March is a great month to introduce you to LiveWiseMS.org!

MS-awareness-Month.pngMarch is Multiple Sclerosis (MS) Awareness Month and a great opportunity to spread the word about multiple sclerosis, a chronic, unpredictable autoimmune disease of the central nervous system (CNS), as well as to introduce you to a new patient resource site, LiveWiseMS.org.

According to the National MS Society, there are over 400,000 people in the U.S. and 2.3 million people worldwide living with multiple sclerosis. Chances are that you see patients with MS in your practice and probably know people personally who are affected by this disease.

MS causes a varying array of symptoms, including balance issues, muscle spasms, cognitive problems, pelvic floor disorders, depression, disability, and much, much more. No two cases of MS are exactly the same, and there is currently no cure.

Advances in research and treatment have been on the rise in the past few decades for MS. There is hope on the horizon for potential new therapies and treatment options that seek to repair, as well as prevent, damage to the CNS. Current disease-modifying therapies (DMTs) only work to hold off any worsening of the disease; they do not treat or repair any damage already done. More DMT options are being approved all the time, and current therapies have had some success for keeping MS at bay for as long as possible, and hopefully, in turn improving quality of life for patients. Fortunately, MS is not the disease it used to be, but there is still a lot of work that needs to be done.

13years.pngI am one of those 400,00 people in the U.S. living with multiple sclerosis, and I live my life daily trying to raise awareness, educate, and most importantly, support others living with this disease. Recently, my personal and professional lives met in what, I believe, to be a serendipitous moment, and I am fortunate to be part of an exciting new MS patient and caregiver resource site, LiveWiseMS.org.

LiveWiseMS.org emerged out of a partnership between Wolters Kluwer and the International Organization of MS Nurses (IOMSN), supported by an unrestricted educational grant from EMD Serono, Inc., a subsidiary of Merck KGaA. Working with nurses for over 15 years, I couldn’t be more excited to work with the nurses at the IOMSN and to be a part of this new site about a topic near and dear to my heart.

LiveWiseMS.org seeks to educate patients and care partners on an even higher level than typical patient education materials and to further empower them to live the best possible life with multiple sclerosis.  This unique site features condensed patient summaries of articles and information from trusted medical journals and textbooks. Patients can read these summaries, and if so desired to further educate themselves, they can continue on to read the original article. While focused on the MS patient, this site also serves as a great resource for those nurses and health care practitioners who may see patients with MS, but may not necessarily specialize in that particular area.

As I said, I couldn’t be more excited to be a part of LiveWiseMS.org. I share my story in the LiveWiseMS.org Blog section and interact with others through the Community section and social media pages such as Facebook and Twitter. My hope is to continue to support and empower the special population of #MSWarriors out there who seek to take back control over this disease that can make one feel so powerless.

I encourage you to visit LiveWiseMS.org today and to recommend it to your patients, as well as colleagues and friends. Knowledge is power so spread awareness about MS and gain valuable information through LiveWiseMS.org.
 
MORE RESOURCES
Nurse On the Move: Lori Mayer [Podcast]
For me, every month is Multiple Sclerosis (MS) Awareness Month – a patient’s perspective
Welcome to LiveWiseMS.org!

 

Posted: 3/3/2017 6:30:43 AM by Kim Fryling-Resare | with 3 comments

Categories: Diseases & Conditions Neurology


Celebrate IV Nurse Day

by Leslie Nikou
INSider Associate Managing Editor, Infusion Nurses Society
 
IV-Nurse_Logo.jpgInfusion therapy has evolved from an extreme measure used on only the most critically ill to a highly specialized mode of treatment used for 90 percent or more of all hospitalized patients. No longer confined to the hospital setting, infusion therapies are now delivered in alternative care sites, such as homes, skilled nursing facilities, and physicians’ offices.

Nursing involvement in the practice of infusion therapy has become a highly specialized practice. The role of the nurse in infusion therapy has changed a great deal over the past 50 years. Today’s infusion nurse is responsible for integrating the holistic principles of medicine and nursing, management, marketing, education, and performance improvement into the patient's plan of care. Clinical expertise is key. Nurses who specialize in infusion therapy, particularly, certified registered nurses of infusion (CRNI®s), are an integral part of health care teams that provide the correct dose of medication and keep patients safe from catheter-related bloodstream infections and other complications. CRNI®s are part of a global community of elite nurses  across multiple disciplines—including home care, pediatrics, oncology, and many more—who have demonstrated through certification that they are the most informed, and most highly qualified infusion nursing specialists. CRNI®s are continuously exposed to the newest advances and latest developments, technologies, and techniques in the infusion nursing specialty.
 
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On January 25, infusion nurses and other health care professionals will observe National IV Nurse Day. Proclaimed by then Massachusetts Congressman Ed Markey in 1980, the U.S. House of Representatives designated this day to honor and recognize the accomplishments of the nation's infusion nurse specialists each year, as well as the Infusion Nurses Society (INS). Markey called the specialty “a vital branch of our nation’s nursing profession.” INS CEO Mary Alexander, MA, RN, CRNI®, CAE, FAAN, stated that "INS and infusion therapy have come a long way in the last 50 years. Medical technology has changed dramatically and today our specialty looks very different. Celebrating IV Nurse Day gives us an opportunity to recognize the evolution of our specialty and the significant contributions that infusion nurses make in their patients' lives."

IV Nurse Day promotes the advancement of the specialty and recognizes decades of continuing education, advocacy, and professional development offered by the infusion nursing community. This year's theme, “It’s About Us. It’s About Infusion,” invites nurses everywhere to commemorate their commitment to their work and to their patients.

It is the perfect opportunity to increase recognition of the specialty, whether displaying IV Nurse Day posters around your medical practice, hosting a CRNI® educational event, or sporting some new IV Nurse Day gear. Order yours at www.jimcolemanstore.com/ins. Email photos of your IV Nurse Day event to [email protected], and we’ll share them in a future INSider. Happy celebrating!

For more information, visit http://www.ins1.org/IVNurseDay.
 
Leslie Nikou is responsible for managing the manuscript submission process for the Journal of Infusion Nursing from start to finish. She assists in manuscript selection and works with reviewers, authors, and publication staff to deliver polished, relevant content in each print issue. Leslie also oversees the editorial content of INS’ membership publication INSider, as well as other INS-related print and web materials. Prior to joining INS, Leslie served as a multimedia staff editor for a monthly RF/engineering publication. She is also a veteran news and promotions writer/producer, with more than 15 years’ experience in the Boston and Rhode Island television markets. Leslie is an avid photo enthusiast and loves to create scrapbooks detailing the milestones, adventures, holidays, and activities of life with her husband and two daughters. When she’s not busy attending soccer games or dance rehearsals, Leslie enjoys catching up with family and friends, movies, shopping, and planning her family’s next getaway. She can be reached at [email protected]

More Reading & Resources
Journal of Infusion Nursing
Infusion Nurses Society
For our nurse colleagues with the super I.V. skills
CE by specialty: Infusion

 
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Posted: 1/22/2018 8:52:59 AM by Kim Fryling-Resare | with 0 comments

Categories: Education & Career Infusion Nursing


A Million Reasons to Raise MS Awareness

I am one in a million. Literally. Or rather, I should say that I am one of the million.

Earlier this year, the National MS Society released a study that says nearly one million people in the United States are living with multiple sclerosis, which is more than double the original estimate of 400,000.*

One million! The number blows my mind! There are one million people in the United States living with MS and I am one of them. This disease is not as rare as once thought, and chances are, you know someone affected by multiple sclerosis.  

So who are we? Who are the million?

Technically speaking, we are likely to be between the ages of 20 and 50 when we are diagnosed and we are two to three times more likely to be female. We can be of any ethnic group but are more likely to be of northern European ancestry. We are most likely to live in areas of the earth that are farthest from the equator, and we join with our brothers and sisters in the rest of the world to make up 2.3 million people living with this disease worldwide.   

While we all have the diagnosis of MS in common, the disease presents so differently in all of us, and often is called the “snowflake disease” because it varies greatly from person to person. MS attacks and short circuits our central nervous systems leaving scars on our brains and spinal cords. We experience symptoms such as fatigue, spasticity, numbness, walking difficulties, vision problems, weakness, vertigo, bowel and bladder problems, pain, cognitive changes, mood swings, and depression…and those are just the tip of the iceberg. We can also experience sexual dysfunction, speech problems, difficulty swallowing, tremors, and headaches. Yes, living with MS is no picnic.  

However, I’m proud to say that there is a bright side to this disease and that is the people living with it. People living with MS are some of the most resilient and strong people that I have ever encountered! We live with the unpredictability of MS and we fight daily to have as normal of lives as possible. Yes, we will get knocked down often but we always find a way to get back up.

We’ve had to discover a new way of living that some don’t understand. There is a saying that has circulated around social media that states: “you don’t get MS until you get MS.” Of course, I think that probably can pertain to any chronic illness in that you don’t really understand it until you are actually trying to live with it.

I am proud to say though that MS does not hold us back. There are so many people living with MS doing extraordinary things with their lives. We each fight the disease in our own unique ways, but most importantly, we support each other in our individual battles. We are all striving to help one another and to overcome the obstacles that often accompany MS. We all understand and can relate to the bad days but we also revel in and celebrate our good ones. There is no greater celebration than to hear about one’s positive MRI results or check-ups! In that positive news, we are all victorious.
 
I think we’ve made great strides and important medical discoveries concerning multiple sclerosis in the past few decades. MS is definitely not the disease it used to be but we still have a long way to go. There are too many people affected by multiple sclerosis and there is still so much more that we need to learn. There is still no cure for MS, just band-aids in the form of disease-modifying therapies that aim to hold off progression.

March is MS Awareness Month and raising awareness is all a part of that greater journey on our path to a cure. I will keep sharing information, keep fighting, and I will never give up on hope. One day there will be a cure and I will join the 999,999 other people in the U.S. as we shout out and proclaim, “WE USED TO HAVE MS!”

*https://www.nationalmssociety.org/About-the-Society/MS-Prevalence
 
More Reading and Resources
 
For me, every month is Multiple Sclerosis (MS) Awareness Month – a patient’s perspective
 
March is a great month to introduce you to LiveWiseMS.org!
 
Nurse On the Move: Lori Mayer [Podcast]

 



WHO: State of the World's Nursing 2020

April 7th marked the celebration of World Health Day. This year, the World Health Organization (WHO), in concert with the International Council of Nurses and Nursing Now, released the State of the World’s Nursing 2020 report. This report comes at a critical time, for not only is 2020 the Year of the Nurse and Midwife, but we are also experiencing the global COVID-19 pandemic where we find nurses at the front and center of this fight. This report is a collaboration of over 170 countries for the purpose of bringing clarity on the state of the nursing profession today and where it will be headed through the next decade.

