® The Career and Education Resource for the Minority Nursing Professional • WINTER 2019
Weight Management for
Nurses
+
Alternative Medicine
CONQUERING A DISABILITY PALLIATIVE CARE
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Table of Contents
In This Issue 3
Editor’s Notebook
4
Vital Signs
7
Making Rounds
Academic Forum 24
Strategies of Incorporating Palliative Care as a Direct Care Nurse By Christian Catiis, BSN, RN, PCCN
Cover Story 8 Weight Management for Nurses: The Why’s and How’s of Losing or Maintaining Weight
By Jebra Turner
Features 14 Complementary and Alternative Medicine: What Nurses Need to Know
By Michele Wojciechowski
Degrees of Success 26
Greater Houston Nurses Taking It to the Streets
By Debbie Ann Jones, PhD, RN
Second Opinion 30 Arrogant Opinions Supported by Unverified Theories: It’s Just Inflammatory
By Regina G. Goldwire, FNP-BC
Health Policy 32 Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities
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By Janice M. Phillips, PhD, FAAN, RN
Minority Nurse | WINTER 2019
20 Conquering a Disability and Becoming a Nurse
By Lynda Lampert, RN
Editor’s Notebook:
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very year, we make unrealistic resolutions to find true love, to find the perfect job, etc. New Year’s Eve comes with a lot of pressure to live up to our own high standards. With 2020 right around the corner, I challenge each of you
to look at the bigger picture and make resolutions that will not only positively impact
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CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer
your life but also the lives of those around you. MINORITY NURSE MAGAZINE
As a nurse, you have undoubtedly told your overweight patients of the higher risks for cardiac disease and diabetes, but you may feel like a hypocrite if you’re packing on a few extra pounds yourself. Next year, walk the walk and make self-care a priority per ANA’s Code of Ethics for Nurses (“The nurse owes the same duties to self as others”). In this issue’s cover story, Jebra Turner speaks with wellness professionals and nurses alike to share realistic weight management tips for the incredibly busy nurse. Does it seem like your patients are more skeptical of pharmaceuticals these days? If so, make it a resolution to get up to speed on complementary and alternative medicine trends. Michele Wojciechowski chats with experts so you can help your patients gain better control over their own health. Perhaps equally important, don’t let your patients—or yourself—neglect mental health. This year was filled with anxiety for most (and most likely will in 2020). Help end the stigma of mental health so others aren’t afraid to seek help when needed. Lynda Lampert shares a few success stories of those who overcame their struggles to become nurses. If you’re still struggling to come up with a resolution, consider your community needs. This could be in the form of incorporating palliative care into your practice to help improve your patients’ quality of life, taking it to the streets to help the local homeless population, resolving to make your work environment less toxic, or volunteering your expertise with an advisory board. Whatever you decide, let’s agree to put aside the vitriol in 2020 and let love conquer hate for the health of all.
Publisher Adam Etkin Editor-in-Chief Megan Larkin
Creative Director Mimi Flow
Production Manager Diana Osborne
Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Andrew Bennie 212-845-9933 abennie@springerpub.com Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers
Happy holidays! —Megan Larkin
Eric J. Williams, DNP, RN, CNE, FAAN President National Black Nurses Association
Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York. Articles and columns published in Minority Nurse represent the viewpoints of the authors and not necessarily those of the editorial staff. The publisher is not responsible for unsolicited manuscripts or other materials. This publication is designed to provide accurate information in regard to its subject matter. It is distributed with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. The publisher does not control and is not responsible for the content of advertising material in this publication, nor for the recruitment or employment practices of the employers placing advertisements herein. Throughout this issue we use trademarked names. Instead of using a trademark symbol with each occurrence, we state that we are using the names in an editorial fashion to the benefit of the trademark owner, with no intention of infringement of the trademark. Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe.
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Vital Signs
New CDC Report Provides First Analysis of Lung Injury Deaths Associated with Use of E-cigarette, or Vaping, Products As of October 22, 2019, 34 deaths in patients with Recommendations At this time, FDA and CDC e-cigarette, or vaping, product use associated lung have not identified the cause injury (EVALI) have been reported to CDC. Of the 29 or causes of the lung injuries in deaths among patients with EVALI analyzed, 59% were these cases, and the only commen and the median age was 45 years. Patients with monality among all cases is that EVALI who died were older than the overall population patients report the use of vaping products, including e-cigarettes. of EVALI patients.
T
he MMWR report released on October 28, 2019 is the first to describe characteristics of patients with EVALI who died to date, and also updates previous data on all EVALI patient characteristics, including sex, age, and substances used in e-cigarette, or vaping, products. Among the 19 EVALI patients who died and for whom CDC had available data on substances used, 84% reported any use of THCcontaining products, 37% reported any use of nicotinecontaining products, 63% reported exclusive use of THCcontaining products, and 16% reported exclusive use of nicotine-containing products.
Report Adds Updated Information on Patient Characteristics As of October 22, 2019, 49 states, the District of Columbia, and the U.S. Virgin Islands have reported 1,604 cases of EVALI. Data from the MMWR report indicate that patients with EVALI are mostly young, white males. Among patients with available data, 79% were under age 35, 78% were non-Hispanic white, and 70% were males.
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Additionally, about half of the cases, and two deaths, occurred in patients under age 25 years. “It is evident from [the October 28th] report that these lung injuries are disproportionately affecting young people,” says Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention. “As CDC receives additional data, a more defined picture of those impacted is taking shape. These new insights can help bring us a step closer to identifying the cause or causes of this outbreak.” The report also reinforces that THC-containing products continue to play a major role in the outbreak. Among 867 patients with available data on specific e-cigarette, or vaping, product use in the three months preceding symptom onset, 86% reported any use of THC-containing products, 64% reported any use of nicotine-containing products, 52% reported any use of both THC-containing products and nicotine-containing products, 34% reported exclusive use of THC-containing products, and 11% reported exclusive use of nicotine-containing products.
No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. We do know that THC is present in most of the samples tested to date, and most patients report a history of THC-containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak. As such, we recommend that you do not use e-cigarette or
vaping products that contain THC. And since the specific cause or causes of lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette and vaping products. Adults addicted to nicotine using e-cigarettes should weigh all risks and benefits, and consider utilizing FDA approved nicotine replacement therapies. They should not turn to or resume using combustible tobacco. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk. CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak. More information about the investigation is available at www.cdc.gov/lunginjury.
Vital Signs
Unique Case of Disease Resistance Reveals Possible Alzheimer’s Treatment Defying the odds, an individual at high risk for early-onset Alzheimer’s disease remained dementia-free for many years beyond what was anticipated. A study funded in part by the National Institute on Aging (NIA), part of the National Institutes of Health, led researchers to suggest that a gene variant may be the key, perhaps providing a new direction toward developing a treatment.
T
he research focused on the case of a woman who carried a gene mutation known to cause early-onset Alzheimer’s. However, she did not develop signs of the disease until her 70s, nearly three decades after her expected age of onset. The researchers suspect that she may have been protected because in addition to the gene mutation causing early-onset Alzheimer’s in her family, she also had two copies of the APOE3 Christchurch (APOE3ch) gene variant. Findings of this case study as published in Nature Medicine suggest that two copies of the APOE3ch variant, named after Christchurch, New Zealand where it was first identified, may protect against Alzheimer’s.
