Last week I had the privilege of speaking with Carole Eldridge, RN, DNP, CNE, NEA-BC, Director of Graduate Programs at Chamberlain College of Nursing. This fall, Chamberlain is launching a new Masters of Science in Nursing Healthcare Policy Track and I was particularly interested in learning more about Dr. Eldridge, as I’ve been following her on twitter for years (@Nerdnurse), and about this new MSN track.

I was more than impressed when I asked Dr. Eldridge to share her nursing background with me. In a nutshell, after about 15 years in acute care (including critical care, post-surgical care, hemodialysis, and transplant), Dr. Eldridge and her husband moved to Africa for about a year to run a health clinic. When she returned to the U.S., she started a Home Health and Hospice Agency which grew into about 50 agencies in 4 states! After selling this business, Dr. Eldridge became interested in education and saw a need for training nurse aides. She started her own publishing company which developed training packets. After selling this company, Dr. Eldridge returned to school herself for her MSN in Leadership and Healthcare Business, and later her DNP. She taught for about 3 years, and since then has held various titles including Director of a Master’s program, Dean, and Campus President. Wow!

In her current role, Dr. Eldridge oversees all of the graduate programs at Chamberlain College of Nursing. As previously stated, this fall, a new Healthcare Policy track is available for MSN students. The development of this track is timely in the wake of the report from the Institute of Medicine – The Future of Nursing: Leading Change, Advancing Health – and as we approach a Presidential election here in the United States. An MSN in Healthcare Policy will prepare nurses to be active in bill and policy writing, foundations, education and training, academia and research, disease investigations, health services, and other positions where one can “Impart the voice of nursing to direct the path of healthcare policies that benefit patients, the community, our nation and the world.”

This particular program involves 6 core courses (foundational concepts, theory, informatics, leadership, research, and basic healthcare policy) and 6 specialty courses (healthcare systems, economics, global health, nurse leadership and healthcare policy, healthcare policy practicum, and a capstone project).  When asked for more details about the capstone project, Dr. Eldridge gave me several examples that students from similar programs have done, such as global health projects, legislative proposals, and oral testimony collaboration. The coursework is flexible, can be completed in 2 years, and is completely online.

My favorite part of our conversation had to be discussing the upcoming election. Dr. Eldridge reminds us that as nurses, we have a responsibility to be politically engaged in order to best advocate for our patients. In particular, we need to be alert to the following:

• Economics – how will healthcare be funded? 
• Affordable Care Act
• The aging population, including funding their care & medical devices
• “Equitable access”
• Epidemiology
• Vaccines
• Global Healthcare 

Remember, Florence Nightingale was our first political activist. As nurses, let’s remain educated about the issues and share our voice. We are more than 3 million strong – it’s important that we are heard!

Resources:

The Future of Nursing: Leading Change, Advancing Health 

Keeping Health Care Reform Healthy, Patients Informed (American Nurses Association) 

ANA’s Policy and Advocacy page 

ANA's Nurses Strategic Action Team (N-STAT)

The American Diabetes Association's 71st Scientific Sessions took place at the end of June and several headlines have come across our newsfeed .  Here are some highlights that you might be interested in:

• Diabetes Prevention Strategies Are Cost-Effective: Lifestyle intervention and metformin treatment are cost-effective and improve quality of life
• Cardiac Risk Factors Up in Teen Girls With Diabetes: Adolescent girls with diabetes have higher CRP, LDL, HbA1c and BMI than boys
• Longer Life Expectancy for Patients With Type 1 Diabetes: Survival gap between patients with type 1 diabetes and the general U.S. population decreasing
• Diabetes Prevalence, Glycemia Levels Rising Globally: In high-income subregions, North America has largest increase in mean fasting plasma glucose
• Dietary Support Helps Type 2 Diabetes Outcomes: Intense diet intervention improves glycemic control, but exercise does not offer more benefits
• High-Protein or High-Carb Diet Help Weight Loss: Found equally effective in helping patients with type 2 diabetes lose weight
• Sulphonylurea Agents May Increase Cardiac Events: Sulfonylurea therapies may increase risk of CVD events in older patients with type 2 diabetes

Access more information from this meeting, including video highlights, webcasts of select presentations, and links to abstracts, at DiabetesPro: Professional Resources Online.

It always happens whenever I travel on business, there is almost always a health care emergency. I seem to be a magnet for them.

I recently returned from a business trip to China and had the opportunity to see the Chinese Health Care System up close and personal. One of my colleagues had an injury and needed to be taken to the hospital. As the "nurse" in the group, I went with her along with an interpreter. What I saw really opened my eyes to how luckly I am to practice in the United States.