Nursing as a profession is extremely important in maintaining and protecting the health of the world’s population. According to the report, 59% of all healthcare professionals are nurses and the global workforce of nurses is currently around 28 million, of which 19.3 million are professional nurses, 6 million are associate professional nurses and the remainder not being classified (WHO, 2020). Although the global nursing shortage has declined from 6.6 million estimated in 2016 to around 6 million in 2018, the bottom line is that by 2030, there will be a need for 36 million nurses practicing across the globe to meet the needs of every individual on the planet.

The Report

The report recognizes the need for governments to invest in and address three areas in order to meet this growing need.
  1. Nursing education – Today an estimated $27.2 billion (USD) is spent on nursing education; however, this spend is not equitable across all countries. There needs to be a massive acceleration of nursing education in the areas of faculty, infrastructure, technology and student resources to address the changing models of care.
  2. Nursing jobs – At least 6 million new nursing jobs will need to be created by 2030, predominantly in areas where the shortage is projected to be worse, such as in low- and middle-income countries.
  3. Nursing leadership – An investment in nursing leadership is needed to ensure nurses have a seat at the table where health policy and practice decisions are made.
In addition, the report defines 10 sustainable development goals (SDG’s) for the foreseeable future. Highlights of these goals include funding for education and training, creation of 6 million additional jobs, insurance that nurses are practicing at the full scope of their practice and will continue to lead nurse-models of care to address social determinants of health and population health issues. The report also addresses the importance of a healthy workplace while improving the ability to collect vital information on the nursing workforce and the value nurses bring to healthcare.

Nursing: Our Value is Evident

One thing that has become inherently clear during the COVID-19 pandemic is the value of nurses in health care. Our contributions as care providers, patient advocates, researchers, and educators have never been more important than they are right now. The WHO’s State of the World’s Nursing 2020 provides a framework to build our profession to be strong, adaptable and innovative to meet the changing health needs of people and optimize their health. 
 
Reference:
World Health Organization (WHO). (2020). 2020. State of the World’s Nursing 2020. Retrieved from https://www.who.int/publications-detail/nursing-report-2020


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More Resources
Blog Blog Blog
U.S. Nurses in 2020: Who We Are and Where We Work Did you Choose Nursing or Did Nursing Choose You? Grateful for Innovation and Enthusiasm in Nursing
 

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COVID-19 – Not Your "Typical" ARDS

Over the past few months of managing patients with COVID-19, one thing has become abundantly clear, we are continually learning how to treat this infection and its complications. While the majority of people who contract COVID-19 have mild symptoms and recover, others need further intervention, including hospitalization. Patients with severe symptoms of COVID-19 often go on to develop acute hypoxemic respiratory failure and pneumonia and 17 to 29% of these patients develop adult respiratory distress syndrome (ARDS) (Auwaerter, 2020). Critical care clinicians have managed ARDS for years; however, COVID-19 ARDS does not act like the typical ARDS we’ve known, and we need to learn a new way to manage it.

“Typical” ARDS

ARDS was originally defined in 1994 by the American-European Consensus Conference, however, experts started to doubt the reliability and validity of the definition. In 2011, the European Society of Intensive Care Medicine, the American Thoracic Society and the Society of Critical Care Medicine developed the Berlin definition of ARDS which is based on degree of hypoxemia and four other variables, including chest radiographic severity, respiratory system compliance, positive end-expiratory pressure (PEEP) and corrected expired volume per minute (ARDS Task Force, 2012).

Let’s look at lung compliance

Lung compliance is very important when we are comparing traditional ARDS to COVID-19 ARDS. Lungs expand with inspiration and recoil with expiration. The ability of the lung to expand and recoil is compliance. Compliance can be divided into two types:
  • Static compliance
    • Compliance of the lungs when the lungs and the muscles of the lungs are at rest; pressure is the only variable
    • Think “lungs not moving”
  • Dynamic compliance
    • Compliance of the lungs during breathing
    • Think “lungs moving”
In patients with traditional ARDS, lung compliance is decreased. Interventions are based on preventing barotrauma and optimizing oxygenation, ventilation and perfusion with interventions such as low tidal volumes (6 mL/kg of predicted body weight), keeping the plateau pressure less than 30 mm H2O, avoiding oscillatory ventilation, prone positioning, and using higher levels of PEEP in patients with moderate or severe ARDS.

What’s different in patients with COVID-19? Lung compliance is high

Patients with COVID 19 often progress to acute hypoxemic respiratory failure and go on to develop ARDS, however, their ARDS is different. In COVID-19 patients, lung compliance is high; this is not what you see in a traditional ARDS patient (Gattinoni et. al., 2020). So, although the patients with COVID-19 meet the Berlin criteria for ARDS based on their degree of hypoxemia, they do not meet the compliance component.

In a recent anecdotal study conducted in Italy with 16 intubated and mechanically ventilated COVID-19 patients, the authors noted these patients appear to lose their ability to regulate lung perfusion and hypoxic vasoconstriction (Gattinoni et al., 2020). In the ventilated COVID-19 patients, oxygenation increased with high PEEP and prone positioning but, this was not due to alveolar recruitment which is normally seen in traditional ARDS. In these patients, oxygenation increased with high PEEP and prone positioning due to the redistribution of perfusion in response to pressure and gravitational forces. Higher PEEP was sometimes associated with hemodynamic instability. In addition, improvements due to proning were modest and took more time to appreciate. Their recommendation was to use gentler ventilation and the lowest possible PEEP (Gattinoni et al., 2020).

The findings of Gattinoni et al., are somewhat contradictory to other reports which suggest that COVID-19 ARDS with relatively high lung compliance benefit from 10 to 15 cm H2O of PEEP as compared to 5 cm H2O (Anesi, 2020).

Patients with COVID-19 may not tolerate traditional modes of ventilation such as volume-limited, low tidal volume ventilation. This is evident by their inability to achieve a plateau pressure that is less than or equal to 30 com H2O or they experience ventilator dyssynchrony. Using pressure-limited modes or volume targeted pressure-controlled ventilation may be required (Siegel & Hyzy, 2020). Clinicians around the world have recognized that weaning these patients from ventilatory support takes a long time. The weaning process is done slowly with small incremental changes in FiO2 and pressure support (PS) since decreasing ventilation support appears to hasten decompensation even in a patient that appears quite comfortable  on PS settings. These patients end up being on the ventilator for 2 weeks or more and may require tracheostomy placement.
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COVID-19 ARDS and Proning: Learning in Real Time

Impact to clinicians at the bedside

As clinicians at the bedside, we need to rely on the evidence and recommendations made available to us. We also need to accept that every day we will learn something new about managing COVID-19 patients. Everyone can agree that the strength of the evidence regarding many of the recommendations for managing COVID-19 are either best practice statements or weak recommendations, and it will take time and research to discover what truly works for these patients.  

Here are the current suggestions and recommendations from the Society of Critical Care Medicine (Alhazzani et al., 2020):
  • Start with supplemental oxygen if the SpO2 is less than 90% and consider it if the SpO2 is less than 92%.
  • In acute hypoxemic respiratory failure, target oxygen therapy to keep the SpO2 no higher than 96%.
  • Use high flow nasal cannula (HFNC) over conventional oxygen therapy in acute hypoxemic respiratory failure; if this is not available and the patient doesn’t need intubation, it is suggested to try noninvasive positive-pressure ventilation (NIPPV) with close monitoring.
For mechanically ventilated patients, the Society of Critical Care Medicine recommends the following:
  • Use a low tidal volume (Vt) ventilation strategy (Vt 4-8 mL/kg of predicted body weight).
  • Target plateau pressures of less than 30 cm H2O.
  • In those with moderate to severe ARDS, consider a higher PEEP strategy (greater than 10 cm H2O) and monitor closely for barotrauma.
  • For patients with hypoxemia despite optimized ventilation, consider using recruitment maneuvers but do not use staircase/incremental PEEP.

In conclusion, COVID-19 is not the “typical ARDS”

COVID-19 presents an opportunity for us to learn as we practice and research the optimal approach to managing these patients. It is important to recognize that the pathophysiology of COVID-19, high compliance ARDS, is different than traditional ARDS. It begs the question, should we call what we are seeing in clinical practice high compliance ARDS or should we call it severe acute hypoxemic respiratory failure secondary to COVID-19? Regardless, understanding what we are seeing clinically is not “typical ARDS” can help us fine-tune our approach to mechanically ventilated patients in order to prevent barotrauma and optimize oxygenation, ventilation, and perfusion.
 
References:
Alhazzani, W., Moller, M., Arabi, Y., Loeb, M., Gong, M., Fan, E.,…Rhodes, A., (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Critical Care Medicine. doi: 10.1097/CCM.0000000000004363

Anesi, G., 2020. Coronavirus disease 2019: Critical care issues. UpToDate. Updated March 2020.  

ARDS Definition Task Force, Ranieri V., Rubenfeld G., Thompson B., Ferguson N., Caldwell E., Fan, E., Camporota, L., & Slutsky A. (2012). Acute respiratory distress syndrome: the Berlin Definition. JAMA,.307(23). doi: 10.1001/jama.2012.5669.

Auwaerter, P. (2020). Coronavirus 2019: COVID-19. Johns Hopkins POC-IT Guide. Unbound Medicine. Updated April 2020.

Gattinoni, L., Coppola, S., Cressoni, M., Busana, M., and Chiumello, D. (2020). COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. ATS Journals. doi: https://doi.org/10.1164/rccm.202003-0817LE

Siegel, M., & Hyzy, R., (2020). Ventilator management strategies for adults with acute respiratory distress syndrome. UpToDate. Updated Mar 2020.


Patient Education in the Time of COVID-19

Like everyone else, our patients are full of questions during these uncertain times of COVID-19. A cough that one might otherwise ‘wait out’ now consumes our thoughts that maybe it’s COVID-19 and makes us question our health and our safety. Should I be wearing a mask? What kind of mask? Where can I go and who can I be with during this period of social distancing? What if I am sick? What if someone in my family is sick?

While we don’t have all the answers, we can reassure patients (and our family and friends who turn to us for guidance) with the facts and reputable resources. One challenge for those with a confirmed or suspected diagnosis of COVID-19 is providing care, whether for oneself or a loved one, at home. Please use and share this new infographic to guide patients and the public who are managing this illness at home. Reinforce the emergency warning signs and the advice to call before visiting any health care provider so clinicians can be prepared.


 
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Convalescent Plasma Therapy – Is it a Viable Treatment for COVID-19?

