursing The Institute for Nursing Leadership is part of the academy’s effort as a founding member of the newly formed Nurses on Boards Coalition to reach the goal of placing 10,000 nurses on boards, commissions and task forces by 2020.

The Institute for Nursing Leadership aligns with the Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” and its recommendation on increasing nurse appointments to decision-making bodies related to healthcare. Currently, many academy fellows hold positions within federal commissions, health-system boards, and other health-related governing entities at national, federal, state and local levels.

Credentialing certification earns patent The U.S. Patent and Trademark Office has issued a patent for the American Nurses Credentialing Center Certification through Portfolio credentialing process.

Certification through Portfolio provides registered nurses and advanced-practice registered nurses an alternative assessment methodology to achieve American Nurses Credentialing Center board certification with no exam required.

Currently five American Nurses Credentialing Center certifications are assessed using the Certification through Portfolio method: • ‌Advanced Forensic Nursing • ‌Advanced Genetics Nursing • ‌Advanced Public Health Nursing • ‌Emergency Nurse Practitioner and

• ‌Faith Community Nursing.

Two more certifications assessed through portfolio are in development — Hemostasis Nursing and Rheumatology Nursing. “(The American Nurses Credentialing Center) has developed high-quality individual credentialing programs for more than 40 years and continues to

revolutionize nursing excellence with the patented portfolio certification,” said Linda C. Lewis, MSA, RN, NEA-BC, FACHE, and executive vice-president and chief American Nurses Credentialing Center officer.

“Our renowned team of nursing talent collaborated to invent this alternative methodology that employers and nurses alike can be confident is a sound assessment

of nursing knowledge and skills. We are delighted to pioneer the next generation of certifications for the nursing profession.”

The U.S. patent, issued March 3, 2015, ensures nurses can feel confident in seeking American Nurses Credentialing Center certifications through portfolio. Nurses credentialed through the Certification through Portfolio assessment are established as experts in their specialties and rank among the highest-qualified nurses in the world.

“We are thrilled (the American Nurses Credentialing Center) was granted the patent for Certification through Portfolio – an outstanding demonstration of the organization’s continued innovation

continued on page 17

www.nursingmattersonline.com

Patent

continued from page 18 in credentialing,” said Theresa A. Kessler, PhD, RN, ACNS-BC, CNE, chair of the American Nurses Credentialing Center Commission on Certification and professor at the College of Nursing and Health Professions at Valparaiso University. “Through this new assessment method, (the American Nurses Credentialing Center) leads the way in offering opportunities for nurses to be credentialed for their expertise and excellence in improving healthcare outcomes.”

The Certification through Portfolio application process is completed entirely online. Eligible applicants submit an online portfolio of evidence to document their specialized knowledge and skills, understanding, and application of professional nursing practice and theory. Applications must articulate performance in four domains of practice: Professional Development, Professional and Ethical Nursing Practice, Teamwork and Collaboration, and Quality and Safety.

Inventors contributing to this patent include: • ‌Nancy J. Robert, PhD, MBA, BSN, ANCC, EVP and chief product and marketing officer; • ‌Marianne Horahan, MBA, MPH, RN, NEA-BC, CPHQ, American Nurses Credentialing Center director of certification; • ‌Vicki Lundmark, PhD, American Nurses Credentialing Center director of research; • ‌Diane L. Thompkins, MSN, RN, American Nurses Credentialing Center

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May • 2015

senior certification program analyst; • ‌Stephanie L. Ferguson, PhD, RN, FNAP, FAAN, international consultant; • ‌Karen Drenkard, PhD, RN, NEA-BC, FAAN, former American Nurses Credentialing Center executive director; • ‌Ellen Swartwout, PhD, RN, NEA-BA, former American Nurses Credentialing Center senior director of certification and measurement services; • ‌David Paulson, PhD, CAE, former American Nurses Credentialing Center director of measurement services; • ‌Patricia R. Deyo, MSN, BA, RN, former American Nurses Credentialing Center product manager, certification; and • ‌Christine Depascale, MS, former American Nurses Credentialing Center research scientist, measurement services Visit www.nursecredentialing.org/ certification to learn more about American Nurses Credentialing Center certification.

Visit www.nursecredentialing.org/CertificationPortfolioRequirements to learn more about Certification through Portfolio requirements.

The mission of the American Nurses Credentialing Center, a subsidiary of the American Nurses Association, is to promote excellence in nursing and healthcare globally through credentialing programs.

The American Nurses Credentialing

Center’s internationally renowned credentialing programs certify and recognize individual nurses in specialty practice areas. The American Nurses Credentialing Center recognizes healthcare organizations that promote nursing excellence and quality patient outcomes while providing safe, positive work environments. In addition, the American Nurses Credentialing Center accredits healthcare organizations that provide and approve continuing nursing education. Visit www.nursecredentialing. org for more information.

GRADUATE

NURSING P RO G R A M S

Doctor of Nursing Practice (DNP) in Leadership Blended online!

Prepares for formal managerial, director and executive level roles.