“Sometimes close analysis of a single case can lead to discovery that could have broad implications for the field,” says NIA Director Richard J. Hodes, MD. “We are encouraged that as part of our wide array of studies, this research in the unique genetic makeup of an exceptional individual can reveal helpful information.” Early-onset Alzheimer’s disease is rare, representing less than 10% of all people who have Alzheimer’s. It typically occurs between a person’s 30s to mid-60s. Risk for both early- and late-onset Alzheimer’s disease is affected by genetic factors. For the study, researchers led by investigators at Massachusetts General Hospital, Boston, in collaboration with the University of Antioquia, Medellin, Colombia,
Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, and Banner Alzheimer’s Institute, Phoenix, looked at genetic data from a Colombian family with more than 6,000 living members. Family members who carry a rare gene mutation called Presenilin 1 (PSEN1) E280A, have a 99.9% risk of developing early-onset Alzheimer’s disease. The researchers confirmed that the woman in this case carried the PSEN1 E280A mutation, which caused early-onset Alzheimer’s in her other family members. However, she also had two copies of the APOE3ch gene variant, while no other affected family member carried two copies of this variant. Affected family members develop Alzheimer’s in their 40s, but she remained disease
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free until her 70s. Imaging tests showed that the woman had only minor neurodegeneration. She did have large amounts of amyloid protein deposits, a hallmark of Alzheimer’s disease, in her brain. But the amount of tau tangles, another hallmark of the disease, and the one more correlated with how thinking and memory are affected, was relatively low. Experiments as part of the study showed that the APOE3ch variant may reduce the ability of APOE to bind to certain sugars called heparan sulphate proteoglycans (HSPG). APOE binding to HSPG has been implicated as one mechanism that may contribute to the amyloid and tau protein deposits that destroy the brain. The research suggests that a drug or gene therapy that could reduce APOE and HSPG binding has the potential to be a new way to treat or prevent Alzheimer’s disease. The research team was led by Yakeel T. Quiroz, PhD, a clinical neuropsychologist and neuroimaging researcher at Massachusetts General Hospital, and a 2014 NIH Director’s Early Independence Award recipient. Quiroz partnered with Joseph F. ArboledaVelasquez, MD, PhD, at Shepens, Francisco Lopera, MD, at the University of Antioquia, and Eric M. Reiman, MD, at Banner Alzheimer’s Institute. The individual is from the same family participating in the ongoing Autosomal Dominant Alzheimer’s Disease (ADAD) trial, which is designed to find out if the anti-amyloid treatment crenezumab can prevent the disease.
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Vital Signs
AACR Project GENIE Begins Five-year Collaborative Research Project with $36 Million in New Funding The American Association for Cancer Research (AACR) initiative known as AACR Project Genomics Evidence Neoplasia Information Exchange (GENIE) is launching a five-year, $36 million research collaboration with a coalition of nine biopharmaceutical companies with the goal of obtaining clinical and genomic data from an estimated 50,000 de-identified patients treated at the institutions participating in AACR Project GENIE.
T
he additional clinical data furthers the project goals of advancing precision oncology and powering clinical decision making through open and transparent data sharing.
The nine biopharmaceutical companies participating in the collaborative project are: • Amgen Inc. • AstraZeneca • Bayer HealthCare Pharmaceu ticals Inc. • Boehringer Ingelheim • Bristol-Myers Squibb Company • Genentech, member of the Roche Group • Janssen Research & Development, LLC • Merck • Novartis AACR Project GENIE is a publicly accessible international cancer registry of real-world data assembled through data sharing between 19 of the leading cancer centers in the world. Through the efforts of strategic partners Sage Bionetworks and cBioPortal, the registry aggregates, harmonizes, and links clinical-grade, nextgeneration cancer genomic sequencing data with clinical outcomes obtained during routine medical practice from
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cancer patients treated at these institutions. Currently, AACR Project GENIE’s registry contains clinical-grade cancer genomic sequencing data from nearly 71,000 patients. These data are linked to a limited set of clinical data, such as age, sex, primary diagnosis, and type of tumor sample analyzed (primary or metastatic). The new collaboration will greatly expand the scope and accelerate the speed of clinical data collection. • In the first two years, the project will add prior cancer treatments, tumor pathology, and clinical outcomes to the clinical data already linked with the genomic profiles of nearly 8,000 bladder, breast, colorectal, lung, pancreatic, and prostate cancer patients treated at three of the institutions participating in AACR Project GENIE: Dana-Farber Cancer Institute, Memorial Sloan Kettering Cancer Center, and VanderbiltIngram Cancer Center. • In years three through five, this data collection will be expanded to as many cancer types as possible from all active participating institutions. “Recognizing the importance of the outputs of this project
to the broader research and patient communities, and in alignment with the guiding principles of openness, transparency, and inclusion, all data generated will be made publicly available 12 months following data lock,” says Shawn M. Sweeney, PhD, director of the AACR Project GENIE Coordinating Center. “Additionally, in the spirit of inclusion, this project represents a true collaboration with the biopharma team members serving as active participants with additional project governance roles.” “We are extremely excited about the opportunity to work collaboratively with our colleagues in the biopharma
sector to expand the clinical content of the GENIE registry and bring us closer to fulfilling our goals of improved clinical decision making, and catalyzing clinical and translational research,” says Charles L. Sawyers, MD, FAACR, chairperson of the steering committee for AACR Project GENIE, chairperson of the Human Oncology and Pathogenesis Program at Memorial Sloan Kettering Cancer Center in New York, and an investigator of the Howard Hughes Medical Institute. Sawyers added, “This is just the beginning of the next chapter for GENIE, and you can expect many more advances in the years to come.”
Making Rounds
March
May
10-13
7-9
2020 Annual Conference Indianapolis Downtown Marriott Indianapolis, Indiana Info: 215-320-3881 E-mail: info@nacns.org Website: http://nacns.org
2020 Annual Conference Hyatt Regency Chicago Chicago, Illinois Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org
National Association of Clinical Nurse Specialists
18-20
Southern Nursing Research Society 34th Annual Convention Sheraton New Orleans New Orleans, Louisiana Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org
18-21
Dermatology Nurses’ Association 38th Annual Convention Crowne Plaza Denver Denver, Colorado Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org
April 15-19
National Student Nurses’ Association 68th Annual Convention Disney’s Coronado Springs Hotel and Convention Center Orlando, Florida Info: 718-210-0705 E-mail: nsna@nsna.org Website: www.nsna.org
15-18
Academy of Neonatal Nursing 2020 Spring National Advanced Practice Neonatal Nurses Conference Hilton Hawaiian Village Oahu, Hawaii Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org
American Nursing Informatics Association
June 13-17
Association of Women’s Health, Obstetric and Neonatal Nurses 2020 Annual Convention Phoenix Convention Center Phoenix, Arizona Info: 800-673-8499 E-mail: customerservice@awhonn.org Website: www.awhonn.org
23-28
American Association of Nurse Practitioners 2020 National Conference Ernest N. Morial Convention Center New Orleans, Lousiana Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org
14-17
National Association of Hispanic Nurses 45th Annual Conference Hyatt Regency Miami Miami, Florida Info: 919-573-5443 E-mail: info@thehispanicnurses.org Website: http://nahnnet.org
July/August July 28 – August 2
National Black Nurses Association 48th Annual Institute and Conference The Diplomat Beach Resort Hollywood, Florida Info: 301-589-3200 E-mail: info@nbna.org Website: www.nbna.org
August 5-7
Doctors of Nursing Practice 2020 National Conference Hilton Tampa Downtown Tampa, Florida Info: 888-651-9160 E-mail: info@doctorsofnursingpractice.org Website: www.doctorsofnursingpractice.org
July 1-5
Philippine Nurses Association of America 2020 Annual Convention Manchester Grand Hyatt San Diego San Diego, California E-mail: infomypnaa@gmail.com Website: www.mypnaa.org
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Weight Management for Nurses The Why’s and How’s of Losing or Maintaining Weight BY JEBRA TURNER
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As you well know, America is in the grips of an obesity epidemic. According to the National Institute of Diabetes and Digestive and Kidney Diseases, over 70% of adults are considered overweight or obese, which is associated with multiple medical conditions. Nurses, as role models, advocates, and educators, are poised to make a difference in reversing this trend.
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nfortunately, nurses are not immune to weight problems themselves. In fact, research suggests the rate of overweight and obesity within the profession is on par with the general working-age population. Here nurses and wellness professionals offer savvy advice for managing weight and fitness. Even for those working long, stressful, rotating or night shifts that offer few healthy food and exercise options.
Workplace leadership that buys into a wellness culture will reinforce the healthy behaviors that nurses must adopt.
eating better and moving more. Most of those groups are comprised of people from all walks of life. But you may find there’s even more power in teaming up with fellow nurses who understand the struggle, especially if they’ll be around regularly to hold each other accountable. Victoria Randle, MSN, NP-C, is a family nurse practitioner in the Atlanta area and cofounder of Nurses 4Ever Fit™. Since January of 2018, the organization has held monthly in-person events at venues such as a nurse-owned yoga studio. “We all have a special bond that only another nurse can understand. It’s a platform for like-minded individuals to talk together, it’s a form of therapy, a form of camaraderie, and you can get your fitness in,” she explains.
Becoming a Healthy Role Model Many nurses feel hypocritical telling patients to exercise and eat right if it’s obvious that they don’t walk the talk. Maybe that’s one of the reasons nurses enjoy a stellar reputation for honesty and trustworthiness, according to annual Gallup polls. Yes, nurses are role models for patients, but there’s another professional reason to take care of one’s weight and fitness—the health and longevity of your career. The American Nurses Association Code of Ethics for Nurses includes several mentions of the importance of self-care (e.g., “The nurse owes the same duties to self as others”).