There are promising signs that the COVID-19 curve is beginning to flatten, however the pandemic is far from over. Scientists are working diligently to find a preventative vaccine and to prove the efficacy of many currently available drugs including antivirals, antimalarials, interleukin inhibitors, and protease inhibitors. Convalescent plasma (CP) is another therapeutic strategy that is under investigation to treat patients with severe COVID-19.

History

The use of convalescent blood products (CBP) to treat infectious diseases dates back to the late 1800’s when it was first used to treat diphtheria. Since that time, CBPs have been employed in the management of bacterial infections such as scarlet fever and pertussis (Marano et al., 2016). The therapeutic regimen was studied during the Spanish influenza pandemic of 1918-1920 and later explored as a remedy for the measles, Argentine hemorrhagic fever, influenza, chicken pox, cytomegalovirus, parvovirus B19, Ebola virus, Middle East Respiratory Syndrome coronavirus (MERS-CoV), H1N1 and H5N1 avian flus and severe acute respiratory infections (SARI) viruses (Marano et al., 2016). In 2009, H1N1 influenza A studies showed a reduction in mortality in those treated with convalescent plasma as well as a decrease in viral load within five days of symptom onset, without severe adverse events (Chen et al., 2020). CP is currently being studied to treat Ebola in several countries, however conclusive results are pending complete data collection. The majority of research in CP lack randomization, control subjects and large sample sizes, therefore efficacy has not been proven but instead considered empirical or anecdotal.

How does it work?

CP therapy is based on the concept of acquired passive immunity which is developed after a person receives immune system constituents, such as antibodies, from another person. This type of immunity provides immediate protection against the antigen, but is not long lasting. CP that is obtained from a patient who has survived a previous infection and developed humoral immunity against the pathogen contains a large amount of neutralizing antibodies which are able to remove the virus from the blood and tissues.

How is CP collected from the donor?

CP is obtained from the donor through apheresis, a process in which whole blood is removed from the donor via the veins and passed through a machine where the blood is separated by filtration or centrifuge into components such as platelets, plasma, leukocytes, lymphocytes and red blood cells. After separation, the desired blood component, in this case plasma, is removed and the remainder of the blood is reinfused back to the patient. The process takes a couple of hours, similar to a blood donation.

Who can donate?

Individuals who have been infected with SARS-CoV-2, the virus that causes COVID-19, and have recovered now have antibodies to the virus in their blood. Levels of antibodies will decrease over time after the initial illness, within three to four months, thus plasma from recently recovered patients may be most effective. The U.S. Food and Drug Administration (FDA) has issued guidelines on the administration and study of investigational convalescent plasma (FDA, 2020).

CP may be collected from individuals who meet the following criteria (FDA, 2020):
  • A diagnostic test (i.e. nasopharyngeal swab) at the time of illness OR a positive serological test for SARS-CoV-2 antibodies after recovery, if prior diagnostic testing was not performed
  • Either one of the following:
    • Complete resolution of symptoms at least 28 days prior to donation OR
    • Complete resolution of symptoms at least 14 days prior to donation AND negative results for COVID-19 from one or more nasopharyngeal swab specimens or by diagnostic blood test
  • Negative for human leukocyte antigen (HLA) antibodies
  • SARS-CoV-2 neutralizing antibody titers, if available
    • Recommended neutralizing antibody titers of at least 1:160; a titer of 1:80 may be considered if an alternative matched unit is not available
Donated CP should undergo routine laboratory testing:
  • Blood type: ABO and Rhesus D (RhD) grouping
  • Blood screening tests for HIV, HBV, HCV, syphilis and other locally transmitted infections

Who can receive CP?

Under the FDA (2020) guidelines, CP can only be administered: 1. Within the context of an FDA-approved clinical trial; 2. Under an expanded access protocol for patients with serious or immediately life-threatening COVID-19 disease who are not eligible or unable to participate in a clinical trial; and 3. As requested by a licensed physician for a single patient emergency.

In order to receive CP, patients must meet the following criteria (FDA, 2020):
  • Laboratory confirmed COVID-19
  • Severe or immediately life-threatening COVID-19:
    • Severe disease is defined as one or more of the following:
      • Shortness of breath (dyspnea)
      • Respiratory frequency ≥ 30/min
      • Oxygen saturation ≤ 93%
      • Partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300
      • Lung infiltrates > 50% within 24 to 48 hours
    • Life-threatening disease defined as one or more of the following:
      • Respiratory failure
      • Septic shock
      • Multiple organ dysfunction or failure
Nurses administering convalescent plasma should follow standard blood administration precautions outlined by their specific hospital protocols and monitor their patients closely for potential blood transfusion reactions.

Challenges?

Finding eligible donors and implementing testing to confirm adequate antibody levels in plasma are both logistical challenges. In addition to blood transfusion reactions, another potential complication of CP therapy is transmission of unknown pathogens. There is also an infection risk to laboratory personnel who process the plasma.

Will convalescent plasma play a key role in the treatment and recovery of severely ill COVID-19 patients? We don’t know and we will have to wait until researchers have enough data to properly analyze the efficacy. Do you have experience with convalescent plasma therapy? What have you seen in your clinical practice? Please share in the comments below.
References
Chen, L., Xiong, J., Bao, L., & Shi, Y. (2020). Convalescent plasma as a potential therapy for COVID-19. The Lancet. Retrieved from https://www.thelancet.com/article/S1473-3099(20)30141-9/fulltext

Kim, A.Y. & Gandhi, R.T. (2020). Coronavirus disease 2019 (COVID-19): Management in Adults. UpToDate. Retrieved from https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-management-in-adults

Marano, G., Vaglio, S., Pupella, S., Facco, G., Catalano, L., Liumbruno, G.M. & Grazzini, G. (2016). Convalescent plasma: new evidence for an old therapeutic tool? Blood Transfusion. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781783/

U.S. Food and Drug Administration (2020). Recommendations for Investigational COVID-19 Convalescent Plasma. Retrieved from https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma
 


Thinking about My Fellow Nurses During the COVID-19 Pandemic

I am not on the frontlines. Even the clinic where I work just once each month has been closed except for phone consults and medication refills. But I get it. You – on the frontlines, no matter the setting – are facing something more intense than you have ever faced, and you have faced some heavy stuff. I see my friends separating from their families. I see my mentors and orientees from my days in the unit spearheading their COVID-19 units. I see my husband returning to the ICU as a respiratory therapist working long shifts, much different from his Monday-Friday days in the clinic. For all these personal connections and for all of you, my heart is full of pride.

As I continue to work with our team here on NursingCenter to develop and bring you news, content and practice updates, my thoughts often return to my own days at the bedside in acute care and then quickly turn to all of you. Here are just a few of the things that regularly cross my mind.
 
  1. Caring for COVID-19 patients must take a team approach. We really are all in this together and all members of the healthcare team – physicians at every level, medical students, unit secretaries, respiratory therapists, certified nursing assistants, dietary, nutrition, pharmacy, physical therapists, laboratory, radiology, housekeeping, all support staff – have an important role. Are you finding this to be truer now?
  2. We are learning new things about transmission, incubation, spread, prevention, and treatment every day. Are you open to changes in practice, trying new things, and realizing that what works for one patient might not work for the next? How are you staying informed and up to date?
  3. Everyone is stressed, tired, and scared but only your fellow clinicians know the battles you are facing in your unit. Are you in a supportive environment? Are you practicing self-care? (Here’s some great advice from AJN’s Off the Charts blog, Practicing the ABCDEs of Self-Care in Pandemic Times.)
  4. Do you remember why you became a nurse? Please know that you are strong, and you are making a difference. Be proud of who you are and what you do.
  5. Are you celebrating the successes? Have you seen the photos on social media of whiteboards or bulletin boards keeping track of each extubation, each discharge, each save…?
  6. Do you have time to grieve and are you sharing in your grief? I worry about the mental toll this pandemic is taking on you all. Lean on each other and share your grief. Being a nurse can take an emotional toll on any given shift, let alone during a pandemic.
I am reading your stories and seeing your photos. Please keep sharing them. I couldn’t be prouder to be a nurse and I couldn’t be prouder of you.

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Contact Tracing: A Critical Component in Combatting COVID-19

Millions of Americans across the country have been practicing social distancing and following “shelter in place” orders, all united in an attempt to slow the spread of COVID-19. These efforts have not been in vain as many cities are experiencing a much-anticipated “flattening of the curve”. Leaders are now developing plans to loosen restrictions and re-open local economies, however exactly when that can happen is yet to be determined. The U.S. Federal Government has outlined a three-phased approach to Open Up America Again that should not commence until gating criteria has been met and state governments have the appropriate processes in place to ensure they are adequately prepared to prevent further transmission of the virus.

According to White House experts, before states begin to ease restrictions, the following gating criteria should be met: 1. Downward trend in influenza-like illnesses (ILI) as well as COVID-like cases reported within a 14-day period; 2. Downward trend in documented COVID-19 cases within a 14-day period or downward trend of positive tests (as a percent of total tests) within a 14-day period; and 3. Hospitals are capable of treating patients without crisis care in addition to a vigorous testing program for at-risk healthcare workers, including antibody testing (Whitehouse.gov, 2020). At the time of this writing, Governors are expected to secure adequate personal protective equipment (PPE) and other medical equipment to handle a significant increase in demand as well as a surge in intensive care unit capacity. Protecting individuals employed in critical industries, high-risk facilities, and mass transportation remains a priority. States should encourage sustained social distancing and advise people to wear face masks in public. Continued surveillance is imperative as any upswing in the number of new COVID-19 cases should trigger a reinstatement of earlier restrictions to mitigate a second wave of infection.

Contact Tracing

Two key processes that should be established before entering Phase One are testing and contact tracing. Testing has been a controversial issue due to a shortage of appropriate supplies and chemical reagents as well as a lack in reliability of the tests themselves. Once dependable testing is achieved, contact tracing and isolation should follow. While this methodology has not received as much attention in the media, the Federal Government has recommended that states establish safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID-19 positive individuals (Whitehouse.gov, 2020).

What is contact tracing and can it really help combat COVID-19?
Contact tracing or contact investigation is a public health approach that has been utilized to contain pathogens including tuberculosis, polio, Ebola virus, and the first 2003 severe acute respiratory syndrome (SARS) epidemic (Cates et al., 2016; Shuaib et al., 2017). The goal of contact tracing is to identify, treat and isolate current and potential cases of an infectious disease in order to control and prevent further human-to-human transmission. Countries such as South Korea, China, Singapore, Germany and New Zealand have employed contact tracing with varying degrees of success to hinder the spread of COVID-19 and re-open their economies.

