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Dear Colleagues,
According to the American Nursing Association (ANA), advocacy is a pillar of nursing. Nurses instinctively advocate for our patients, in our workplaces, and our communities; but legislative and political advocacy is no less critical to advancing the profession and patient care.
On February 26, 2019, the Nevada Nurses Association (NNA) sponsored Nurses Day at the Legislature (NDAL) wherein 80 nurses and nursing students met in Carson City. Discussions on advocacy and issues affecting nurses as well as health and health care were the topics of the day. As the day concluded, I reflected on the concept of advocacy, and I would like to share some thoughts.
Merriam-Webster defines advocacy as the act or process of supporting a cause or proposal. Wikipedia, one of the least scholarly, but most often cited sources around, proposes that Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions. Neither definition mentions the word patients, but most nursing texts adapt these and other generic descriptions to our profession such that nurses advocate for health, health care and individuals who are unable or cannot advocate for themselves.
No doubt we all learned about advocacy in our Nursing Fundamentals course; for some of us that
current resident or
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NevadaRNFORMATION
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATIONThe Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 42,000 Registered Nurses and Licensed Practical Nurses in Nevada
May 2019 • Volume 28 • Number 2 www.nvnurses.org
Insidearticles
2 Be Part of an Awesome Team
3 Research & EBP Corner
4 NV Nurses Called to Advocacy
5 What a Great Time to be a Nurse Practitioner
5 Check it Out!
6 NNA Environmental Health Committee
7 Nevada Nursing Student Association
8 Cassi Gonzales - A Special Catalyst for Health
9 Veterans Corner
10 Antibiotic Stewardship
11 Bicycle Safety
12 Nurses in the News
13 What the Mirror Doesn’t Tell You
14 Safe Infant Sleep Practices
regular features15 Nevada Nurses Foundation
Mark Your Calendars• Saturday, June 1, 2019 – Crowns & Tiaras Big Hat
High Tea – Governor’s Mansion• Saturday, September 14, 2019 – Convention 2019:
Inclusivity in Nursing – Las Vegas • Saturday, September 14, 2019 - NNA Annual Meeting – Las Vegas• Saturday, October 12, 2019 – Shining Stars of Nursing in Nevada –
Las Vegas
Mary D. Bondmass, PhD, RN, CNEPresident, Nevada Nurses Association (2018-2020)
The President’s Message
may have been quite a while ago, while others, not so much. While advocating is probably something we all do daily, regardless of our practice setting, it may be helpful to take a few minutes or so to reflect on the concept and its importance. Often, we get caught up in the daily tasks that we must accomplish, that I fear we do not always consider just how vital nurses’ role as an advocate is. I wonder what a world without nursing advocacy would be like. Who would, as Merriam-Webster defines, would act to support causes; who, as Wikipedia defines, would influence decisions within political, economic, and social systems and institutions relating to health and health care? Fortunately, we don’t have to wonder about a world without nursing advocacy because as the ANA indicates, it is a pillar of our profession of which we can all be proud.
If you would like to become more involved with NNA’s advocacy activities at the State level, I strongly suggest you visit our webpage at https://nvnurses.org and browse the content. If you are more interested in national advocacy issues, view the ANA’s webpage at https://www.nursingworld.org/practice-policy/advocacy/
Colleagues, no matter your level of interest or involvement, I ask you to take a moment to reflect upon advocacy as a common thread of our profession as we go about our daily lives in the workforce and collectively work to improve health and health care for the citizens of our state.
Respectfully yours,Mary Bondmass, PhD, RN, CNEPresident, Nevada Nurses Association
Happy Nurses Week!May 6-12, 2019
Page 2 • Nevada RNformation May, June, July 2019
NNA Mission StatementThe Nevada Nurses Association promotes professional nursing practice through
continuing education, community service, nursing leadership, and legislative activities to advocate for improved health and high quality health care for citizens of Nevada.
NNA State Board of DirectorsMary D. Bondmass, PhD, RN, CNE [email protected] . . . . . . . . . . . . . . PresidentNicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC [email protected] . . . . . . . Vice PresidentRochelle Walsh, DNP, RN, PCCN [email protected] . . . . . . . . . . . . . . . . . . . . . . SecretaryGlenn Hagerstrom, PhD, APRN, FNP-BC, CNE [email protected] . . . . . . . . . TreasurerPeggy Lee, BSN, RN [email protected] . . . . . . . . . . . . . . . . . . Director at LargeAmie Ruckman, MSN, RN [email protected] . . . . . . . . . . . . . . . Director at LargeChrista Secord, MSN, FNP-BC [email protected] . . . . . . . . . . . . . . . . Director at LargeDarlene Bujold, BSN, RN [email protected] . . . . . . . . . . . . . . . President, District 1Ruth Politi, PhD, RN [email protected] . . . . . . . . . . . . . . . . . . . . President, District 3Donna Miller, RN [email protected] . . . . . . . . . . . . . . . . . . . . . .Legislative Chair
Editorial BoardManaging Editor, Linda Bowman, RN, [email protected]
Print Editor, Kathy Ryan, MSN, RN-BC
Mary D. Bondmass, PhD, RN, CNEEliza J. Fountain, RN, BSNWallace J. Henkelman, Ed.D, MSN, RNTracey Long PhD, RN, MS, CDE, CNE, CCRNMary Baker Mackenzie, MSN, RNJohn Malek, PhD, MSN, FNP-C
Lisa Pacheco, MSN, RN Betty Razor, RN, BSN, CWOCNDenise Rowe, MSN, RN, FNP-CVal Wedler, MSN, RNBernadette Longo, PhD, RN, FAAN
Are you interested in submitting an article for publication in RNFormation? Please send it in a Word document to us at [email protected]. Our Editorial Board will review the article and notify you whether it has been accepted for publication.