When we arrived in the Emergency Department, there were no wheel chairs to be found, patients were sitting or lying on the waiting area floor. Once back in the treatment area, there were patients on stretchers, in chairs obviously brought from home, and lined up against the walls. The physicians, nurses and many patients were all wearing masks and there weren't any boxes of gloves or containers of anti-bacterial hand wash to be found.

After sometime, we discovered there was a special area for "foreigners" in another section of the hospital. So off we went through dimly lit corridors to our special area. Without an interpreter we would never have been able to register or speak to the nurses and physicians. "Pay for Service" takes on a whole new meaning in this setting. Before every examination and procedure, you had to get an estimate of the cost and then go pay for it with your credit card before the service was rendered. It was the nurses who gave the cost estimates for care. Can you imagine doing that in the U.S.?

Language was a definite barrier. The nurses spoke virtually no English but I was able to communicate with them through the interpreter. The physicians were somewhat more fluent in English medical terminology so it was less difficult communicating with them. When all else failed, hand gestures worked well.

 The care my colleague received, once we found the right place to be, was very good. The physicians and nurses appeared to be very knowledgable and skilled at their jobs despite having minimal supplies and staff.  

What lessons did I learn?

1.We often take supplies, cleanliness and being able to communicate with our patients for granted here in the U.S. In the rest of the world, that simply is not the case.

2. If you travel to a foreign country where you can't speak the native language, you better know where to find an interpreter.

3. Always carry a credit card or local money so you can pay for services.

4. If possible, travel with a nurse or other health care professional, they may save your life.

And finally, on the flight home, you guessed it, another medical emergency. And yes, I was the only health care provider on the plane.

As nurses, it is in our nature to want to intervene and “make things better.” Add fundamental medical knowledge and clinical skills to that desire to help and we are the ideal candidates to promptly respond to any emergency situation or mass casualty incident. Right? Not always.

Desire and clinical expertise are not enough when it comes to volunteering during or after a disaster. Preparation is an essential component that cannot be overlooked. If you’ve tried to help in the past but weren’t able, or think you might be interested in being a disaster volunteer in the future, now is the time to look into becoming part of an established disaster response team. Start your research by visiting the websites of organizations such as the National Disaster Medical System, American Red Cross, and Medical Reserve Corps.

Does anyone already belong to any of these groups? Have you been part of disaster relief efforts in the past? What advice can you share with us?

Reference: Adams, L.M. (2010). It’s a Disaster! How can I help? Nursing2011 Critical Care, 6(1).

Today is World AIDS Day, dedicated to raising awareness of the AIDS pandemic across the globe. AIDS has killed more than 25 million people between 1981 through 2007. Today 33.4 million people live with HIV and there are 2.7 million new cases each year. In the U.S., 1.1 million people are living with HIV and of those, 1 out of 5 people don't know they are HIV positive.

Funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), The Global Fund to Fight AIDS, and with donations from other organizations, AIDS medications are reaching people around the world however, many people still don't have access to these medications and the AIDS pandemic still claims far too many lives.

In the U.S. the effort has been made to make HIV testing part of routine health care. Over 80 million people in the U.S. have been tested at least once. The latest guidelines from the CDC recommend that everyone between the ages of 13 to 64 should be tested at least once and those at high risk should be tested more often and women should be tested during pregnancy.

For more information on World AIDS Day visit, www.cdc.gov/features/worldaidsday/.

In the latest issue of the Journal of Christian Nursing, Anthony Hoffman BSN, RN, describes his experiences as a diabetic educator in Nouakchott, Mauritania (located on the west coast of Africa). In his article, Universal Principles for Culturally Sensitive Diabetic Education, we are reminded of the importance of cultural awareness.  While most of us might not travel abroad to work, we care for and will continue to care for patients from other countries or with different faiths and traditions that impact how they manage illness. Mr. Hoffman shares the following “universal principles” which truly can apply to any patient in any setting:

"1. Patients own their culture. A patient needs to be allowed and encouraged to describe his or her culture. I found travel guides and documentaries useful as a starting point in understanding culture, but quickly learned the danger of stereotyping. Having an inquisitive attitude helps us be students of our patients' cultures and avoid stereotyping.

2. Patients own their bodies. In every culture, patients have the right to make their care decisions. Sometimes cultural mores and values will make adherence to the plan of care more challenging, but the final course of action belongs to the patient. We must continue to respect and offer the best to our patients regardless of their healthcare decisions.

3. Patients own their care plans. We need to help patients design their own care plans. Let them suggest ideas for how to follow the recommended plan of care. Set small and incremental goals with the patient for lifestyle modifications and celebrate the achievement of goals. In this way, nurse and patient become teammates working together.