Contact tracing involves the following steps (Centers for Disease Control and Prevention, 2020a; World Health Organization, 2017):
  1. Identification: Once an individual is confirmed to be infected with COVID-19 by way of a positive diagnostic test, request that they self-quarantine at home if they do not require hospitalization. Interview them about their activities and with whom they have been in close contact such as family, work colleagues, friends, etc.
  2. Notification:A public health worker will call every potential contact and notify them of their exposure. They will request that the contact isolate themselves at home and monitor for potential symptoms. Length of quarantine may vary based on the level of risk and duration of exposure.
  3. Isolation: Support the safe, sustainable and effective quarantine of contacts to prevent additional transmission.
  4. Follow-up: Conduct follow-up calls with all contacts to monitor for symptoms and to test for infection if symptoms do develop.
Challenges
As mentioned earlier, reliable testing is required in order for contact tracing to be effective. However, priority testing targets hospitalized patients, health care workers with symptoms, patients in long-term care facilities, the elderly, individuals with underlying conditions with symptoms, first responders with symptoms, and critical infrastructure workers with symptoms (CDC, 2020b). Not everyone with symptoms can be or will be tested at this time. In addition, a high percentage of COVID-19 positive individuals are asymptomatic and do not have access to testing. The inability to identify those carrying the virus will impede efforts to halt person-to-person transmission, leaving current shelter-in-place orders an unfortunate but critical necessity in many areas.

Contact tracing is labor and resource intensive, requiring a sizable army of knowledgeable individuals to coordinate and carry out this undertaking. Under the circumstances, it is not feasible to conduct contact tracing interviews with the hundreds of thousands of individuals with the disease, let alone their contacts. It may be achieved in smaller populations, as the infection curve flattens, and the number of new cases decreases. While several states have ramped up their hiring of contact tracers, there’s no guarantee that a tracer will be able to track down each and every contact. If they do reach them, those contacts may not comply with recommendations to self-quarantine. Digital tools such as mobile applications are being utilized in other countries to augment and automate this process. Here in the U.S. however, privacy is a major concern and until confidentiality can be protected, this technology will likely not be adopted.

Experts warn that a rush to re-open the economy could backfire and send us tumbling into a second-wave of infection. Finding the right balance between loosening restrictions and safeguarding those at greatest risk will be difficult. For now, a cautious, moderate approach is our best bet.
References
Cates, J., Trieu, L., Proops, D., Ahuja, S.D. (2016). Contact Investigations Around Mycobacterium tuberculosis Patients Without Positive Respiratory Culture. Journal of Public Health Management Practice. 22(3), 275-282. DOI: 10.1097/PHH.0000000000000261

Centers for Disease Control and Prevention (2020a). Contact Tracing: Get and keep America open: supporting states, tribes, localities, and territories. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/contact-tracing.html

Centers for Disease Control and Prevention (2020b). Priorities for testing patients with suspected COVID-19 infection. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/downloads/priority-testing-patients.pdf

Shuaib, F.M., Musa, P.F., Muhammad, A., Musa, E., Nyanti, S., Mkanda, P., Mahoney, F., Corkum, M., Durojaiye, M., Nganda, G.W., Sani, S.U., Dieng, B., Banda, R., and Ali Pate, M. (2017). Containment of Ebola and Polio in low resource settings using principles and practices of Emergency operations centers in public health. Journal of Public Health Management Practice. 23(1), 3 – 10. DOI: 10.1097/PHH.0000000000000447

Whitehouse.gov & Centers for Disease Control and Prevention (2020). Guidelines - Opening Up America Again. Retrieved from https://www.whitehouse.gov/openingamerica/#criteria

World Health Organization (2017). Contact Tracing. Retrieved from https://www.who.int/news-room/q-a-detail/contact-tracing

 



COVID-19 Guidance for your Specialty

We are all aware how quickly recommendations are changing. While the Centers for Disease Control and Prevention and the World Health Organization update their websites and clinician resources regularly, did you know that several specialty organizations have also issued specific guidance? Find links below for best practice recommendations, guidelines and more. In some instances, we’ve created related content in the form of summaries, podcasts, and blog posts.

The National Institute of Health (NIH) COVID-19 Treatment Guidelines can be accessed in full here. For recommendations related to specific specialties or patient populations, we’ve included links in the lists below.

Anesthesia

Critical Care

Related Content:  Guideline Summary | Podcast | Blog Related Content:  Blog

Infectious Disease

Oncology

Pediatrics

Pregnancy

Related Content:  Podcast | Blog

School Nurses

Surgery

Radiology

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Ten COVID-19 Pearls for Nurses

There are task force briefings and news updates multiple times each day, but what do nurses really need to know about COVID-19? Here are takeaways from some of our recent posts and podcasts…

1.  Limit the number of staff in COVID-19 patient rooms, especially when aerosol-generating procedures are occurring. (Read more in Coronavirus: Infection Prevention and Control).

2.  Consider the appropriateness of beginning and continuing CPR, discuss care goals with patients or their proxies and implement policies to help clinicians. (Read more in Cardiac arrest in patients with COVID-19: Reducing resuscitation risks.)

3.  After repositioning a patient to the prone position, wait 10 to 15 minutes to allow the patient to recover before considering a return to the supine position; consider increasing support of their oxygenation and hemodynamics temporarily. (Learn more by listening to COVID-19 ARDS and Proning: Learning in Real Time.) 

4.  In acute hypoxemic respiratory failure, target oxygen therapy to keep the SpO2 no higher than 96%. (Read more in COVID-19 – Not Your "Typical" ARDS.)

5.  Screen patients with severe COVID-19 for hyperinflammation markers such as increasing ferritin, decreasing platelet counts, or erythrocyte sedimentation rate, to distinguish patients that could benefit from immunosuppression therapy. (Read more in Is COVID-19 Fueled by a Cytokine Storm?)

6.  When implementing a team model approach to care, have supplemental staff report directly to an experienced med/surg or critical care nurse. (Learn more in Bringing Back the Team Approach: It’s Time for Alternative Staffing and Onboarding Models.)

7.  For adults with COVID-19 and shock, titrate vasoactive agents to target a MAP of 60-65 mmHg. (Learn more by viewing Managing Critically Ill Patients with COVID-19.)

8.  If possible, identify a nurse ‘superuser’ who has advanced understanding of the correct use of PPE and request that they be a resource and counselor for other staff. (Read more in Nurses and COVID-19: Into the Battle with All That We Have and All That We Lack.)

9.  When faced with a difficult decision, focus on what you can control; focus your attention on the patient in front of you at that moment. (Read more in Preserving Integrity and Staying Power as a Nurse in a Pandemic.)

10.  A positive test for another respiratory virus does not rule out COVID-19 and should not delay testing if there is a high suspicion of COVID-19. (Learn more by listening to Managing Critically Ill Patients with COVID-19.)

What pearls do you have to share? Now more than ever, it’s important to keep learning from each other.


Self-Care Tips for Nurses, from Nurses

This Year of the Nurse and Midwife is much more than we could have ever imagined. Today, May 1, 2020 kicks off Nurses Month and the American Nurses Association has organized the month into themes, with this first week focusing on self-care. Now more than ever, self-care for nurses can’t be emphasized enough as a high priority. Below you’ll find a round-up of advice from nurses.

Nutrition

“Take stock of your own dietary habits and make informed choices that promote optimal health.”
Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN 
Healthy Eating: Food for Thought

“Always eat some kind of breakfast, preferably protein and low carb (you’ll avoid that mid-morning slump. My go-tos: hard-boiled egg, peanut butter on a piece of whole wheat bread, a scoop of cottage cheese with some fruit.)”
Shawn Kennedy, MA, RN, FAAN
Work-Life Balance: The Elusive Golden Ring

Sleep

“Don’t check email or social media or use a computer or tablet before bed (I know – it’s hard). Give yourself at least an hour to wind down before sleep.”
Shawn Kennedy, MA, RN, FAAN
Work-Life Balance: The Elusive Golden Ring

“Try to get 7 hours of sleep each night.”
Shawn Kennedy, MA, RN, FAAN
Work-Life Balance: The Elusive Golden Ring

Exercise

“…just how do you fit exercise into an already busy, exhausting schedule? My brother, an exercise physiologist says, that there are plenty of 15-minute opportunities in a day; 96 to be exact, so there’s no reason why you can’t be intentional about reserving at least one or two of them for yourself. It seems pretty achievable when you look at it that way, doesn’t it?”
Collette Bishop Hendler, RN, MS, MA, CIC
Hit the road…or the mat

“Move -- Twenty minutes a day of running, walking, cycling, etc., will help to dissipate the effects of stress. Regular exercise improves cardiovascular function, produces endorphins in the brain that result in improved mood, strengthens muscles, and improves tone.”
Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Stress: The Elephant in Your Career

Spiritual well-being

“How are you caring for your spirit? Do you engage in spiritual renewal? A renewal experience is doing something you enjoy like a walk in nature or a hobby. I find renewal exercising with friends and playing the piano. For nurses of faith, attending a gathering in your worship tradition can be (should be!) a renewal experience.”
Kathy Schoonover-Shoffner, PhD, RN
Are You Soaring Spiritually?

Yoga

“To increase strength, endurance, and body tone, take 15 minutes to practice yoga. You don’t need to venture away from home to establish a regular practice. All you need is a yoga mat and some floor space to get started. There are online videos and apps to guide you through your practice. Yoga practice consists of different postures, referred to as asanas. During a practice session, you’ll use your breath to help guide you through the different postures, and you’ll focus on using core strength (referred to as mula bandha) to move energy through your body.”
Collette Bishop Hendler, RN, MS, MA, CIC
Hit the road…or the mat

Laughter

“Laugh – Humor provides release and helps put things in perspective. Most importantly, laugh at yourself even at your best efforts.”
Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Stress: The Elephant in Your Career

Meditation & Imagery

“Your imagination can save you from revealing negativity, disapproval or even fear. Use fantasy to get yourself through difficult situations.”
Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Stress: The Elephant in Your Career

Music

“Sing in the privacy of your car or the shower. Sing uplifting and inspirational songs that emphasize self-empowerment. Or download … songs on your phone and sing along or listen on your break. Music reorganizes the brain and the messages sung are uniquely remembered.”
Gloria F. Donnelly, Ph.D., RN, FAAN, FCPP
Stress: The Elephant in Your Career

“Listen to music on the way home from work. I find it helps me make that transition and I arrive home more relaxed.”
Shawn Kennedy, MA, RN, FAAN
Work-Life Balance: The Elusive Golden Ring

Personal Health

“Nurses may not follow recommended preventive and screening practices for a multitude of reasons. Shift work, long hours, limited paid time off, and an unpredictable schedule make it difficult to schedule appointments. As caregivers to the core, the needs and activities of our children, spouses, and parents become our focus during our non-working hours, and our own health care needs tend to take a backseat. But, in order to take care of our patients, as well as our families, we must make our own health a priority.”
Vicki Cantor, RN, BSN, MA
Protect yourself so you can continue to protect others




Giving Meaning to Resilience during COVID-19

There has been no test of resilience as there is happening right now with the COVID-19 pandemic. Even before this time, depression, burnout, compassion fatigue, and secondary traumatic stress among health care professionals have been researched and are being addressed by ongoing initiatives, such as Healthy Nurse/Healthy Nation and the Action Collaborative on Clinician Well-Being and Resilience. Resilience is often identified as an attribute to describe clinicians who face challenges time and time again, but are we doing a disservice by setting the expectation that we must be willing and strong enough to keep facing adversity? In an editorial last year, Linda Laskowski-Jones, editor-in-chief of Nursing2020 wrote, “A singular focus on resilience as the fix could portray the clinician who is not resilient enough as the problem.”