Nurses Helping Nurses Many nurses know about the power of a group for establishing healthier habits like
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Victoria Randle, MSN, NP-C
Randle says the emphasis is on fitness, rather than diet, because “I see a lot of nurses who are vegan, for instance, and they don’t seem healthy. The element that’s missing is movement. When you’re 90 and you don’t have good muscle tone or you have brittle bones, that’s not healthy.” Also, many women say they are “fearful of going to a gym
because ‘I’m afraid people will look at me and judge me’ but here we’re all learning, and it’s a judgement-free zone,” she adds. Saturday morning fitness sessions are only part of the Nurses 4Ever Fit experience. “We’re going to do an annual retreat. We take a weekend away and it’s a form of therapy. It includes a massage or a hot tub together,” she explains. “Exercise is good, but it’s not everyone’s idea of self-care. The nature of a nurse
When overworked and overstressed nurses complain that they don’t have time to take care of themselves, Thoman suggests gardening, journaling, or even coloring as a way to decompress. is to care for others and put the patient first. So, when it comes time to care for yourself, you don’t have much left. That is embedded in you—the workplace culture needs to change. Nursing school actually taught that if you get a 30-minute break in a 12-hour day, you’re lucky!”
Healthy Workplaces Equal Healthy Nurses Some hospital systems have started programs to ensure that healthy food and fitness opportunities are available to their nursing staff. MD Anderson Cancer Center in Houston, Texas, is lauded as an outstanding example of a wellness workplace. Evan Lee Thoman, MS, PMP, CWP, wellness
Evan Lee Thoman, MS, PMP, CWP
specialist in the HR Wellness and Recognition unit has been in health promotion field for 13 years. He works to find out what other employers at other top hospitals and universities are doing to engage employees toward a healthier lifestyle. And he investigates what his own hospital’s employees want before offering up a range of at-work health initiatives. “The program is different for every unit. I go in and have a conversation with the leadership and we may do a needs and interest survey. We’re asking: ‘What do nurses need?’,” Thoman says. For instance, “we had many questions in one unit regarding how to make use of dental insurance. Who would not have guessed that medical consumer information was a top concern?” But it was, so the wellness department set up a program to fill the knowledge gap. They aim to provide education and services to every shift ranging from an on-site fitness center and gym membership to ergonomic assessments and resources to address compassion fatigue, resiliency, and spiritual care. Workplace leadership that buys into a wellness culture
will reinforce the healthy behaviors that nurses must adopt. Thoman helps nurses to create those wellness habits, without overwhelming them. He asks them: “Who’s going to be your support system? Who’s going to hold you accountable?” The wellness team is there, of course, but so are fellow nurses and nurse leaders. “We get the best results and greatest engagement when we have a leader who walks the talk,” he says. For example, nurses are notorious for neglecting to take meal or water breaks. “If you eat lunch it’s almost like you’re the weak one on the unit,” he says. “We’d been talking to nurses about planning their meals but then we thought, maybe we can bring something to the nurses. So now we try to take snacks to each department—‘Here’s a little something, a granola bar or piece of fruit, to fuel you during the day.’ We also stress micro breaks and encourage them to find five minute for a snack, go for water.”
When overworked and overstressed nurses complain that they don’t have time to take care of themselves, Thoman suggests gardening, journaling, or even coloring as a way to decompress. Because nursing is a predominantly female occupation, Thoman notes that rest and relaxation may be difficult for women who do doubleduty as caretakers at work and at home. Then there are the biological factors that may hamper a woman’s weight management efforts. “From a weight-loss perspective, men tend to have more lean muscle than women, which burns more calories than body fat at rest, so, at the onset, men may lose weight a little faster,” explains Thoman, who was previously a university strength and conditioning coach.
in the Atlanta area, knows that exercise isn’t always convenient for busy nurses working crazy shifts or living in extreme weather zones. When nurses tell her that they have difficulty finding time to exercise, she asks them to challenge that belief. Even nurses with legitimate time constraints, such as parents of young children. “They call it a time barrier or challenge,
Exercise Early, Exercise Often
but we say it’s a self-care issue; they feel guilt over finally taking care of themselves first,” she says.
Cara Sevier, RN, codeveloper of Nurses 4Ever Fit and the CEO of Cara Sevier Industries
Cara Sevier, RN
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Sevier has personally experienced that challenge and now meets it by waking up at 3:00 a.m. to drive to a gym 30 minutes away. Though the gym is open only Monday through Friday, she maintains her schedule seven days a week. “I found out I had to be consistent or I was thrown off. It gives you a peace in your body that you’re doing something for yourself—getting up at 3:00 a.m. for a 4:00 a.m. class,” she explains. “It takes discipline, forcing yourself, forcing my body to get to my highest physical self. On the weekend, I will find a cycle class or something else to do. Is it easy? No. It’s a lot of sacrifice, but it’s worth it.” On the other hand, we do need adequate sleep to stay slim—and to stay sane. One study at Columbia University suggests that getting less than four hours of sleep a night could raise your obesity risk by an astonishing 73%. (Seven hours a night is the sweet spot.) Nurses who work
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overnight or pull 12-hour shifts are also at greater risk for weight gain, according to a University of Maryland study. Scientists suspect that when circadian rhythms get thrown out of whack, so do hunger and fat hormones, which results in excess pounds. Or perhaps lifestyle factors lead tired nurses working off-hours to make poor food choices and avoid exertion.
Become a Healthy Living Warrior Uniqua Smith, PhD, MBA, RN, NE-BC, associate director of nursing programs at MD Anderson Cancer Center, slowly gained weight after tran-
Uniqua Smith, PhD, MBA, RN, NE-BC
sitioning to an administrative role. But with the help of a fitness boot camp and workplace wellness challenges, she started making healthier food choices and exercising consistently. “On Sunday, you had to send in a picture of all the groceries you just bought—to show that there are no snacks, no high-sugar foods,” she explains about a challenge with friends, using a social media app for accountability. “For the weekly weigh-in, you had to take a picture of your feet on the scale.”
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“Workplace weight loss challenges, like the March Madness challenge, keep you going when you have a month-long goal,” Smith explains. “You’re also motivated because you don’t want to let your team down.” A little over a year later, she’d lost 40 pounds through calorie-cutting, portion control, and cardio exercise. Only 10 more pounds to reach her goal weight, but then came a diagnosis of breast cancer. “I truly believe everything happens for a reason: 2017 was about getting myself together health wise,” she says. “It got me ready for 2018, when I had to fight for my life. It gave me the strength to fight cancer.” After six months of chemotherapy, she underwent three separate surgeries over the next several months. “I went through 16 cycles of two different types of chemotherapy. It takes a big toll on someone—I lost my taste buds and energy,” she says. “It took me literally an hour to take a shower, which before that took 10 minutes.” She started exercising again slowly, at the beginning of 2019, after the last of her surgeries. From walking to running and then completing a 5K, she challenged herself to get to her previous state of fitness. Smith is now a healthy living spokesperson and encourages everyone to eat clean and condition their bodies so they’re strong enough to fight any disease that comes their way.
Don’t Fool Yourself For many nurses, weight gain happens slowly, and
they may not even notice it at first. Or they have a pattern of yo-yo weight loss and gain, with pregnancy, holidays, or shift work. Sevier knows what that’s like. “Even at my highest weight—I reached 188 lbs—I
Anderson Cancer Center, does everything she can to fight off chaotic eating. “I work in pediatrics and our [patients’] parents want to feed us all the time. Nobody ever buys us a fruit basket, though we would enjoy it,” she notes.
On the other hand, we do need adequate sleep to stay slim—and to stay sane. One study at Columbia University suggests that getting less than four hours of sleep a night could raise your obesity risk by an astonishing 73%. told myself every story in the book. ‘Maybe these scrubs had shrunk in the hot water. Oh, wait, is this the U.S. size or the European size?” But those excuses didn’t hold up under examination and soon she started working out with a trainer at a gym. “Now scrubs that were once tight on me are loose,” she adds. Though it may be painful to face facts, research shows that being aware of and tracking certain behaviors can help drive healthy habits. A daily food log, whether paper or digital, can help some people to lose weight or keep it off. You can’t argue with the truth, when it’s detailed right in front of you, in black and white.