4. Patients are their own best advocates. Teach patients the hows and whys of diabetic care, not just the "shoulds" and "musts." A patient who understands the basic physiology of diabetes is empowered to make informed decisions regarding his or her care plan and to adhere to that care plan.

5. Honesty is always the best policy. We are sometimes tempted to tell less than the "whole truth" in the name of cultural sensitivity. For example, I didn't like telling patients that dates have a high glycemic index or that fasting and binging during Ramadan can wreak havoc on their blood glucose. Withholding unpleasant information does not honor our patients or empower them to make wise decisions about their health."

You can read Mr. Hoffman’s article in its entirety here. Let us know what you think!

Last week, I had the pleasure of speaking with Susan Fletcher, EdD, MSN, Professor at Chamberlain College of Nursing. I had heard about the International Nursing Service Projects that she developed and was anxious to learn more about the experiences of the students who accompanied her to countries such as Brazil, Kenya, Bolivia, and Uganda.

Dr. Fletcher, whose background includes community health, emergency room, and school nursing, has been taking students on mission trips for over 12 years. I was in awe after hearing about the patients they cared for and how innovative the students were in their planning and interventions. They had to think “outside the box” and come up with clever ideas to improve the quality of life of the people. For example:

• In the slums of Fortaleza, the students saw a quadriplegic man who was regaining some use of his arms. His house was a brick area the size of a closet and he spent his life in bed. Family members would bring him food sporadically. The students noticed pinpoint red marks on his toes. After seeing him for 3 days in a row, they realized these marks were rat bites. The students thought to all take off their socks and put them on his feet to make it harder for the rats to get to his skin.
• Another patient, an elderly woman, was bed-bound with heel decubiti. There was nothing to use to elevate her feet and reduce the pressure. Students filled rubber gloves with water and placed them under her ankles.
• In Bolivia, students met a woman with a severely prolapsed rectum. They gave her pads and a belt to use for support.
• In Africa, where the prevalence of HIV infection remains high, there are many orphans. Students saw families of children taking care of children. In one case, an 11-year old girl was responsible for 3 younger brothers and sisters. She’d cook over an open fire dug into the ground. Students cared for burns, infections, and injuries in various stages of healing.
• Another patient, a man with TB and AIDS, was dying. Students would help the family clean him up. There was one student whom he consistently followed with his eyes. This student learned that “sometimes all you can do is ‘be there.’”

Dr. Fletcher discussed the transformative nature of these experiences. The students developed amazing clinical skills and enhanced their critical thinking ability. They learned to understand the differences in cultures and the problems related to the lack of healthcare facilities, caregivers, and medical supplies. Students became more comfortable using local resources and learned to “create from nothing.”

To be eligible to go on a mission trip, students must maintain a certain grade point average, complete an interview form, provide a letter of recommendation from clinical faculty, and have a one-on-one interview. Dr. Fletcher described the living conditions as “often sleeping on the floor, sometimes eating rice three times per day.” In Kenya, students woke at 6 am, walked 3 miles to the village and then spent all day in the clinic. On that trip, the students saw about 2,500 people in 2 weeks.

Difficulty of leaving… “touch and let go”
In Kenya, as the group was preparing to leave, a 2-year old orphan was squatting outside the clinic, crying. The students “couldn’t stand it; they wanted to take her home.” Dr. Fletcher reassured them  that someone had taken the time to dress this child and would be back for her. She told students, “These are the life circumstances here and we can’t rescue all the orphans.” Another important message, conveyed by one of the team members with the group, was “although you are upset, remember that because you were here, you’ve saved lives.”

Christine Kessler, MSN, CRNP of Walter Reed Army Hospital in Washington, D.C. delivered the opening address at Nursing2010 Symposium in Las Vegas on April 6. In her presentation titled "What Would Florence Do? Nursing Past, Present, and Future", Kessler reported on experts' projections about the severity of the nursing shortage over the next ten to fifteen years. Kessler also warned that we should not assume that the nursing shortage is over because many markets that are experiencing a downturn in the economy have little to no vacancies. The global trend is that the aging nursing workforce will result in many practicing nurses and nursing faculty retiring at high rates. Kessler made optimistic suggestions for increasing numbers in the profession, and generated keen interest from a group of nurses traveling from Jordan who shared their story about the nursing shortage.