Are there really strategies to promote resilience or is this a buzzword being used to mask underlying issues? I’d like to think that we are resilient, but there comes a point when we must be okay with asserting our need for support and resources to achieve and maintain our resilience. 

The 7 Cs of Resilience

In his 2011 book, Parent’s Guide to Building Resilience in Children and Teens: Giving Your Child Roots and Wings, Kenneth R. Ginsburg MD MSEd FAAP identifies 7 Cs of resilience to help children and adolescents cope with illness. Can we apply these strategies for resilience in other situations? Let’s break down these 7 Cs and their relevance for clinicians facing COVID-19.

Control
While this COVID-19 enemy has shut down whole countries and many of us feel a lack of control, there are some things that are within our control; however, we can only control ourselves and what we do. Though we can’t control the actions of others, we do have the responsibility as nurses to inform and educate. And when we don’t agree with the actions of others, we can control our reactions to it; this is important for our own well-being.
 
Competence
We are very familiar with the concept of competence. In fact, most of us must demonstrate ongoing competence for our licensure and jobs. This is no different. As we learn more about this virus, we have to share our experiences and base our care on the evidence as it unfolds. Staying updated on the disease process and management recommendations is essential.
 
Coping
We teach coping skills to our patients all the time. It’s time for us to recognize how we cope best and to make sure we take the time to cope. This is a stress like none of us have ever experienced. Think about how you cope best – talking about your experiences, exercising, meditation, journaling?
 
Confidence
Confidence brings two approaches to mind:
  1. Be confident that we will get through this. Our new “normal” will likely be different, but we will get through this.
  2. Build confidence among your teammates, whether by praising or celebrating successes, or providing encouragement. It can go a long way.
 
Connection
For many patients and families, you are the connection. As visitors are restricted in many facilities, you are keeping people updated and in touch. Also, our own connections with family and friends are much different now as we rely more on technology and less on touch. Make the effort to keep up with those connections.
 
Character
The public is certainly getting a glimpse into the character of those on the frontlines of care. Be proud of the work you are doing. Your integrity and your commitment to care exemplify the nursing profession.  
 
Contribution  
The contributions you are making are immeasurable. Your work, whether on the frontlines on the COVID-19 floors, making administrative decisions, or supporting patients in the community, is making a difference.

Long-term resilience

There is no way to predict how resilient we will be over the long-term. To handle immediate stressors, stay focused and remember these 7 Cs, support one another, and take breaks – physical and mental – as needed. For longer term resilience, seek out and take advantage of resources to help you prioritize self-care. Your experiences now will be transformative; look for ways to incorporate them to add to the meaning of your life and your work. We are facing a harsh reality right now that will lead to growth and yes, I believe, resilience.  
References:
Ginsburg, K. (2011). Building Resilience in Children and Teens: Giving Kids Roots and Wings. Illinois: American Academy of Pediatrics.

Laskowski-Jones, L. (2019). Clinician burnout and resilience. Nursing2019, 49(11).
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Building a Healthier America: Transforming Health and Healthcare During and After a Pandemic


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This blog is part of the series, Nurses on Boards: Building a Healthier America. Wolters Kluwer is a Founding Strategic Partner of the Nurses on Boards Coalition.
 
Now more than ever, the public has become increasingly aware of the importance of health and the issues surrounding healthcare based on the impact of COVID-19. Having the nursing perspective represented on all types of boards is imperative. Your current or future governance roles will require reflecting on what has transpired over the past few months, considering the impact on patients, families, businesses and communities, and reimagining health, healthcare and healthcare systems.

As nurse leaders advise and inform others about real issues related to health and health system improvements, we will have to engage in reflection. David Schon, noted  philosopher, describes reflection-in-action as “reflecting on the situation while changes can still be made to affect the outcome, rather than waiting until a later time to reflect on how things could be differently in the future.”

Here are a few tips to on how to engage in reflection when serving on a board during and after COVID-19:

Body
  • body.jpgAsk others why they do things.
  • Pay attention to what is going on around you.
Mind
  • mind.jpgKeep informed; with the rapid influx of new information, be sure to take time to read about COVID-19 and related topics/issues.
  • Consider systems and processes before COVID-19, now, and what they might become.
Heart
  • red-heart.jpgPay attention to your emotions – what prompts them, and how you deal with negative ones.
  • Ask yourself, based on your skills, talents, connections, influence, and passion, what you might do to improve or enhance health and healthcare delivery.

According to Carla D. Sanderson, PhD, RN, Chamberlain University Provost:
 
“Boardsmanship is a privilege that comes with significant responsibility every day to be mindful of the mission and opportunities for the institutions and organizations we serve. At this historical moment in time, we have profound responsibility as board members to the institutions we serve,  to think well and lead courageously.   
 
This is the moment of our time as nursing leaders serving on boards. The future of health and healthcare in the US is at stake. The Future of Nursing 2030 was top of mind for our profession before COVID-19.  Because of the global pandemic, we have more clarity and deeper meaning to our opportunity for “building a healthier America.” How do we prioritize this moment and take hold of the opportunity? 
 
Nursing is stepping up in this moment. Yet we will not be able to reimagine health and healthcare during short breaks in days filled with surge planning, resource allocation and a host of other problem-solving activities. The best thinking happens in deliberate reflection.   
 
We must stand back even as we step up. We need to withdraw. Find solitude in a solitary place. Present ourselves silence. From an insular place of solitude, we are positioned to be open-minded in our reflection and consideration of important questions. 
 
Here are a few tips on reflection: 
  1. Prepare for reflection just like we prepare for action. Plan the time well. Put a pause on all distractions and embrace the opportunity to just think.  
  2. Make a list of three questions unique to your institution or organization, such as: 
    • What big ideas were in a parking lot before COVID-19 that we’ve now figured out because of COVID-19?   
    • What is our institution’s new reality because of COVID-19? 
    • Despite COVID-19, what must remain true in our mission, identity, and purpose?
  3. Journal your reflections (at least jot them down), ponder them daily and give them expression as opportunities come along. 
Nursing’s future and the health of our nation will be reformed through the collective wisdom and actions of its leaders.” 
References:
Schon, D.A. (1983). The Reflective Practitioner, Basic Books, New York.
Nurses on Boards Coalition Resources retrieved from https://www.nursesonboardscoalition.org/resources/


Honoring Unsung Heroes: Home Health Nurses

It’s 6:00 am and Daisy rushes out the door to see her first patient of the morning. Short in stature, yet never shy in her approach, her energy is limitless. A typical day for Daisy will involve seeing a variety of patients from the elderly gentleman recovering from major gastrointestinal surgery to a woman battling cancer and entering the palliative stage of care. With bright eyes and a warm smile, she treats each individual as if they were family.

During the COVID-19 pandemic, nurses working in hospitals have garnered tremendous support and attention. But there are other unrecognized heroes out there continuing their critical work to ensure that their patients are staying safe. Home health nurses are one example of those who are making a difference in the fight against COVID-19.

I had an opportunity to speak with my friend and fellow nurse, Daisy Gonzalez, MSN, RN who recently went back to work part-time in home health.

1. Daisy, can you tell me a little bit about your background and why you decided to go into nursing?
 
I always had a nurturing personality and enjoyed taking care of others. I have a deep sense of empathy and a desire to help. Nursing manifests that part of me. I grew up in Philadelphia and recall seeing a commercial depicting a home health nurse driving through a severe storm to see her patient. It was at that moment I decided I wanted to be a nurse just like her. After graduating from nursing school in 2000, I went on to become board-certified as a Family Nurse Practitioner in 2006. My husband’s work moved us to Denver, Colorado where we settled and continued to grow our family. I resumed work in an acute care setting until I decided to take a leave to care for my young children.
 
2. What led you down the Home Health Nursing path?
 
Almost 2 years ago, I was driving and saw a sign for BAYADA Home Health Care, the same agency that advertised the “nurse in the storm” many years ago. I said to myself, "Could that really be the same company?" I had been wanting to get back into nursing, and after taking ten years off, it was time. I had no idea what the world of home health would be like as all my previous work had been in the hospital setting. A friend encouraged me to “take a leap and all will fall into place.” I took a chance and interviewed for a position. A few days later I had a job! Working in home health is extremely flexible which was very important for me. I cannot express how meaningful and purposeful my time in home health and our patient population has been.
 
Daisy.png3. Can you describe a typical day as a home health nurse?
 
Nurses who work full-time in home health can see between six and eight patients each day. I’m currently working a PRN schedule and can see between three and five patients a day when the census is high. These visits are located throughout the metro area. My days have had to be a bit more flexible due to my children’s schedules and I am able to scatter my visits to accommodate for that as a PRN nurse. I may see a patient newly discharged from the hospital and will spend a great deal of time completing the history and physical exam as well as medication reconciliation. Another patient may experience an emergency at home and I will need to manage that as best I can. Working in the field, you never know what to expect. It’s not a controlled, sterile environment… rather unpredictable. And patients are being discharged from the hospital earlier, with higher acuity and complexity. While the work we do is by no means easy, and at times exhausting with all of the added pressures, it has the enormous potential to make a positive difference to everyone we encounter. We are entering their lives in the most vulnerable of times…the amount of humanity there is beyond measure. 
 
4. Can you describe the range of diseases and diagnoses you encounter?
 
I see a wide range of patients, many of which are elderly with several comorbidities including heart failure, diabetes and renal failure. I’ll take care of patients recovering from surgery, actively fighting cancer, and managing chronic conditions such as multiple sclerosis and Parkinson’s. I will assist patients transitioning to palliative care, enhancing their quality of life, advocating for them and helping to provide the resources needed to make decisions.
  