“I’ve realized that I have to pack a healthy snack to make sure there is one at work.” But desserts, junk food, and other caloric gifts and treats aren’t the only landmines threatening your waistline at most nurses’ stations. “In my unit, someone will bake chocolate chip cookies two or three times a shift. We’re surrounded with unhealthy snacks—choco-
Feed Yourself Healthy Meals, Healthy Snacks If you’re like most nurses, you struggle to plan, shop, and cook yourself nutritious meals and snacks. Regular meals may go out the window, replaced by chaotic eating habits. But simple meal planning strategies can help nurses to eat well. Tiambe Kuykendall, BSN, RN, a clinical nurse at MD
Tiambe Kuykendall, BSN, RN
late, cookies, chips, pizza, and other junk,” she explains. “But the wellness department brings snacks on a weekly basis—granola bars, bananas, apples, and popcorn. When everyone is trying to be healthy it makes it so much easier.”
Kuykendall notes that when she works out in the morning, her level of energy is much higher later. She’s made other changes in the a.m., too: “I don’t drink energy drinks anymore, just green tea in the morning before I go to work, and sometimes in the afternoon.” She avoids the cafeteria even though there are healthy food options there. “We have a 30-minute lunch break and MD Anderson is huge, so the cafeteria lines are long,” she says. “Yesterday I planned meals for the next three days and will bring my own lunch and snacks. You can make small changes,
like eating grapes instead of candy. I don’t advise that you deny yourself all the time, but indulging should not be the norm.”
people to simply be aware of why they eat,” explains Mark Mitchnick, MD, CEO of MindSciences, Inc, a New
Ditch Dieting in Favor of Mindful Eating Most nurses are familiar with programs such as Weight Watchers, and in fact, some hospitals hold on-site meetings. But there’s been a nationwide shift in attitudes away from dieting and toward a focus on healthy living. Mindful eating is one such approach. “We don’t promote any particular diet, or if you don’t follow a diet, we want to teach
Mark Mitchnick, MD
York City developer of digital therapeutics apps. “Right now, it’s keto, but we don’t want to chase fads.” The company’s Eat Right Now app teaches users about the habit loop and how to navigate triggers to eating. Most of us eat for a variety of reasons, most often the trigger doesn’t have anything to do with physical cues. “Sometimes it’s that you’re hungry, and sometimes it’s that you’re stressed, or you’re tired, or it’s a fight with your significant
A daily food log, whether paper or digital, can help some people to lose weight or keep it off. You can’t argue with the truth, when it’s detailed right in front of you, in black and white.
about an upcoming test, study, don’t eat.” The app helps people to break the habit loop through educational content in a highly sequenced series of 28 modules. It’s constructed to deliver a module a day, which takes only eight minutes, and which can be repeated as desired. A user can also access lessons when on a just in time basis. When feeling a craving, they can bring up a short series of questions to help shape their response to it. A scientific study showed a 40% reduction in cravingrelated eating—eating for reasons other than hunger—after use of the app. In addition to the mindful eating app, there is one to relieve anxiety and one for smoking cessation. “A lot of behavior people would like to change in a high-stress field like health care—smoking and eating—is actually stress-related. Ask yourself: ‘Do I have an eating issue or an anxiety issue?’,” Mitchnick advises. It’s not easy for nurses to stay slim, but it’s worth doing. Shift work, long hours, sedentary lifestyle, heavy lifting, high stress, and fatigue can be overcome with a mindful approach. Jebra Turner is a freelance writer located in Portland, Oregon. Visit her at www.jebra.com.
other,” Mitchnick says. “You can learn to separate the trigger from inappropriate behaviors and do something more productive. If you’re stressed
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Complementary and Alternative Medicine What Nurses Need to Know BY MICHELE WOJCIECHOWSKI
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Acupuncture, aromatherapy, supplements, and the like—more and more people across the nation are using these therapies. Because a number of these people will be your patients, it’s important for you, as a nurse, to know about them and about how to get more education if you’d like to implement them into your practice.
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F
irst, let’s make some distinctions: while “complementary” and “alternative” both represent the same types of therapies, they are different. Both words refer to nonmainstream treatments such as aromatherapy, meditation, massage, etc. However, when a health care provider uses complementary medicine, it’s used in conjunction with common, Western medicine. When the provider uses alternative medicine, it’s used in place of common, Western medicine. Within this article, we will use the abbreviation CAM, which stands for
complementary and alternative medicine. The focus here is not on if it’s used with or without Western medicine, but how it is used with patients at all.
Why Learn About CAM? If CAM isn’t used yet at every health care facility, then why should nurses learn about it? “Patients are using them. Time and time again, research finds that the majority of the population is using integrative health products, and this rate is much higher for patients with higher socioeconomic status and/or patients who suffer from chronic
health conditions,” says Jessie Hawkins, PhD, director of the Franklin School of Integrative Health Sciences. “Without guidance from their care providers, patients are left to self-educate through online sources. This results in reduced efficacy at best and injury at worst.” With so many patients using CAM, Mollie Aleshire, DNP, MSN, FNP-BC, PPCNP-BC, FNAP, DNP program director and clinical associate professor at the University of North Carolina at Greensboro School of Nursing says, “It is essential that nurses have knowledge about common CAM and obtain information to elicit use of CAM therapies from the patient history.” “It’s important to help patients get information from reliable sources and to know if a suggested alternative treatment, such as herbal supplements, may interfere with the medications they are currently prescribed or may be detrimental to their health,” says Tina M. Baxter, APRN, GNP-BC, president and CEO
Integrative Wellness Center. “It’s nice to have other modalities to help the patients.” “It’s important for nurses to learn about alternative therapies because they offer patients new avenues that may improve their conditions and overall health,” says Linda Steele, PhD, MSN, BSN, APRN, ANP-BC, program director for Walden University's NP programs.
The Most Commonly Used CAM According to Baxter, there are eight most commonly used CAM therapies in health care: acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and vitamins/herbal supplements. These, she says, are the most researched and studied. “For example, aromatherapy oils are now used post-op in some hospitals to reduce anxiety and pain after surgery so that patients will require less pain medications. Meditation has been used in psychiatry through progressive muscle
Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”
of Baxter Professional Services, LLC. “Patients are now looking for alternative therapies. A lot of people don’t want to go with pharmaceutical drugs anymore,” says Jennifer Burns, NMD, founder of Burns
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relaxation, guided imagery, and mindfulness meditation to augment the practices of cognitive behavioral therapy and dialectic behavioral therapy. Tai Chi has been shown to improve balance and flexibility for older adults and thereby
reducing falls in long-term care and community settings,” explains Baxter. “Herbal supplements such as CBD oil have shown some efficacy in reducing seizures, pain, and anxiety. Hypnosis is a treatment that is offered for smoking cessation and obesity treatment. Massage therapy and acupuncture have been demonstrated to be beneficial in addiction
“Continuing education in integrative health is one of the best career investments a nurse can make.” treatment. Therapeutic touch has been demonstrated to help with pain in some instances by manipulating the energy fields that surround the body.”
Audrey Christie, MSN, RN, a self-employed holistic wellness practitioner, says that CAM has become more common because of evidence illustrating their benefits. “Things like aromatherapy in labor and delivery units, as well as mindfulness and meditation or Reiki-style practices, are becoming more and more mainstream,” Christie says. “They can help with pain reduction, mindset, relaxation, anxiousness, and many other aspects of the body-mind connection. In recent years, science has been beginning to catch up to what we have known intuitively for years.” Hilary Erickson, RN, BSN, a labor and delivery nurse and creator of Pulling Curls says that if patients are pregnant with breech babies, she will often recommend that they
see a chiropractor, as she believes that a skilled practitioner may help prevent them needing a C-section. Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”
“Integrative health is a concept that is rapidly growing and expanding worldwide. Sales of dietary supplements
While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of education they need depends entirely on the state in which they are practicing.”
Getting Educated Don’t be like your patients and simply look up information about CAM online. If you want to implement it into your practice, it’s necessary for you to get some kind of formal education.
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are up year after year, and the industry itself is a multitrillion-dollar global market. Patients are using alternative therapies, and that use is increasing,” says Hawkins. “Continuing education in
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integrative health is one of the best career investments a nurse can make.” But there are other reasons to study CAM. “Nurses should be skilled in the therapy before providing it, and it should abide within hospital policies so that they can maintain the standard of care the hospital wants them to provide—and so that they are protected,” cautions Erickson. A number of our sources recommend that nurses first look to the American Holistic Nurses Association for educational opportunities in CAM. The organization offers certification as well as online training programs. “There are some complementary certificates available, such as the two-year program with alternative therapies expert
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Dr. Andrew Weil,” says Steele. “Many nurses also get certified as a licensed massage therapist or acupuncturist.” Steele also notes that some conferences, like the annual one offered
Hawkins stresses that nurses need to know if their individual state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well. by the American Academy of Nurse Practitioners, may offer CAM single sessions and indepth training.