I met two of the nurses from Jordan at the reception that evening and asked them if I could share their strory in my blog. Randa, a doctoral nurse and Alia, a baccalaureate nurse, were eager to discuss how there is a shortage of female nurses in their country. They explained that not only are fewer women entering the workforce than men, but that the women often leave the profession when they marry and have children. A factor that compounds the problem is that in this predominently Muslim nation, there are religious traditions that dictate who can deliver care based on gender. Randa said that "men an women are separate floors in the hospital" and "women only are permitted to care for other women and children". Therefore, these nurses are very concerned about the quality of care of women and children. Randa and Alia are encouraged by the government's action of setting quotas in nursing schools that require admission of a higher percentage of females. Still they are seeking additional ideas from Nursing2010 Symposium to take back to Jordan and disseminate in papers and presentations.

Like these Jordanian nurses, nurse exectives, nurse educators, and government officials around the globe must collaborate to find realistic solutions to the nursing shortage. To learn more about the global nursing shortage, go to the International Council of Nurses website at www.inc.ch and the World Health Organization website at www.who.int.

  Hi, I'm Karen Innocent, Director of Continuing Education and Conferences for Lippincott Williams & Wilkins. I'm very delighted to have this privilege and opportunity to share insights on continuing education and other issues related to nursing professional development with you through this blog.
  The topic for today is education and training on disaster preparedness. By now you have encountered more than a week of news reports about the earthquake in Haiti. This strikes close to home for my family. My husband grew up in Haiti, and has friends and family still living there. While most of the family has made contact, the communication problems has left the well-being of others unknown. Like many other compassionate observers, we wait anxiously for good news and are doing what we can to send help.
  As a nurse, the most troubling part about witnessing the aftermath of this disaster is seeing the uncoordinated rescue efforts and difficulties that had occurred with providing medical services and supplies to survivors. It is a shame that many people may die because of lack of access to basics such as antibiotics or clean drinking water. This underscores the importance of government and social agencies having a plan and trained professionals ready to respond to emergencies.
  Not many of us were aware of the possibility of an earthquake in Haiti, particularly because the Caribbean Islands are more concerned with the threat of hurricanes. Just as this unexpected tragedy occurred, there is a possibility that natural disasters or accidents of large proportions could occur anywhere. Nurses may be called upon to assist in these emergencies. While nurses are highly educated and have specialized skills, we all might want to brush up on emergency response because we never know when a disaster might hit our home towns.
   We'd like to know what you are doing in your community to prepare for disasters, and how your employer is training nurses on the leadership, organizational, and clinical skills needed to respond to emergencies.

Resources
   If you do not practice in emergency, trauma, or public health, it's likely that you could use a review. So I've collected a group of links to websites with reading materials on emergency preparedness that are designed for nurses, health professionals, and the general public.

Emergency Preparedness for Home Healthcare Nurses, Home Healthcare Nurse, January 2006: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=621933

Essential links: Emergency Preparedness, Home Healthcare Nurse, January 2006: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=621942

Ready. gov: http://www.ready.gov/

National Library of Medicine, Disaster Preparation and Recovery: http://www.nlm.nih.gov/medlineplus/disasterpreparationandrecovery.html

How Can I Help?

For those who want to volunteer, you may be interested in contacting the following organizations that are sending healthcare professionals to support the rescue and recovery efforts in Haiti.

Center for International Disaster Information: http://www.cidi.org/

United States Government: http://www.usaid.gov/locations/latin_america_caribbean/country/haiti/eq/dstechas.html

The American Red Cross: http://www.westred.org/Volunteer-Disaster.htm

If you think about the issues affecting world health today, it's easy to be overwhelmed. Just thinking about the challenges we're facing in the United States is overwhelming enough; so you can imagine the task the U.N. faced when it decided to address the health and welfare issues of the globe. 

The Millennium Development Goals developed by the U.N. include: end poverty and hunger; universal primary education for all persons; promote gender equality and empower women; reduce child mortality; improve maternal health; combat HIV/AIDS, malaria, and other major diseases; ensure environmental sustainability by providing safe drinking water and basic sanitation; and develop a global partnership that addresses special needs of developing countries, provides access to affordable essential drugs, and access to new information and communication technologies.

As nurses we are in a unique position to impact the health and welfare of people in our own back yard and around the globe. Several thought leaders from Sigma Theta Tau International, the Nightingale Initiative for Global Health, and the Florence Nightingale Museum believed in this ideal and created the 2010 International Year of the Nurse initiative. IY Nurse 2010 was developed to recognize the contributions of nurses globally and to engage nurses in the promotion of world health.

I challenge each of you to read about the U.N. MDG goals (http://un.org/millenniumgoals), and the efforts of IY Nurse 2010 (http://www.2010IYNurse.net ).  Look for opportunities where you work, in your neighborhood, and in your community where you can partner with other nurses and healthcare providers to affect change.  I look forward to hearing your ideas on how we can make a difference.