5. How has the COVID-19 pandemic affected your work?
 
I feel an even bigger commitment to my profession during this time. Our patients need us more than ever as they will likely have less access to their primary care providers. Our goal really is to avoid non-emergent hospital encounters and readmissions. I worry about the potential exposure my patients may have to COVID-19. Who is entering their home and are family members visiting them? I am fearful for how I am being exposed. For my family especially, the fear is compounded as both my husband and I are in direct contact with patients every day. However, I have never once thought I would stop. And my patients are fearful as well. They worry about me coming into their home, if I have been exposed to the virus, how many patients I have seen that day. I try to be as diligent as possible to keep myself, my family and patients safe. We have very specific protocols for sanitizing everything between patient visits, vigilant hand hygiene practice, glove and mask use. Home healthcare providers are well-versed in infection control procedures and we have routines for each task to minimize contamination and the spread of coronavirus. I know personal protective equipment (PPE) has been an issue for many frontline workers and so far, we have had the PPE we need to properly and safely take care of our patients. As more people recover from COVID-19 and are discharged from the hospital, we will begin to see more of these patients at home as they will likely still require frequent assessments and a variety of therapies for their deconditioned states.
 
6. What specific skills are needed to work in home health?
 
First of all, you need strong assessment skills. You are the “eyes and ears” for the multidisciplinary team. Collaboration, communication, and teamwork are key. You need strong time management and organizational skills. You are also providing so much teaching on disease processes, on how to help these clients manage their own care all while maintaining a holistic approach to each individuals’ needs. In addition to the direct patient care, much of what I do involves case management, following up with patients, families, or their providers, coordinating resources, identifying barriers and constantly managing every aspect of care. I believe you also need an overall sense of “humanity” and people skills. Your patients are vulnerable, they need to trust you as you are entering their personal space. You need to make strong connections. For me, I establish really close bonds with my patients, they become like family and it is hard to pull myself away at times.
 
7. What do you enjoy most about your job?
 
I love that my job is purposeful, I’m doing something for others that is beautiful and rewarding. I have to say that I get as much out of it as my patients do. Patients tell me I’m meaningful to them and they allow me to enter their lives. I enjoy the “human connection.” I also really enjoy being part of a team. I work closely with a wonderful group of people – fellow nurses, physical, occupational, and speech therapists, social workers and our amazing home health aides. Ordinary tasks that we often take for granted can be obstacles for many patients. We have to work together and “think outside of the box.” It is a wonderful feeling seeing your patients recover and progress – whether it’s helping them take their first steps or helping them take their first shower in days, weeks, or months, every moment is special and important. Being able to “restore a sense of dignity” to my patients is incredible.
 
8. What are the biggest challenges that you face? 
 
Documentation is a big challenge. I feel that we are spending more time these days documenting rather than with our patients. After seeing patients and now having to home-school my children, I often spend several hours at night, carefully documenting the care I provided. For many nurses working full-time, this is really the most time-consuming part of their day.
 
9. Do you have any words of advice for nurses interested in home healthcare?
 
I would say “try it!” It is one of the most rewarding specialties. For new graduate nurses, hospital experience is likely necessary to help strengthen your assessment skills first. But after gaining some experience, home health puts it all together; everything you learned throughout your nursing education about holistic care of a patient is applied here. You assess every aspect of a patient’s life, their home environment, their family dynamics, the whole picture.
 
One of Daisy’s patients stated “… your compassion and professionalism are top notch. You are wonderful and mean so much to me and my recovery.” Daisy has been honored with BAYADA’s Hero Award for the first quarter of 2020. I want to thank Daisy and all the visiting nurses across the country who put aside their personal safety to ensure their patients continue to receive quality care in their homes. They are truly on the front line of the pandemic. I can’t wait for the day when I can give Daisy a big hug once again.
 
More Reading and Resources
Utilization of a Visit-Based Sepsis Assessment to Prevent Hospital Readmissions
A Day in the Life of a Home Care Nurse Practitioner
Personal Protective Equipment Removal: Preventing Self-Contamination
 
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Honoring Unsung Heroes: School-Based Nurse Practitioners

Schools across the nation have been closed for weeks and many are questioning whether or not they will re-open. We don’t have answers today as the COVID-19 pandemic rages on and experts predict we will experience another wave this fall. Millions of families who are juggling work while home-schooling their restless children have found a renewed appreciation for teachers. Yet there is another group of individuals, who often go unrecognized, quietly working behind the scenes caring for our young ones. They are the nurse practitioners who work in school-based clinics, filling a critical societal gap in primary care. While school may be on hold right now, these clinicians work tirelessly throughout the year ensuring every student’s healthcare needs are met.

I had an opportunity to speak with my friend and fellow nurse, Sharon Kobak, ARNP, MSN, RN who is a primary care nurse practitioner at one of Denver Health’s School-based Health Centers (SBHC), a large network of health clinics located within the Denver Public School campuses that serve over 13,000 students each year at 18 locations.

1. Sharon, can you tell me a little bit about your background and why you decided to go into nursing?
 
I grew up in Nicaragua and come from a large family of nurses on my mom’s side - my mom is a retired nurse and my aunts are nurses as well. My mom was a pediatric nurse at the local children’s hospital and that was my first introduction. I would visit the children’s hospital with my mom and really admired the work that she did. It was always in the back of my mind that I would go into medicine to be a physician or nurse. When we moved to the U.S., I worked as a pharmacy technician and my parents tried to convince me to become a pharmacist, but I wanted to be more hands-on, so I decided to go into nursing. I attended the University of South Florida for my bachelor’s degree and began my career in pediatrics. While working full-time I went back to school for my nurse practitioner degree specializing in Family Practice.
 
2. You have an advanced nurse practitioner degree and decided to work in a school-based clinic. What led you down that path?
 
When my husband and I moved to Norfolk, Virginia, I worked in the hospital on an adult gastroenterology unit for 10 years. My husband’s work brought us back to Colorado where he did his residency training and we reconnected with an old friend, one of the physicians here in Denver who was in charge of the school-based clinics at the time. I had no idea we had health services in the school system. I wanted to return to pediatrics once we moved back, as I love adolescent medicine. After speaking with our friend at length and providing him with my background and training, I was offered a school-based position as a primary care nurse practitioner.
 
Sharon-Kobak-IMG_3358-(1).JPG3. Can you describe a typical day working at the clinic?
 
A nurse practitioner and a medical assistant will usually staff the student health clinic, and as a provider in this role, you need to be very independent. Our goal is to see 12-14 patients each day; I have seen up to 15 kids on a busy clinic day. Students can see us autonomously after age 11 if a parent signs a consent form at the beginning of the school year. Once consented, the students can be seen for the entire academic year. They are in charge of their health and if they aren’t feeling well, they can make an appointment with me. Similar to a pediatric clinic, I’ll see kids that are sick with upper respiratory infections, migraines, asthma, or various diabetic issues. I do regular physicals and sports physicals as well. We try to see every single student that is consented. We perform risk assessments using personal tablet devices that are loaded with questionnaires to assess mental health, sexual health, safety, diet, and nutrition as well as drug and alcohol use. The software analyzes the answers and will red flag items such as elevated body mass index (BMI), sleep issues, depression, anxiety, substance use and high risk sexual behaviors. That gives us an idea as to where we need to focus our efforts for that student. If they are high risk for depression or anxiety, we have a mental health therapist available at the clinic. All information is confidential, it is a safe environment. We ensure they feel comfortable talking about their issues.

We also have an opportunity to educate them about things like sexual health. That part is very important, because when kids visit their pediatric provider in a clinic with their parents, it’s a different environment. In SBHC most patients are being seen on their own and can feel more comfortable talking about these issues with that provider - not feeling ashamed or fearful that they will get into trouble.
 
I enjoy seeing teens become adults, taking charge of their health and being responsible. But it’s scary as a parent; I also have a teenager and I would want my teenager to be comfortable talking with someone, an adult that is going to give them the right information and the right tools to hopefully make the right decisions.
 
We can also be a student’s medical home. We see kids with insurance and kids without insurance. We really want to reach those kids without insurance as we may be the only health care they have access to. If they are sick, we have an outlet pharmacy with medications – antibiotics, topicals, inhalers, oral contraceptives and other birth control methods for confidential visits. I am able to prescribe and dispense medications, if they are available. We spend a lot of time with these kids, often more than they would with their personal primary care provider.
 


4. How do you work/collaborate with other health care providers on issues that do arise with students?
 
It depends on which health care providers. Confidential issues are never shared and are documented in a safe place. We do use EPIC, a computer system that is connected with local hospitals in which we can share information on mutual patients. I also have relationships with specialty clinics. For example, if the child is seeing a gastroenterologist for a chronic GI condition or a neurologists for migraine headaches, I would talk to the patient to make sure it is ok for me to share that information.
 
5. The COVID-19 pandemic has obviously closed schools across the country. If schools re-open this fall, COVID-19 will certainly have a tremendous impact. How do you foresee the virus affecting your work and the clinic?
 
Our school-based clinics have adapted to conduct telehealth. Three clinics have remained open for students that need well child care visits, medications and immunizations during the pandemic. Mental health services are still available for kids that have anxiety or other mental health issues, such as students that may not have transitioned well to not being able to go to school or see their friends.
 
We don’t know what the fall will look like – how the schools will reopen - we are watching it closely. I think telehealth will be utilized to a greater extent at that time and nurse practitioners will be employed more in that format, especially for kids that have no other source of healthcare. We will certainly modify things at our physical locations, similar to doctors’ offices - use masks, clean rooms before and after each patient and limit the number of students in the clinic. We’ll plan to have our clinics open to service our students in the fall.
 
6. What specific skills are needed by nurses to work in a school-based clinic?
 
For school-based clinics, you need to be a medical provider – nurses should have an advanced degree such as a pediatric or family nurse practitioner. You need to be a team player as we collaborate with mental health therapists, psychiatrists, dental hygienists, dentists, and health educators. We also have supervising physicians we can consult at any time. You need to be comfortable working independently and have a couple of years of experience under your belt.
 
7. What do you enjoy most about your job?
 
This is my dream job. I love working with adolescents and watching these teens transform into young adults, and witnessing their successes, making the right choices, and making it through school. Seeing them go from 8th or 9th grade to graduation is very special to me.
 
8. What are the biggest challenges that you face? 
 
Sometimes we get overwhelmed with students who do not have insurance, trying to navigate them to get the help that they need with chronic illnesses and giving them the support that they may not receive at home from their families. There may be dysfunctional family dynamics and their only resource is school. That’s their safety network. How do we help them get to where they need to be mentally and physically? How do we support them with all their challenges at home? I often feel that I am putting in more work to help them succeed and that’s very difficult for me.
 