“We train nurses to become board certified health coaches, herbalists, and aromatherapists. We focus on these specific areas because they are the dominant integrative health fields in nursing practice,” says Hawkins, speaking of the Franklin School of Integrative Health Sciences. “These therapies complement a nurse’s practice by providing additional tools that can be used to boost overall quality of life as well as patient compliance with wellness programs. For example, much of the research on aromatherapy is specific to pre-procedural applications such as anxiety relief before a surgical intervention. For many applications of herbs and essential oils, there is high quality evidence supporting its use,” explains Hawkins.
“Sometimes this evidence also clarifies its use. For example, recent research we conducted found that children with an autism spectrum disorder respond differently to pre-procedural aromatherapy than the general population. This helps to demonstrate not only that these interventions work, but with which populations they are found to be effective.” Most nurses can streamline their training at Franklin because they have general health education. Nurses train via interactive distance learning—so they can still work— and most complete their programs within a year. While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of
CAM Resources • American Holistic Nurses Association • Complementary and Alternative Therapies in Nursing (8th ed.), edited by Ruth Lindquist, Mary Fran Tracy, and Mariah Snyder • International Journal of Palliative Care Nursing • Journal of Holistic Nursing • National Center for Complementary and Integrative Health • Therapeutic Touch International Association
education they need depends entirely on the state in which they are practicing.” “Medicine is evolving, as is the state of health. It’s critical to explore options and be at the forefront of new therapies. In fact, most nurses took an oath to continue educating themselves,” says Christie.
CAM and Patients While many patients will be using some form of CAM, you may encounter some who aren’t. As a result, you’ll need to explain it to them to make them comfortable. “Never force them,” says Christie. “I try to come from a place of explaining it on their level. If you think of something like a breathing technique and work from there—often in conversation and assessment—you can find a connection to discuss with the patient and make them comfortable. If they never get to comfortable, I try to send them with some education to learn more about the therapy on their own time.” Steele suggests that nurses begin by giving basic tips to their patients to improve their overall health and wellness. “Ask the patient to identify
what types of therapies they have heard about and what their level of comfort with them is. Always assure them that they will have access to different medical recommendations, including alternative therapies, if and when they are ready to take that step,” says Steele. “Stress the idea of complementary medicine and nursing as a blend of both Western traditional medicine and Eastern modalities, which are more than 2,000 years old. Patients become much more comfortable when they realize they have choices in their health care.” Baxter says that she explains to patients that there is research and evidence for the prescribed therapy as well as how the therapy may benefit them. “I would be very careful, as some clients are concerned about promoting a specific religion when you talk of medication and Tai Chi. I encourage the clients to think of it as learning to ‘quiet your mind’ and ‘learning to move your body to promote healing’ as opposed to supporting a particular ideology,” she says.
Cautions to Keep in Mind With any kind of health therapy, there are cautions to
be aware of. For example, just because vitamins and other supplements are sold over the counter, that doesn’t mean that they are safe at all times. Steele says that there are still precautions nurses should take. “As with any medical or physical therapy, all have side effects and can cause potential harm or injury to the patient,” she says. “Avoid a one-size-fits-all approach. Like medications, what works for one person may not work for another. I have clients who do not respond well to aromatherapy but may respond better to some acupressure,” says Baxter. “I would make sure that if I am recommending any treatment, I would first research it for the evidence that it may be effective and make sure that you are qualified to provide the service that is offered. For example, Tai Chi is of great benefit to older adults, but I am not a certified instructor. I do know some basic moves from a video that I will often demonstrate to the other health care providers to show them the movements, but I refer clients to a certified instructor if they want to take the class.” Hawkins stresses that nurses need to know if their individual
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state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well. “Nurses should be aware that alternative therapies are not free from risks and contraindications. Many of these therapies interact with conventional medications or treatments, and many others pose risks to patient health,” says Hawkins. “There are also restrictions on how these therapies should be used, even on otherwise healthy patients. For example, some essential oils can slow breathing in infants. Others can cause someone who does not typically burn to get a sunburn. Studying integrative health provides the framework needed to keep patients safe.” Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They'll Carry Me Out in a Box.
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Conquering a Disability and Becoming a Nurse BY LYNDA LAMPERT, RN
Nursing can sometimes be a difficult profession for many of the men and women who choose to give their lives to the service of others. However, many nurses bring additional challenges to their calling, such as physical and mental hurdles that extend beyond the nursing experience. Although physical disabilities can make nursing hard at times, mental roadblocks are just as common and essentially hidden from teachers, coworkers, and sometimes the nurses themselves.
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he good news is, though, dealing with an invisible challenge isn’t insurmountable. For example, attention deficit disorder (ADD) can cause difficulty focusing, brain fog, and trouble concentrating. Nursing school requires attention to detail and focused concentration. Yet, this is just one of the many challenges that nurses can overcome—and many have. For instance, Carin Shollenberger, RN, CRNA, has had ADD since childhood. She wasn’t diagnosed until well into adulthood, and she could have let it hold her back. “Not being diagnosed impacted my ability in succeeding to my highest potential in nursing school and anesthesia school,” Shollenberger says. “With ADD, the ability to focus on what you are told to focus on is nearly impossible.” When nurses are drilled on how to use their senses to assess patients, those
The good news is, though, dealing with an invisible challenge isn’t insurmountable. with ADD must marshal all of their will to get the job done. Success is doable, but it requires a strong effort and indefatigable motivation to overcome a brain that fights back. It isn’t merely issues with focusing that can potentially stand in the way of a successful nursing career. Posttraumatic stress disorder, or PTSD, can make entering the
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nursing field complicated. Some of the tasks asked of nurses can trigger unwanted emotions and feelings. Miranda Gallegos, RN, is one such nurse who has succeeded in nursing and even flourished while facing PTSD. Like most nurses—those who enter nursing with relatively few challenges and those who have to work harder to attain the same goals—she dedicated her life to making nursing work for her no matter what. In fact, Gallegos states, “I found nursing school to be a welcome distraction and almost a period of remission. I had no interest in my peers so I could 100 percent focus on my studies. I did have a tendency to zone out or dissociate in times of stress.” Gallegos, a hard worker, took refuge in the high attention to detail that nursing requires. In her case, her PTSD symptoms could help her to push through and succeed. And this is the point: nurses who are faced with physical and mental challenges can become excellent nurses. Nursing may seem intimidating, especially to someone who is struggling. Nursing can sometimes seem impossible as a profession with a diagnosis of an attention disorder. Yet these two women have shown what can happen with effort. “My tip to prospective nurses would be to seek professional help sooner,” advises Shollenberger. “I would have told my past self that it was not normal to procrastinate nor was it normal to have the inability to focus on school work while most everyone else could. I didn’t know that I could be helped!”
Gallegos agrees: “I found that nursing school really empowered me to get help. Once I got help for my conditions my grades went from B’s to A’s. I didn’t know I had something wrong at the time until through school I learned about these disorders and realized I fit into a lot of these categories and symptoms.” Surely, early detection is key. If you are having trouble with focusing or intense anxiety, these are symptoms worth
And this is the point: nurses who are faced with physical and mental challenges can become excellent nurses. checking out. Nursing is hard enough as it is, and no one should work with any hindrance that can put a patient in danger. Examine yourself. Know yourself. Discover what your needs are to make nursing a success. Shollenberger found that both nursing school and anesthesia school could prove challenging before she knew about her ADD. “In nursing school, I did not have a husband or kids. My friends in the dorm got a visit from me several times a day when it was time to study. In anesthesia school, it was even tougher with a family. I wish I would have been diagnosed and treated early on...it wouldn’t have been so stressful.” Gallegos found that her PTSD actually helped her be a better student and a better nurse.