Masters of Science in Nursing Administration and Education

The University of Wisconsin–Madison School of Nursing extends its sincere appreciation to the nurse preceptors and other health care professionals who have shared their valuable time and expertise with our undergraduate and graduate nursing students. Thank you for the formative role you play in educating future nurses and nurse leaders.

Thank you!

Post-Masters Certificates in Nursing Administration and Education

www.edgewood.edu

Contact Jenna Alsteen

608.663.4255, gps@edgewood.edu

May • 2015

Page 18

Nursingmatters

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Celebrating National Nurses Week May 6–12, 2015

The National Association of Clinical Nurse Specialists has presented its prestigious Affiliate of the Year Award to the Wisconsin Association of Clinical Nurse Specialists. The Award recognizes a National Association of Clinical Nurse Specialists affiliate that has sustained membership growth, offered educational opportunities, built clinical nurse specialist leadership, contributed to National Association of Clinical Nurse Specialists’ growth, and advanced the clinical nurse specialist role.

The Wisconsin Association of Clinical Nurse Specialists has worked hard to ensure advanced practice registered nurse title protection in Wisconsin. The affiliate has a lobbyist and also conducted grassroots efforts to ensure passage of the legislation. The affiliate developed and distributed toolkits to help its members urge the legislature to support the advanced practice registered nurse uniformity act.

During its annual conferences and other meetings, the affiliate regularly holds sessions and workshops on cutting edge topics. It also works to promote awareness of the clinical nurse specialist role with other health professionals and the public through a Chief Nursing Officer- clinical nurse specialist shared governance breakfast. In collaboration with a community organization, Wisconsin Association of Clinical Nurse Specialists will provide a clinical nurse specialist to lead a walk and health education activity as part of an annual

“Walk with a Doc” program.

“The Wisconsin Association of Clinical Nurse Specialists has done a remarkable job of increasing awareness of the clinical nurse specialist role with health care professionals, policy makers and the public,” said Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC, National Association of Clinical Nurse Specialists 2015 president. “Their outreach and education efforts are making a difference, not only for clinical nurse specialists in Wisconsin, but also for the patients they care for and in the state’s overall health care.”

Founded in 1995, the National Association of Clinical Nurse Specialists is the only association representing the clinical nurse specialist. Clinical nurse specialists are advanced practice registered nurses who work in a variety of specialties to ensure high-quality, evidence-based, patient-centered care. As leaders in health care settings, clinical nurse specialists provide direct patient care and lead initiatives to improve care and clinical outcomes, and reduce costs. National Association of Clinical Nurse Specialists is dedicated to advancing clinical nurse specialist practice and education, removing certification and regulatory barriers, and assuring the public access to quality clinical nurse specialist services.

www.nursingmattersonline.com

May • 2015

Page 19

Health officer reflects on career Gina Duwe/AP

JANESVILLE (AP) – Retired Health Officer Karen Cain said officials across all health services have spent years studying Rock County’s health problems.

“One thing we haven’t done a good job of doing... (is) really changing what we’re doing – because it’s easier to do the status quo,” said Cain, who retired April 10 from the Rock County Health Department.

A new community health-improvement plan by the major health organizations in Rock County has the potential to help Karen Cain improve health in a county that has consistently ranked low, she said.

The Affordable Care Act requires hospitals to complete a regular community healthneeds assessment, and the health department has worked with Rock County’s four hospitals to do one study. Over the next few years, organizations will be encouraged to not just have these reports that sit on the shelf, she said.

“For many years, that’s kind of what happened,” she said.

No health department can solve all problems itself but must rely on community partners and services, she added.

Cain will remain on the county healthneeds assessment team, now as a volunteer, working to address four problems the team prioritized: access to dental services, access to mental services, lifestyle choices and preventative health screenings.

Cain had served as health officer since 2008 and worked in public health since 1977. She started at the Rock County Health Department in 1986, working for 15 years as the nursing supervisor for public health before leaving to teach. She came back in 2006 for three months to help the city of Beloit’s health department merge with the county department.

She ended up staying for good.

Her replacement, Marie-Noel Sandoval, started in mid-April. Cain said Sandoval is inheriting a great team of public-health nurses, sanitarians and health educators.

Cain also credited the county’s board of health, which oversees the department, for being a great group of supporters.

Cain reflected on her career and the future of public health.

Q: How has public health changed over your career?

A: When she started in 1977, seven vaccines were available for kids, compared to 15 now. “The beauty of having all those vaccines is it really has reduced disease outbreaks in children.” Health officials are finding vaccines don’t necessarily protect

for a lifetime, so they need to look at adult vaccine initiatives, she said. When the flu vaccine first came out, it was only recommended for high-risk individuals. Now officials recommend everyone be vaccinated.

“The proliferation of vaccines, I think, has been really a change.”

Q: What are your biggest accomplishments at the health department?

A: “We have so many good public-health programs. It’s an accomplishment and it’s a challenge. I think people are more aware of the health department and health-department services.” Public health has been in the limelight a lot in the past decade for things such as H1N1 and Ebola, she said.