If you wish to contact the author of an article published in RNFormation, please email us and we will be happy to forward your comments.
Have you visited the NNA Job Board recently? Visit our website www.nvnurses.org and click on the Job Board tab to view many available Nevada nursing jobs. If you want to receive email notice when a new job is added, join our Job Board mailing list! Just
send your email address by text message:
Text NNAJOBBOARD to 22828 to get started or email [email protected].
If you have a job to advertise, contact Ian at [email protected]. Our rates are reasonable and
money raised helps to benefit Nevada nursing.
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Publishing Agency, Inc.
www.nvnurses.org
SAVE THE DATE!!!Convention 2019: Inclusivity in Nursing
September 14, 20197:30 a.m. – 5:30 p.m.
Clinical Simulation Center of Las VegasShadow Lane Campus – Bldg. B
1001 Shadow Lane Las Vegas, NV
The Nevada Nurses Association (NNA) along with the Nevada Nurses Foundation (NNF) and the Nevada Nursing Student Association (NVNSA) are planning a collaborative convention. The theme for the convention is Inclusivity in Nursing and will feature nationally known keynote speakers, breakout sessions, and poster presentations. Continuing Education hours will be awarded. Abstract submission and registration information will be available on the NNA website in early May 2019. More information will also be available in the June/July RNFormation.
BE PART OF AN AWESOME TEAM! Do you enjoy learning from your colleagues? Would
you like to be a part of an action-oriented team that contributes to Nevada nurses? If yes, consider running for one of NNA’s open offices. The following positions are now open for candidates:
• State level- seeking candidates for Secretary (2-yr term) and one director (3-yr term)
• Northern Nevada – District 1: seeking candidates for President, Vice President and one director (all 2-year terms)
• Southern Nevada – District 3: seeking candidates for Treasurer (2-yr term)
• ANA Membership Assembly in Washington DC: seeking candidates for one Representative and two alternates (1-yr terms). Candidates should actively participate in at least one NNA committee. Tentative date for the Assembly is June 17-June 19, 2020. Expenses are covered.
• Nominations Committee: seeking three candidates (1-yr term)
Visit NNA’s website for nominating form and full description of officers. Question? Email Linda Bowman at [email protected]. Nominations close May 15, 2019.
May, June, July 2019 Nevada RNformation • Page 3
Research & EBP Corner
Submitted by Mary Bondmass, Ph.D., RN, CNE
This feature will present abstracts of research and evidence-based practice (EBP) completed or spear-headed by nurses or student nurses in Nevada. The focus is on new evidence (i.e., research) or on the translation of evidence (i.e., EBP) in Practice, Education or Research. Submissions are welcome and will be reviewed by the RNF editorial board for publication; send your abstract submission in a similar format used below to [email protected].
Danielle C. Craperi DNP, CNML, CNLUniversity of Nevada Reno
Background:Acute care settings can have
a treatment gap for patients that exhibit behaviors of a psychiatric/mental health illness (PMHI) that have a length of stay (LOS) greater than 15 days. There may not be proper knowledge for the clinicians and/or programs to care for patients in this population. Often these patients have had their acute condition cared for, they are medically cleared and are awaiting
placement to an outside facility. Barriers to discharge include needing guardianship, pending approval from a payer source, or have filled out an application for health insurance and are waiting for acceptance. The extended LOS that this population can experience puts them at a higher risk to experience conflict event. Conflict events include acts of aggression, verbal abuse, dependency issues, self-harm, noncompliance with medication regime, HAI, falls, and elopements. This population may have a diagnosis of a mental health illness or they may have medical condition that causes the patient to exhibit behaviors of a mental illness.
Purpose: The purpose of this Doctor of Nursing Practice
(DNP) final project was to develop a Patient Enrichment Program (PEP) to decrease the LOS and number of conflict events experienced by this population. Another purpose of this project was to increase the nurse’s knowledge on how to care for patients that exhibit PMHI. This population may have a diagnosis of a mental health illness or they may have medical condition that causes the patient to exhibit behaviors of a mental illness.
Intervention: The PEP provided education for nurses, a daily
routine and therapeutic activities for the patients. Some therapeutic activities included, daily walks, music therapy, art therapy, social skills, and pet therapy to mention a few.