“PTSD has a known symptom of hyper vigilance and I use that to my advantage. I am able to quickly scan whole pictures and scenarios to develop my assessments and my priorities,” she explains. These nurses have documented challenges they faced when they entered the profession. Both faced them head on and used their diagnoses to make their skills better than they may have been without them. Although they both walked a hard road at times, they have succeeded well in the profession. What is it that helps them overcome what could be a daunting challenge? What should other nurses know about traveling down this road? “My tips for other nurses is to just keep your head down, study, and do your work,” Gallegos explains. “Focus on lots of self-care, whatever that means for you. Don’t worry about what other people are doing.” Nurses tend to compare themselves to others, trying to
Nursing is hard enough as it is, and no one should work with any hindrance that can put a patient in danger. Examine yourself. Know yourself. Discover what your needs are to make nursing a success. be the super nurse that doesn’t need any help. For someone facing additional challenges, this could be disastrous. Focus instead on introspection and
using your unique skills to make yourself the best you can be. Shollenberger sums up her positive nursing journey this way: “Before my diagnosis, I felt like a failure because even though I got good grades, my
Nurses tend to compare themselves to others, trying to be the super nurse that doesn’t need any help. For someone facing additional challenges, this could be disastrous.
struggle to get them was real. I felt even more of a failure in anesthesia school because I couldn’t skate by the skin of my teeth anymore. Once I had the diagnosis, a lot of what happened in my life made sense, but I still had to work to overcome the adversity. Medication helped but knowing in my mind that I could overcome this was an even bigger push to succeed.” Lynda Lampert, RN, has worked medical-surgical, telemetry, and intensive care units in her career. She has been freelancing for several years and lives in western Pennsylvania with her family and pets.
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Academic Forum
Strategies of Incorporating Palliative Care as a Direct Care Nurse By Christian CATIIS, BSN, RN, PCCN
Palliative care is defined as a practice with emphasis on maintaining and improving consult if services are provided a patient’s quality of life that can be incorporated at any stage during the disease at that health care institution. process. With a focus on symptom management and identifying clear goals of care, Symptom Management palliative care plays a vital part in optimizing quality of life. Currently, palliative care From a physiological standservices are offered at a multitude of health care organizations that may consist of a point, multiple symptoms can team of physicians, advance practice nurses, social workers, chaplain services, etc. prove to be quite challenging And although palliative care can be beneficial for the patient and their loved ones, there in supporting a patient’s comfort level. Symptoms such as are still many barriers preventing its integration in care delivery. This can result from a shortness of breath, consismisunderstanding of what palliative care can offer, its presumed synonym to hospice, tent coughing, fatigue, naulate referrals to the palliative team, or a complete lack of consultation where a patient sea, vomiting, constipation, could have benefited. However, how can direct care nurses integrate the principles of and diarrhea can be a difficult burden. Hospitalized patients palliative care in their everyday clinical practice?
P
alliative care is multifaceted; however, some essential components include pain control, symptom management, and addressing goals of care.
Pain Management Regarding pain control, the direct care nurse can begin by completing a comprehensive pain assessment. By understanding how to properly assess a patient’s pain, nurses can have a better understanding on how to effectively treat it. While the Numeric Rating Scale can provide some insight to the severity of pain, nurses can also utilize the OPQRST mnemonic to supplement their pain assessment. Onset: Was the pain sudden or developed gradually? What were you doing when the pain began? Provocation: What makes the pain worse? What makes the pain better? Quality: Could you describe the pain? Words like sharp, stabbing, burning can help the
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nurse better understand what the patient feels. Region: Is the pain localized in one area of the body or does it move? Severity: From a scale of 1 - 10 with 1 being minimal pain to 10 being extreme pain, how would you rate your pain? Time: When did the pain start? Have you experienced this type of pain before? A functional assessment plays a very important role in controlling pain as well. For
By understanding how to properly assess a patient’s pain, nurses can have a better understanding on how to effectively treat it. example, if a patient states no pain staying in only one position however discomfort when standing or sitting, that patient would be described as having limited functional ability due to inadequate pain relief.
Providing efficient pain relief does have its barriers. Patients may be hesitant to accept narcotics in fear of being seen as drug-seeking or they may feel apprehensive to admitting they have pain. Because of this, education is especially important to allow patients better control of their symptoms. Additional tools that a nurse can incorporate in their pain assessment are noticing body behaviors, like those presented in the Face, Legs, Activity, Cry, Consolability (FLACC) scale for children as well as nonverbal adults. A patient may state minimal pain; however, grimacing, clenched teeth, sweating, and tachycardia might indicate otherwise. Finally, when an intervention is implemented, such as medication, a pain reassessment should be conducted within an appropriate timeframe to evaluate its effectiveness. However, if repeated ineffectiveness of the current pain regimen, nurses should feel empowered to inquire about a proper pain management
introduced to new medications and treatments are at risk for developing side effects, which is why medication education is especially important for patients in understanding what they may expect. For example, opioid treatment may be met with resistance for fear of its constipating side effect; however, effective management is possible by addressing fears, providing education, and potentially supplementing with a stool softener. While pharmacological interventions are utilized more often in the hospital environment, manipulating the environment can provide some benefit as well. For example, in conjunction to oxygen support and medication, having a fan blow cool air in the direction of the patient or lowering the temperature in the room can provide some additional relief. Dyspnea is not always caused by a patient’s low oxygen saturation as contributing factors such as anxiety could produce the feeling of difficulty of breathing.
Academic Forum Conclusion
Coughing can interfere with adequate sleep and oral intake and can lead to physical exhaustion. Positioning and removing environmental irritants can be supplementary interventions that can be uti-
While pharmacological interventions are utilized more often in the hospital environment, manipulating the environment can provide some benefit as well. lized alongside medications. A full respiratory assessment should be conducted, especially in regard to assessing the characteristics of a patient’s cough. Adjectives such as dry, moist, and productive can help the provider prescribe the appropriate medication. Constipation and diarrhea attributed by underlying disease or medication side effects are distressing and exhausting symptoms that impacts patient mood and dignity. What can be done to help alleviate these symptoms? In regard to medication-induced constipation,
commonly seen through opioid usage, prophylactic laxatives/ stool softeners can be started to help potential side effects. Having a consistent regimen and re-evaluating its effectiveness allows the nurse to assess if the patients’ constipation is being managed appropriately.
Communication Communication is the foundation of palliative care; through proper communication and transparency amongst the health care team can patients and families make informed decisions around their treatment options. The nurse is pivotal in accompanying the patient through the illness journey, whether it be simply through active listening and presence to ultimately providing guidance regarding treatment effectiveness. This nurse-patient relationship is built on trust and through supporting patients and families to be active participants in their care. How can direct care nurses improve their communication skills, especially when it comes to a goal of care conversation? One strategy that can be implemented is to utilize open-ended
questions. Questions such as “What do you understand about your medical condition?” elicits the patient’s perspective of their disease course. The conversation can delve deeper potentially into the patient’s perspective of their prognosis and the treatment options they believe to be available. This AskTell-Ask strategy explores the patient’s understanding first before the nurse provides information. This back and forth cycle between the patient and nurses addresses four main principles: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations from the nurse. When delivering information, the nurse should avoid using medical jargon and speak in simple terms. Finally, trust and compassion provide a foundation of effective palliative communication. Many times, when palliative care is discussed, the conversation can be somber as it may be dealing with advanced illness and burdensome symptoms. Therapeutic presence results in empathy, thus creating a safe space to discuss difficult issues.
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Unfortunately, barriers still exist that prevent palliative care from being effectively delivered to those patients who would benefit from it the most. Palliative care is time and time again mistaken with death or hospice, thus resulting in reluctance to appropriate consults being in place. Additionally, some nurses may feel inadequate in engaging the patient and family in palliative topics or believe that these conversations should be solely conducted by the physician. Nurses need to be involved in overcoming these barriers to reduce misconceptions and ensure that other health care
The nurse is pivotal in accompanying the patient through the illness journey, whether it be simply through active listening and presence to ultimately providing guidance regarding treatment effectiveness. providers, patients, and families understand the benefit of palliative care implementation. These benefits include early focus on comfort treatments, reduction in cost of care, and overall decreased length of stay. Nurses play a crucial role in palliative care, and with continued self-education and engagement can the direct care nurse utilize their skills and knowledge to benefit their patients by acting as that essential extra layer of support. Christian Catiis, BSN, RN, PCCN, is a critical care registered nurse living in New Jersey.
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Degrees of Success
Greater Houston Nurses Taking it to the Streets By Debbie Ann JONES, PhD, RN
Homelessness is a global issue. It is on the rise and it impacts health physically and mentally. According to a recently published article in BMC Public Health, emergency departments are more often used by the homeless population for acute health care versus accessing preventative health care services. A 2018 study published in SAGE Open reported that the homeless population experiences health disparities with multiple chronic health conditions, mental illness, substance abuse, and depression.