9. Do you have any advice for nurse practitioners interested in this specialty?
 
It’s challenging, but it’s very rewarding at the same time. You have to love it, to love what you do, love working with that population. You need to be aware of the challenges… the plan you have for that student may not work all the time.
 
Thank you, Sharon! I’ve learned a great deal during our conversation. I also have two teenagers at home and knowing they have this invaluable resource, that can be accessed in full confidentiality, gives me great solace. Our children, whose lives shifted so abruptly from their normal routines to unstructured and somewhat inconsistent homeschooling, are subject to great anxiety and other adverse effects during this time. For children who do not have strong support systems at home, who lack health care insurance, whose parents are unemployed due to the mandatory lockdowns, and who rely on our public schools for nutritious meals, the impact will be even more profound. It’s reassuring to know that student health care services have not been suspended completely and that those high-risk students and their families are still able to attain necessary mental and physical care during the pandemic.
 
A note about Denver Health. Denver Health’s School-based Health Centers form a large network of clinics located within Denver Public School (DPS) campuses that serve any DPS student as well as children enrolled in DPS-affiliated Early Childhood Education programs at no charge to families. The clinics provide a range of services including:
  • Well child/well adolescent checks that meet the requirements of school, sports, camp and employment physicals
  • Prescriptions and medications and routine lab tests
  • Care for chronic conditions such as asthma and depression
  • Care for acute injury and illness
  • Reproductive health services including pregnancy testing and birth control evaluation, dispensing and management
  • Testing and treatment of sexually transmitted infections
  • Individual, group and family mental health counseling
  • Dental screenings, routine cleanings and preventive health (at select locations)
  • Parent and child education
 
Many thanks to all the primary care and community health providers within our school systems across the country who give so selflessly to a very vulnerable segment of our population.
 
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Unimaginable Challenges and Changing Care Models

We’re in the most unbelievable of times with COVID-19, where the healthcare world has been turned upside down. COVID-19 is making extraordinary demands on nurses and other healthcare workers, as they work tirelessly and at great personal risk to deal with this crisis. Their resilience shows as they toil with limited or nonexistent resources, pulling extended shifts and putting their self-care on the back burner.

This crisis will forever change care models and when it’s over, it’s inevitable that the nursing profession (and other healthcare fields) may face attrition due to burnout. Will that impact more experienced nurses or newer nurses in greater numbers?

Our recent independent health survey, Next-Generation Nurses: Empowered + Engaged, was taken prior to this health crisis, but the results shed light on how the next generation of nurses see their roles in the rapidly changing healthcare system. The results are part of a broader survey that Wolters Kluwer conducted to understand how various industry stakeholders and consumers view the state of healthcare in America.

For this report in the series, we examined the responses of nurses with less than 10 years of practice experience (called next-generation nurses) who made up 35% of the total survey base. We wanted to explore just how equipped they feel to render the highest quality care and where they’d like to see things go, given the US healthcare picture.

How They See the Healthcare World: Proponents of Value

We know that nursing is evolving based on the changing healthcare paradigm from disease to wellness and the shift to care based on evidence that improves outcomes. This shift to a value-based care model has been shown to improve practice, enhance patient outcomes and optimize healthcare reimbursements—and that’s a trend that next-generation nurses embrace. These nurses believe these care models are yielding results, with 71% reporting they are having a positive impact on treatment.

With respect to having the tools and resources they need to stay current on care, 78% of respondents say they do. They add that most healthcare facilities are doing a good job in identifying areas where they can reduce practice variations. Even so, they’re pragmatic: they recognize the practice gaps because 82% acknowledge that care hand-offs between various healthcare professionals are not easy. They see a lot of variability in care: 73% notice it in the training of new nurses and 77% in the degree of collaboration across healthcare departments.

But while these nurses may carry the torch for more consistent and effective healthcare delivery, nurses who are early in their careers have a blind spot when it comes to other areas where variability exists. They appear to be less aware of transparency challenges and the variation in the cost of medications and treatment than more experienced nurses.

They also have less appreciation of the power of evidence-based practice in delivering the best care possible. This presents an opportunity for hospitals to understand the generational gaps that exist among their nursing staff. They can then develop plans that recognize each group’s unique needs, understanding, and the actions required. This positions next-generation nurses to be ready to take the reins when more experienced nurses retire.

Championing Patients, Advocating Change

Next-generation nurses not only see healthcare in a positive light; they also see patients differently than previous generations of nurses have. Most envision patients as in charge of their own health—taking a hands-on role in their own health. And, in the interest of providing more-robust and multi-dimensional care, they support the idea of being able to access data that enables them to recognize and respond to patients’ social and/or lifestyle needs, as well as to have at their disposal certain tools that provide the most up-to-date evidence-based practice information.

Although they remain positive, next-generation nurses are advocates for change. Care alignment is one of the major areas in which they see significant room for improvement. An overwhelming majority (86%) deem alignment so that the entire team is practicing based on the same information as important to improving care. Virtually all of them (89%) say they want to see more consistency, which would result in better patient outcomes.

Evolving Role of Technology

When care is better, this group says it can be attributed to technology. 87% say technology that enables clinical decision support at the point of care is making it easier for healthcare professionals to make the best care decisions. Most also indicate a level of optimism when it comes to artificial intelligence and emerging technologies that will enhance care. These nurses are more comfortable navigating the electronic health records than their more experienced colleagues and this may speak to their overall comfort with technology. They are, after all, digital natives, having grown up in a time of widespread use of the Internet, social media and mobile communication.

Taking Nursing into the Future

These nurses join the half million nurses expected to join the workforce from 2012 to 2022, shaping the future of healthcare as demand gets greater.1 Their vision of nursing focuses on empowered patients, being informed and well-educated healthcare workers, and utilized technology. They understand their role in the transforming healthcare landscape, even as they experience dramatic changes. They know what needs to be done. And the good news is, they’re ready.

Want to learn more about the findings? Download the survey report.
Reference: 1. Network for Regional Healthcare Improvement. Getting to affordability, November 8, 2018. Available at: http://www.nrhi.org/uploads/rwj_tcoc_phaseiii_benchmark_2018_r7.pdf. Accessed February 17, 2020.


Nurses – Leaders at the Bedside and Beyond

Right now, nurses are in the spotlight. And not because it’s the Year of the Nurse and Midwife, or because it’s Nurses Month…but because so many of you are there on the frontlines, along with colleagues in other disciplines, fighting COVID-19 head-on. Many are tired and weary and many wish for life – both at work and at home – to return to some variation of ‘normal.’

Remember that you are a leader, no matter your role or setting, whether at the bedside, in the clinic, in the classroom, visiting patients in their homes, or in a boardroom. You may be facing the stress of caring for critically ill patients or learning how to effectively provide care via telemedicine. You may be interpreting the research as it comes out to field questions from family and friends who turn to you to make sense of headlines and news conferences. How you respond and your actions speak volumes.

10 Tips to Lead Like a Nurse

Here are quick tips to help you demonstrate leadership. What would you add to this list?
  1. Be prepared.
  2. Be safe.
  3. Set an example.
  4. Collaborate.
  5. Actively listen.
  6. Seek mentors and be a mentor.
  7. Solve problems.
  8. Connect.
  9. Share your voice.
  10. Demonstrate respect and kindness.

YOU are a Leader

Do you consider yourself a nurse leader? Ask yourself these questions below. If you answer ‘yes’ to any of them, you are a leader. Why? Because ALL nurses are leaders.
  • Are you an expert? We all have certain things that we are good at. What are some of the things that your colleagues come to you for repeatedly? Is it a question about a certain diagnosis or patient population? Or maybe you are the go-to person for placing I.V.s when there is a patient who is a difficult stick.
  • Are you an educator? Do you teach students or new nurses or precept new-to-your-unit nurses? Do you teach colleagues from other disciplines about the unit where you work? What about patient education? (We all do this one!)
  • Are you an advocate? Do you speak up for your patients and their families? How about for yourself? Your colleagues? The nursing profession?
  • Are you a role model? Do you take on the charge nurse role? Do you collaborate effectively with other nurses and other members of the health care team? Are you a nurse that others strive to be like? Do you model healthy behaviors for patients and the public?
  • Are you a voice for our profession? Are you educated about the issues affecting nursing and health care? Are you a committee member at your institution? Are you a member of a professional nursing organization? Are you involved in local, state, or national boards?
  • Are you a nurse? How often do family members and friends come to you with a health-related question or advice? The title ‘nurse’ signifies leadership to those around us.

Thoughts on Leadership

I’ll leave you with these inspirational words from some of the nurses who’ve inspired me.
 
“The work of nursing happens in the moment but can have a lifetime impact.” 
Angelleen Peters Lewis, PhD, RN, FAAN
Nurses Make Profound Impacts
 
“Be authentic – know yourself and know nursing” and “Recognize the importance of team – respect strengths and boundaries.”
Connie Delaney, PhD, RN, FAAN, FACMI, FNAP
The Power of Informal Conversations and Bold Relationships
 
“We understand what happens with patients, we understand how things work in clinical organizations, and we are the most trusted profession.”
Mary Ann Fuchs, DNP, RN, NEA-BC, FAAN
The Unique Perspective of Nurses
 
“Nurses have firsthand knowledge of views and concerns of patients and families.
Nurses know how to achieve high quality care.
Nurses can offer innovative solutions to improve safety and quality.
Nurses understand the need for collaboration across professions and settings.
Nurses are great listeners and ask questions to better understand.
Nurses respect a wide range of professional roles and skills, helping us work as effective team members.”
Angela Patterson DNP, FNP-BC, NEA-BC
Nurses – The Keepers of Patients’ Stories

Stay strong and keep leading like a nurse!
   

 


Virtual Conferences – What to Know Before You "Go"

CONFERENCE-CHECKLIST.pngLearning. Networking. Fun. Meeting CE requirements. Exciting destinations. All in one place. Now cancelled.
 
Many associations and organizations are taking their conferences online. Virtual meetings are not the same as those in-person experiences, but it’s the next best thing until we can safely convene and learn.

Why should you consider attending a virtual conference?

Virtual events are not new, but during this time of COVID-19, they are becoming the norm and becoming better equipped to align closely with the in-person events we are more familiar with. A virtual conference can still bring that learning experience to you, just in a different format and in the location of your choosing. We’re nurses and we are used to adapting, and we still need to meet our continuing education requirements for licensure and certification. Why not consider attending a virtual event?

Here are some benefits:
  • Lower cost – No flights or hotel rooms to book; registration fees may also be reduced.
  • Health and safety – Less travel means less exposure to and transmission of COVID-19.
  • Curate your own experience – Be selective and take advantage of new opportunities!