She also pointed to improvements in restaurant inspections that cut the number of food-borne illness outbreaks reported to the health department from 40 in 19881990, to five in 2012-2014. Rather than having inspectors point out violations, they work with food-service employees to reduce violations and provide education, she said.

The department also started a beach-sampling program that’s become popular because residents can see the results online to know whether to avoid a beach for safety concerns.

Q: What does the future hold for public health?

A: She thinks more services will be

What is the future of public-health care?

available in the community that will be seen as public health, but not necessarily run through health departments. She also predicted service changing to more population-based as opposed to home visits and individual-based services.

While public health is changing, it’s sort of a “disease of the day.”

“It’s no longer tuberculosis; it’s Ebola.

That communicable disease is always going to be among us,” she said.

Protection of groundwater and surface water also will be important, she said.

She said she hopes for advocacy for public-health funding. The health department doesn’t receive state funding for programs that it is mandated to deliver, such as communicable disease follow-up, which the department spent $86,000 on last year, she said.

Wisconsin is toward the bottom nationally for supporting public health, she said, though the county has made a great commitment.

“As long as they’re willing to do that, they’re going to see some good things,” she said of the county.

Honoring Choices program tackles DNR Gina Duwe/AP

JANESVILLE (AP) – “I said, ‘When I’m dead, let me stay that way,’” he told his family and physicians.

Lawrence, 73, of Janesville started his advanced-care directive discussion with his heart doctor, who referred him to Dr. Kelly Fehrenbacher, hospice and palliative care medicine physician at Mercy Health System.

She worked with him to put his wishes in writing and start him on hospice care. He now wears a bracelet to let paramedics and healthcare workers know not to resuscitate him. He encourages everybody to consider the tough decisions in end-of-life care and to let their wishes be known.

“Nobody knows how long they have or what’s going to happen,” he said.

A statewide initiative called Honoring Choices Wisconsin encourages anyone 18 and older to participate. The Wisconsin Medical Society launched Honoring Choices in 2012 to promote the benefits of and improve processes for advanced-care planning across the state. The initiative is starting as a pilot program at Mercy North and Mercy Milton Medical centers. The program offers additional resources and training to Mercy’s previous advance-care

planning efforts.

Twenty Mercy nurses, social workers, chaplains, volunteers and some physicians have been trained as facilitators. Those facilitators will help patients through two appointments – the first to start talking about the patient’s wishes and goals, and the second to complete the legal document.

The form: • ‌Designates up to three healthcare agents, then asks “yes” or “no” questions about what authority the patient wants to give to the agents.

An agent should agree to the patient’s wishes, which is sometimes difficult when close family members are chosen, Fehrenbacher said. She and other healthcare workers described difficult situations when decisions hadn’t been discussed in advance or when agents wanted to go against the patient’s wishes.

• ‌Has patients check boxes to provide instructions on life-prolonging treatments, pain and comfort, CPR and actions upon death such as an autopsy. It also includes spaces to write about other wishes.

• ‌Requires two witness signatures.

• ‌Should be copied and given to all named healthcare agents after completion.

Patients should also keep a copy where it can easily be found. A copy should also

be given to healthcare providers to have on record.

Mercy plans to add the documents to patients’ electronic health-records system; any health system nationwide that uses the Epic health records will be able to access the files.

While such conversations are more critical for elderly patients or those with chronic medical problems, Fehrenbacher said it’s important for anyone 18 and older.

“You could have just a car accident or some serious neurologic injury – diving accident –anything can happen to anyone that makes you unable to make those decisions,” she said.

The process takes the burden off family during a stressful time, and families and patients who have completed the paperwork feel relieved, Fehrenbacher said.

“I think a lot of people are scared. They don’t want to talk about it,” she said.

Fehrenbacher asks patients about what they would want if they weren’t breathing and their heart stopped. A lot of people say they wouldn’t want to be resuscitated or put on a ventilator.

“I say, ‘Well if that’s your wish, then there’s some things we need to do,’” she said.

A lot of people think their wishes will be followed without making them legally

known, she said. But patients who do not want to be resuscitated need to complete “Do Not Resuscitate” orders, have them signed by a physician, and they must wear a bracelet stating the wishes, she said.

The bracelet is the only tangible way for paramedics to know not to go into “full code,” or full resuscitation, which can include CPR, chest compressions, shocks and ventilation for breathing, she said. If a patient isn’t wearing the bracelet, he or she is technically revoking their wishes, and life-saving measures could be taken.

Some patients mistakenly worry that if they’re wearing the bracelet, they won’t be given any care, Fehrenbacher said. But, she said, “Do Not Resuscitate” orders on the bracelet only apply to a full cardiac arrest.

The patient’s heart has stopped and he or she is not breathing.

“You’re already dead, technically,” Fehrenbacher said.

Patients with the bracelet having a heart attack or stroke, or who passed out or fell, will receive the same care as someone without the bracelet.