T
he U.S. Department of Housing and Urban Development, Office of Community Planning and Development provides an Annual Homeless Assessment Report (AHAR) to Congress. On a single night in January 2018, there were 552,830 people who experienced homelessness in
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the United States. Most were sheltered (65%, 358,363) compared to 35% (194,467) who were in unsheltered locations. In the United States, 17 people per 10,000 experienced homelessness in 2018. Some of those who were in shelters (3,864 people) stayed in beds that were funded because the
president declared natural disaster after four Hurricanes (Maria, Irma, Harvey, and Nate) and wildfires in the west. Twenty percent (111,592) of the homeless were children, 71% were over 24 years of age, and 9% ranged from ages 18-24. There were more men in unsheltered locations compared to women.
Almost half (49%, 270,568) of the homeless people identified themselves as white compared to black/African Americans (40%, 219,807). In the state of Texas on a given night in 2018 there were 25,310 homeless people. There were 9 homeless people per 10,000 in the general population of the state. Individual estimates of homelessness in Texas was 19,199; 6,111 for people in families with children; 1,379 for unaccompanied homeless youth; 1,935 for veterans; and 3,269 for the chronically
Degrees of Success homeless individuals, according to the 2018 AHAR report. Houston is the fourth largest city in the U.S. with over 2.3 million people, according to the U.S. Census Bureau. In January of 2019, there were
Taking it to the streets takes courage and a compassionate heart. 3,938 homeless individuals (unsheltered and sheltered) in the cities of Houston and Pasadena and Harris, Fort Bend and Montgomery Counties.
Risk Factors There are various reasons that may cause an individual to experience homelessness. A 2009 study published in Psychiatric Services reported a significant association with childhood adversities and homelessness. The childhood adversities with significant findings include: having a history of running away, being ordered by a parent to leave the home, being neglected by a parent or caregiver, having a biological father incarcerated, being adopted, being in foster care, and the duration of welfare assistance before 18 years of age. Significant findings regarding socioeconomic situations included grade when respondent left school, economic difficulty in the past year, and currently employed. Mental health problems such as being diagnosed with depression and having a psychiatric hospitalization in the past five years were significant predictors of homelessness. More recently, a 2019 study in the Community Mental Health Journal indicated the
individuals with mental illness had high rates of homelessness. Addiction problems such as drugs in the past year was also a significant predictor of homelessness, according to the 2009 Psychiatric Services study. Oftentimes veterans return home after deployments to war zones suffering with invisible wounds such as post-traumatic stress disorder and traumatic brain injury. These individuals are at risk for experiencing homelessness, according to the National Alliance to End Homelessness (NAEH). Homelessness can also be due to loss of property, family violence, or domestic violence. A 2018 study in the Journal of Community Psychology reported loss of support systems and social networks can also lead to a path of homelessness. Lower incomes often lead to an inability to pay for basics such as food, clothing, shelter, and transportation—and this places individuals at risk.
still live in tent cities under freeways. One might say, they want to be on the streets. One might say they do not want to follow the rules of the shelters. Therefore, they chose to be out on the streets. All of those sayings might be true. All the same, someone remains homeless. One night during November 2018, I was driving home and it was very cold outside. The temperature was in the 30s or low 40s. I was overcome with sadness and sorrow to see so many people literally sleeping on the sidewalks without any
Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. shelter. I noticed that some did not have blankets. I found myself feeling so blessed and
fortunate to not be living on the streets. But then, I wanted to do something. I said they need blankets and warm clothes if they will be sleeping on the streets in this cold weather.
Community Outreach Project As a Christmas project for the Black Nurses Association of Greater Houston (BNAGH), we decided to give out blankets and socks to the homeless people in Houston. One Saturday afternoon (December 8, 2018), nurses from the BNAGH gathered the donated items to be distributed and walked the streets where a group of homeless men and women gathered. We drove to a local fast food place near Midtown, between downtown and The Texas Medical Center, and parked with permission from the manager. While still in the parking lot, a man asked me if we were getting ready to do something with the homeless. He was told we were going to pass out blankets, hats, socks, bottled water,
The Problem It is a common sight in Houston to see homeless people living and sleeping on the streets. Whether you walk or drive around the city, you cannot help but see individual men and women panhandling in the streets, standing at corners and intersections. They will routinely walk up to your vehicle with signs, cups, and stretched out hands for money. The homeless can be seen sleeping on the sidewalks and huddled up against buildings and fences. Although shelters for the homeless exist and initiatives have been implemented in attempt to get the homeless off the streets of Houston, the homeless population is huge. Many people who are homeless
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Degrees of Success homeless are many. One might feel overwhelmed if trying to take on every issue alone. It will take many people and resources. However, everyone can do something to help improve the health and lives of others. That is what the nurses of BNAGH wanted to do and that is why you might see homeless people in Houston with a sign displaying the words “BLESSED.”
Relevance to Nursing
and brown bags with snacks (peanut butter cracker, cuties, and peppermint candy canes). He stated his name and the name of his company and said he was there with his crew to do a film about the homeless in Houston. He asked if he could film us passing out the items and we told him yes. He said he would put us in the credits. As we gathered all the items in large black plastic bags and started walking with the water, people started coming toward us to get the blankets and socks and other items. We gave away every item that we had. We even had a set of towels and a bar of soap to give out. One man said he wanted the soap. One man and lady were yelling for us to throw a blanket over the fence to them. One lady asked if we had anything
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girly. She asked for a pink hat. Everyone was so appreciative. Only one person did not want
What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. the items. He said he wanted dollars. He walked back into the street, running from car to car begging for money. Overall, it was an awesome experience. We provided items to approximately 60 homeless individuals. Taking it to the streets takes courage and a compassionate heart. The needs of the
Homeless Individuals are a vulnerable population and are sometimes considered invisible. However, they are not invisible. They can be seen and counted. They are at risk for health disparities including mental health issues. There were so many obvious needs. One was just basic hygiene. Nurses can advocate for housing because personal hygiene is important. Hand hygiene is the most effective way to prevent and control the spread of infection. Individuals experiencing homelessness face barriers to personal hygiene. For example, personal hygiene and self-care barriers are limited access to facilities for bathing, taking a shower, doing laundry, and washing hands. Such barriers to self-care and personal hygiene can cause one to be at risk for an infectious disease. Some things that nurses can do to bring about change: • Contact local coalitions for the homeless for information about their goals and objectives; • Advocate for jobs and housing for the homeless; • Contact and lobby local and state congressional and legislative officials regarding policies
to help alleviate homelessness in America. Such efforts will help reduce health disparities among this vulnerable population. Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. However, if nurses are to make a difference, then we must rise to the calling, step up to the plate, and do something positive to make a change. There are so many things that can be done. What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. Hopefully you will be inspired to do something to help the homeless in your community feel encouraged and strive to be healthier. Debbie Ann Jones, PhD, RN, is a clinical associate professor at Prairie View A&M University College of Nursing. Acknowledgements. The author wishes to thank Betty Davis Lewis, EdD, RN, FAAN and the Black Nurses Association of Greater Houston (BNAGH) and Prairie View A&M University College of Nursing faculty members for donations, and the three other nurses from BNAGH (Patricia Boone, RN, BSN; Vivian Dirden, RN, BSN, MS; and Dametria Robinson, BSN, RN-BC) who also walked in the streets of Houston to distribute the items to the homeless and provided photos. In addition, the author wishes to thank Carmen Lewis, MSN, RNCMNN, IBCLC for providing the “BLESSED” photo.
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Second Opinion
Arrogant Opinions Supported by Unverified Theories: It’s Just Inflammatory By Regina G. GOLDWIRE, FNP-BC
Both nurse practitioners (NP) and physicians embrace the concept of “Do no harm” yet cannot seem to support and respect one another. It’s Just Inflammatory In 2017, an op-ed was posted on a social media network by a physician that was provocative about NPs: “Nurse practitioners are not, I repeat, not physicians. They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true. Who would you want your family member seen by—a nurse or a physician?”—Doximity.com, 10/2017 One’s initial response may be to get angry after reviewing that. Yet, instead of remaining angry, perhaps the use of emotional intelligence and research could be of more benefit with analyses of the social media post.
A Little History Lesson In 1965, Henry Silver and Loretta Ford, a physician and a nurse, developed the first training program for NPs. The course of instruction focused on disease prevention, health promotion, and was in direct response to a national shortage of primary care physicians of that time. The deficit was especially concerning in rural, urban, and undeserved communities. This sounds eerily similar to current health care accessibility issues of today.