 What do you need to know before you “go”?

  1. Map out your schedule. Invest time to plan your schedule, especially if there are overlapping sessions. When available, view the full agenda, including session title, descriptions and speaker bios. Is there a calendar within the event platform or app? Bookmark or add sessions so you don’t miss the ones you are most interested in attending. If session handouts are available, download or view them prior to the start of the virtual event.
  2. Make sure that your device is compatible. Read the technical instructions closely. Look for instructions about what browser to use. If a ‘System Checker’ is available, run it on your device ahead of time. You don’t want to be downloading applications or making sure you have a solid internet connection during the event. Make a note of how to access Technical Support in case you need help before or during the event.
  3. Know how to access your CE credits. Do you need to take a test or answer questions? Do you need to complete surveys or evaluations? Plan how you will meet your requirements and access your certificate or transcript. You may need or want to take care of these logistics as you go through the sessions, while the information is fresh in your mind. If that is not an option, take notes as you would at a live event so that you can refer to them later.    

Final tips

Engage with the other attendees and speakers.
If there is an attendee list and/or chat feature, reach out to other attendees and speakers to network and make the most of the event. You may be asked to ‘opt in’ or ‘join’ so that your contact information is visible to allow others to reach out and network with you.
 
Attend the Exhibit Hall.
If there is a virtual exhibitor showcase, visit the ‘booths’ and learn about services and products that event partners have to offer. Like an in-person event, there may be certain hours that the hall is open, so consider that when you are planning your experience. In some instances, exhibitors may hold live chats or showcases at their booth, or even offer giveaways and raffles to attendees.
 
View the posters.
Is there a poster session included? Be sure to view the posters; there may even be additional CE available, so check out the details and instructions closely!
 
Use social media.
Follow, like, share, and tweet and use the conference hashtag before, during and after the event.
 
Follow up.
Some organizations will grant access to archived sessions. Pay attention to the timing (when they will be available and for how long) so that you don’t miss anything that you want to go back to.
 
While we all navigate this new normal, I hope that any virtual event you attend is inspiring and educational! Be sure to complete evaluations and/or submit feedback to the planners and presenters to help enhance future events!

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What Do You Say When…? COVID Conversations with Science Skeptics

I really struggled with the title of this post. There are many differences of opinion out there right now and I would never presume to be an authority on the right or wrong actions of any individuals. As a nurse, however, I do feel a responsibility to focus on the science behind recommendations, reiterating that even now, there is still so much that we don’t know about COVID-19, and erring on the side of caution has always been my style, even before this pandemic.

When I look around in my community in southeastern Pennsylvania and on social media, it is clear there are many different views. I do understand the toll that this pandemic is taking, both on those who have been affected by the virus personally or have seen it up-close in a family member or friend, and those who have had major impacts on their career, finances, and/or mental health.

I felt compelled to write this for nurses because we did get some questions related to communication with family and friends during our webinar, Calming the COVID Storm: Delivering Effective Clinical and Nursing Care. Here’s some guidance to help diffuse difficult conversations and answer some of the questions that you may be asked. Let’s work on this together – please leave a comment if you have other questions or answers to add!

Question: Why do I have to wear a mask?
Answer: We know that the virus that causes COVID-19 spreads very easily between people. By wearing a face covering over your nose and mouth, you are potentially protecting others from getting the virus from you (and spreading it) if you have the virus and are asymptomatic or presymptomatic.

Question: Do I still have to social distance?
Answer: Maintaining six feet of distance between people is recommended by the Centers for Disease Control and Prevention (CDC). With what we know now, the best way to control the spread of this virus is to maintain physical distance, wear a mask, keep your hands clean, and avoid crowds.

Question: Should I take hydroxychloroquine?
Answer: It’s important to stay educated on the latest research and the advice of your own health care provider, who knows your medical history. Currently, both the National Institutes of Health (NIH) and the FDA recommend against use of hydroxychloroquine or chloroquine for the treatment of COVID-19. Studies are ongoing; the NIH regularly updates the COVID-19 treatment guidelines based on current research results.

Question: Will my kids go back to school this fall?
Answer: The decisions on how and when to open schools safely will be determined by your local public leaders, as circumstances differ by geography. (You can also refer people to the CDC document on Considerations for Schools and here’s another good read for parents, What Parents Can Learn From Child Care Centers That Stayed Open During Lockdowns.)

Question: Why can’t we go to the ____ (fill-in the blank here: concert/party/graduation/etc.)?
Answer: As we learn more about COVID-19, it is important to limit its spread. It has been demonstrated many times since the beginning of the pandemic that crowds – whether at parties, restaurants, concerts, or religious services – increase the spread of the virus. Physical distancing, along with everyday protective actions (handwashing, covering coughs and sneezes, and cleaning and disinfecting surfaces), are recommended. The risk of COVID-19 spread increases the more closely a person interacts with others and the longer the duration of that interaction; follow state or local regulations related to large gatherings. (You can also refer people to the CDC documents on Gatherings and Community Events.)

As states around our country develop and enact plans to open up, we must remember that every individual has their own story and has to ‘open up’ at the pace that is right for them. It’s important to respect one another. Answer questions with the facts, acknowledge the unknown, and please, always be kind.
 
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It’s Time for a Timeout!

Many of us feel like we’re on a treadmill, constantly running to keep up with our responsibilities at home and work. The past 28 months have been especially stressful, dealing with the impact of COVID in our personal and work lives. At work, we are faced with staffing, burnout and resiliency issues as we watch many of our colleagues retiring or leaving the profession all together. At home, we are dealing with changes in the economy that place an additional stress on affording basic needs. It’s time for a time-out!

When my children were young, I used time-out to redirect behaviors and give them time to reflect on what they were doing and think how they could do things differently. It did work for them; they grew up to be successful, independent women. I don’t know about you but, I think many of us could use a timeout right about now to give us the opportunity to relax, think about our life choices and behaviors, and change them for the better. Many of us could use an extended timeout, perhaps a vacation to clear our minds, remember what’s truly important in our lives and do things we enjoy with those we care about.

So often I see my colleagues putting off their vacations or being unable to take a day off because of stresses at work. We need to remember work will be there another day, but we may not be if we keep going at a breakneck pace. I’ve never heard at anyone’s funeral that they should have worked more or spent more time away from their loved ones. We all know it makes sense; we tell our patients to find work/life balance, yet we struggle to do it ourselves.

It’s time to take a timeout! Let’s start investing in our own wellbeing so we can be there for our loved ones and our patients. Being well rested and recharged gives you energy to be your best at home and at work. So, take that vacation and don’t feel guilty about it. Just say no to coming into work on your day off. Do the things you love to do with those who mean the most to you.

Take a timeout daily to reflect on what went well, how you could handle things differently that didn’t go as planned and identify what you can cast off because it’s toxic. It’s time to invest in ourselves and find our balance. We need to discover what feeds our body, mind, and soul and leads us to discover the joy in who we are and what we do. 
 
Posted: 7/1/2022 11:01:28 AM by Kim Fryling-Resare | with 3 comments

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Summing Up the Research: Transforming Practice through Evidence

Awareness of current research is a big component of staying up to date in nursing and healthcare and providing evidence-based care. Here’s a look at a selection of the latest studies and practice-changing recommendations.

Nursing

Health-Sector Shift Work Linked to Increased Odds of Metabolic Syndrome
A new systematic review published in Obesity Reviews examines the association between shift work and the risk of metabolic syndrome (MetS) in employees of the health sector. Researchers found that 10 of the studies demonstrated higher risk of developing MetS for shift workers versus day workers, and based on 12 studies, the pooled odds ratio for MetS in shift workers was 2.17.
 

Guidelines & Recommendations

AAP Updates Recommendations for Safe Infant Sleep Practices
Updated evidence-based recommendations for a safe sleeping environment to reduce the risk for sleep-related infant deaths has been released by the American Academy of Pediatrics (AAP) and published in Pediatrics. The updated recommendations include:
  • placing infants to sleep in a supine position for every sleep until the child reaches 1 year of age; side sleeping is not advised and is not safe.
  • a firm, flat, non-inclined sleep surface to reduce the risk for suffocation or wedging/entrapment.
  • having the infant sleep in the parents' room, but on a separate surface designed for infants, ideally for at least six months.
  • keeping soft objects such as pillows, comforters, and loose bedding away from the infant’s sleep area.
  • offering a pacifier at nap time and bed time to reduce the risk for SIDS.
 
USPSTF Recommends Against Beta Carotene, Vitamin E Supplements
The U.S. Preventive Services Task Force (USPSTF) recommends against the use of beta carotene or vitamin E for prevention of cardiovascular disease or cancer and finds that the evidence is insufficient for ascertaining the benefits and harms of multivitamin use. These recommendations and findings form the basis of a final recommendation statement published the Journal of the American Medical Association.
 
ENDO: Guidelines Updated for Hospitalized Adults with Hyperglycemia
An updated Endocrine Society clinical practice guideline for the management of hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia was published in the Journal of Clinical Endocrinology & Metabolism. A multidisciplinary panel identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia.
 
The panel made 15 recommendations relating to 10 frequently encountered areas specific to glycemic management in the hospital. These include conditional recommendations for use of emerging diabetes technologies in the hospital such as continuous glucose monitoring and insulin pump therapies; insulin regimens for prandial insulin dosing, glucocorticoid-associated and enteral nutrition-associated hyperglycemia; and noninsulin therapy use. For issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital, recommendations were also made.
 
Framework Issued for Developing Living Practice Guidelines
In this framework, published in the Annals of Internal Medicine, there is an emphasis on the role of online dynamic platforms in supporting up-to-date evidence. The goal is to help guideline developers plan, produce, report and disseminate living guideline projects.
 

More Highlights

SCOTUS Overturns Roe v. Wade, Leaving Many Women Without Access to Abortion
On Friday, June 24, 2022, the U.S. Supreme Court issued a ruling that overturns the landmark 1973 Roe v. Wade decision guaranteeing a woman's right to abortion. The decision sets the stage for a swift rollback of abortion rights in more than half of the United States.
 
JCAHO Standards Not Always Supported by High-Quality Evidence
Only six of 20 actionable standards for hospital accreditation published by the Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission) were completely supported by cited references, according to a study published online in The BMJ. Of the six directly supported actionable standards, one, none, and five cited at least one reference of level 1 or 2, level 3, and level 4 or 5 evidence, respectively. The strength of recommendation was deemed GRADE D and GRADE B in five and one of the completely supported actionable standards, respectively.
 
Explore all Nursing News Headlines.
 
Posted: 7/6/2022 12:24:41 PM by Kim Fryling-Resare | with 0 comments

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