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Ford and Silver met much opposition with the development of the first formal program for NPs. Surprisingly, the opposition was not only from physicians but also nurses. Some claim nurses believed that the title of “Nurse Practitioner” would be deceptive and somehow damage the nursing profession; meanwhile, it is believed that some physicians felt that NPs simply did not have the skills to take care of the public health needs without supervision (e.g., oversight). What is captivating, however, is how
What is captivating, however, is how a nurse and a physician identified a need and were able to work in concert to try to address the concern.
a nurse and a physician identified a need and were able to work in concert to try to address the concern.
The Un-Packaging “Nurse practitioners are not, I repeat, not physicians.” Merriam-Webster defines a physician as: “A person skilled in the art of healing.” Thus, this could be considered
offensive to a physician who has gone to school for many years and has done an average of 10,000-15,000 hours of clinical rotation. In con-
should understand that having a high IQ does not constitute knowledge, nor is the IQ the only predictor for one’s success. The language used
What’s wrong with collaboration, anyway? This should be viewed as a valuable tool that assists with the care and safety of patients who may not otherwise have access to adequate health care.
trast, the NP goes to school for many years too but only averages 600-1,200 clinical hours. Humbly, if one is being honest, the sheer number of clinical hours that physicians do may suggest their training is better. Does that mean that they are superior? It should stand to reason that if one’s course of study includes more hours that their training is superior, but this does not mean that a NP is not essential in their own right. Therefore, it is understood that a NP is not a physician. “They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true.” It has been documented that IQ tests do not test intelligence but can simply demonstrate that one is a good “test taker.” Hence, one
in the op-ed may be viewed as crude to some and offensive to others; however, if one could look past the words and get to the root of what was being said it might be helpful. Checking egos at the door and realizing that medicine is not a power structure—it should simply be patientcentered. As such, there may be some value to the thought that NPs need oversight to practice. What’s wrong with collaboration, anyway? This should be viewed as a valuable tool that assists with the care and safety of patients who may not otherwise have access to adequate health care. This should not degrade the NP’s worth but prove valuable for the public. For those arguing about NPs and their worthiness— are they willing to work in rural, urban, and undeserved
Second Opinion
areas? Who does this argument really hurt? To meet the current health care demands, there would need to be a tremendous supply of willing physicians. Where are they? Additionally, some studies imply women and children suffer the most in medically underserved areas, Who will serve them? Is that physician you? “Who would you want your family member seen by—a nurse or a physician?” Qualifications and experiences are probably the central reasons for patients preferring a provider no matter what their title. But physicians may be more often preferred for their skills, whereas NPs may be
favored for their social skill and ability. Maybe fear, lack of confidence, and overwhelm-
Oversight should not indicate a servant-toleader relationship but rather a teamwork concept to support and respect one another. ing need as a NP to validate worth could make them seem unworthy. But this should not be confused with lack of skills or professionalism of the NP. Oversight should not indicate a servant-to-leader relationship but rather a
teamwork concept to support and respect one another. One cannot reasonably argue with the number of hours of study a physician puts in—it is commendable. Having said that, this does not belittle the course of study for the NP, either. Physicians and NPs are all valuable, and working together can be nothing but good for all around. So, in the words of Rodney King, “Can’t we all get along?” Let’s work together in concert to direct a beautiful symphony called safe patient health care. Regina G. Goldwire, FNP-BC, is a veteran and a nurse practitioner who loves medicine.
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Health Policy
Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities By Janice M. PHILLIPS, PhD, RN, CENP, FAAN
A
s nurses we are actively engaged in advocacy activities through our professional and specialty nursing organizations. However, an increasing number of nurses are informing the political discourse by serving as volunteers for a growing list of consumer oriented organizations such as the American
level, according to the Nurses on Boards Coalition. Perhaps less popularized are calls for applications to serve on advisory boards and councils for elected officials. For example, in Illinois at the beginning of Governor Pritzker’s tenure as the state’s 43rd Governor, the governor’s office released a call for applica-
Perhaps less popularized are calls for applications to serve on advisory boards and councils for elected officials.
Association of Retired Persons (AARP), Susan G. Komen, and the Lupus Foundation of America, all of which have local affiliates across the country. These and other organizations often provide advocacy training for their volunteers along with opportunities to engage in advocacy days. Serving as a volunteer for these and other organizations enables nurses to use their expertise and strong familiarity with consumer concerns to inform advocacy efforts on behalf of diverse constituents. Nursing’s engagement in this capacity compliments the current push to ensure that 10,000 nurses are placed on boards or coalitions by 2020. As of October 2019, 6,751 nurses have been placed on a diversity of boards which provide invaluable opportunities to utilize nursing expertise at the local, state, and national
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tions for volunteers to serve on a number of advisory boards. Some of the opportunities were directly related to health such as the State Board of Health. Other non-health specific opportunities were suitable for nurses to lend their expertise on topics such as aging, the environment, or child welfare. Such engagement is critical to infusing a health-in-all-policies perspective into the decision making process. Illinois is not alone in this regard. Other states and municipalities have opportunities in which nurses can use their expertise to help inform elected officials about health-related matters. For example, Catherine Waters, RN, PhD, FAAN, professor at the University of California Sans Francisco, is an accomplished nursing faculty member with expertise in community health, health disparities, and health equity. She served five years
as a health commissioner for the San Francisco Health Commission. Waters not only used her expertise to shape the policy discourse around health issues impacting her city, but also developed additional skills in diplomacy, consensus building, and budgetary decision making.
In Minnesota, Shirlynn LaChapelle, an expert nurse clinician, serves as a nurse consultant to the state’s Attorney General Keith Ellison. In this capacity she serves as a member of the Attorney General’s Advisory Task Force to Lowering Pharmaceutical Drug Prices. As a nurse, she
Health Policy brings real life examples of how people struggle to secure access to affordable health care and life saving medications.
Keeping one’s resume/ CV up to date is key as some calls for applications may have a short turnaround for submissions. In Washington, D.C., Catherine Alicia Georges, EdD, RN, FAAN, professor and chairperson of nursing at Lehman College and the Graduate Center of the City University of New York is a long-term volunteer for AARP and an AARP board member. In 2017 she was elected to serve as the organization’s National Volunteer President from June 2018 through June 2020. Georges serves as the lead national spokesperson for the organization and helps to shape the policy agenda for AARP. From a federal government perspective, some federal agencies or departments have been mandated by law to establish an advisory council. Advisory councils are mandated to include a variety of expertise
including consumer representation. Many nurses serve on federal advisory councils providing recommendations to agency directors on issues germane to the agency’s mission or strategic initiatives. For example, a number of nurses continue to serve as members of the National Advisory Council for Nursing Research and the National Advisory Council on Nurse Education and Practice. Nurses also serve on federal advisory councils that are not specific to nursing but can benefit from nursing’s expertise in patient care and health care in general. For example, the National Institute on Minority Health and Health Disparities and the National Cancer Institute have selected nurses to serve as members of their advisory councils. These members join other members in weighing in on federal funding issues and shaping priorities for advancing the Institutes’ mission. Nurses who aspire to serve in these capacities must always be prepared to respond in case there is a call for applications. Keeping one’s resume/CV up to date is key as some calls for applications may have a short turnaround for submissions. Keeping a nominator
bank with a list of individuals who can provide an accurate and firsthand account of one’s excellence and contributions is also important. Nominators can be called upon to help verify an application or be asked to provide additional information that informs the selection process. In some instances, nurses can pursue opportunities to serve on advisory councils or committees through self-nomination. Either way, strong letters of nomination are often required.
Gaining additional expertise through volunteerism and service can be a strong catalyst for future opportunities in the policymaking arena.
to be one of my most influential gateways to more opportunities in the policymaking arena. Each time I apply for opportunities, I include this as one of my most valuable springboards for developing expertise in providing testimony and gathering evidence to provide a persuasive argument before elected officials. Nurses can gain substantive and meaningful expertise through voluntary and service activity that will enable them to rise to higher levels of engagement and influence in the policymaking arena. So, go for it! Janice M. Phillips, PhD, RN, CENP, FAAN, is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center.
Gaining additional expertise through volunteerism and service can be a strong catalyst for future opportunities in the policymaking arena. My earlier volunteer work with Susan G. Komen positioned me to pursue a board position creating a pathway to become chair of the local affiliate’s Public Policy Committee. This volunteer experience continues
Resources • The Nurses on Boards Coalition www.nursesonboardscoalition.org Nurses can sign up for alerts and potential opportunities. • The Federal Register www.federalregister.gov Nurses can check this listing of federal agency meetings and calls for applications to serve on advisory councils in addition to a listing of meeting times and agendas for numerous federal agencies. Free subscription.
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