Development of Patient Enrichment Program for Patients with Psychiatric Behaviors in Acute Care
Results: After three months of implementation of PEP there
was a statistically significant decrease in the number of conflict events seen in this population. Pre and post nurse evaluations of the education provided regarding the care of psychiatric patients showed that nurses gained knowledge and found that information to be beneficial. LOS increase due to more patients that fit criteria being transferred to unit.
Dr. Craperi presented her project at the American Nursing Conference
December 6 – 7, 2018 in Las Vegas, NV
To see the table containing more information for this article please view the online version of Nevada RNformation at nursingALD.com.
West Hills Hospital located in Reno, NV, a leader in the treatment of behavioral, mental health care and substance abuse treatment is seeking FT/PT/PRN
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in all 50 states, and filter by location and credentials.
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Your always-on resource for nursing jobs, research, and events.
Page 4 • Nevada RNformation May, June, July 2019
By Darlene Bujold, RN, MSN, MSHI
On February 26th, 2019 nurses from throughout Nevada came together in the halls of the state's Legislature to represent our proud profession and to discover what bills are significant to our patients and our practices. The theme for the day was "Advocacy the Power of Nursing."
The agenda for the day was pre-empted by our state’s “Washoe Zephyrs” which made their presence known, bringing wind speeds up to 84 mph and toppling semis. Highways were closed, airlines flights canceled, delayed or rerouted. Neither our keynote speaker, Terry Kerns, PhD, RN who was to speak to our role as advocates in relation to the opioid crisis nor the NNA state president Mary Bondmass, PhD, RN, CNE were able to make it from Las Vegas. In addition, the Senate and Assembly floor sessions, where several nurses were slated to sit with their legislators, were canceled. Despite these deterrents, the event was very well attended by nurses who braved the winds and showed up to the table to learn and advocate.
Nicola Aaker, MSN, MPH, RN the NNA state Vice President took up the torch to welcome this proud group to the day.
Darlene Bujold RN, BSN, MSHI- District 1 President NNA was honored to act as MC for the day and sang the National Anthem to the group.
A round table panel of distinguished nurse leaders shared their experiences of legislative advocacy, how they found their voices and advocated for legislative action. This panel consisted of:
David Tyrell, BSN, RN, Past President NNA – Provided an impassioned call to nursing legislative advocacy and facilitated rousing discussion.
Nicola Aaker, Director of Carson City Health and Human Services - Shared her knowledge of pending bills aimed at increasing Nevada’s public health funding rate which is currently ranked as second to last in the nation! Nicki was able to provide us with timely and crucial pending legislation from the Interim Committee on Health Care and the Regional Behavioral Health Policy Boards.
Cathy Dinaur MSN, RN, Executive Director of the NV State Board of Nursing – Spoke to the importance of understanding the state laws that govern our practice and promoted the re-submission of NV Nursing Compact legislation.
Lisa Thomas PhD, RN, CNE, FAAN – Associate Professor UNR Orvis School of Nursing – Spoke as a subject expert to legislative policy.
Bernadette Longo PhD, RN, APHN-BC, CNL, FAAN – Past NNA State Secretary, ANA Clean Air Ambassador, Nominations Committee Chair NNA – Presented a
NV Nurses Called to Advocacyheartfelt and encouraging plea, that “Each of us are experts” in our own unique fields and how our personal stories can resonate with our representatives for the change we wish to see enacted.
Donna Miller RN/EMS-RN, CMTE – Told her story of how a process dysfunction that she recognized as needing to be fixed propelled her to the halls of the legislature to change statutes for the better. She had no clue how to go about this but she moved forward regardless and “figured it out” as she went. She also relates how relationships, made possible by her involvement with the NNA were invaluable in meeting this goal.
Jessica Ferrato and Paige Barnes (Crowley & Ferrato Public Affairs) - Representative Lobbyists for the NNA – Presented pending current legislation and updates on clean-up of past bills. Policy highlights included: APRN Signing Authority (SB134 and AB147) and Public Health Funding (AB97). The discussion also included: Assemblyman Sprinkle working to consider various means to provide access to insurance for a variety of underserved populations; and consideration of a clean-up bill to resolve providers concerns with prescription drug abuse.
Melissa Washabaugh, BSN, RN - Spoke to the role of nurses in advocating for the rural areas of Nevada, advocating for the Nevada Nursing Compact. She also discussed how nurses can be instrumental in the prevention of the rise in current national and state suicide rates.
Anna Anders, MSN, RN, CENP, Chief Nursing Officer & Vice President at Carson Tahoe Hospital, Inc.- Was able to add lively discussion by sharing her personal and professional experiences with such timely items such as Mental Health legislation, doctor provider shortages and the advantages of Nevada becoming a Nursing Compact state.
Norman Wright, MS, BSN, RN provided an interesting presentation on “Antimicrobial Resistance Organisms” and how this is a serious health threat. He explained the importance of communication as it relates to vaccination history and antibiotic stewardship and urged all nurses be a part of antibiotic stewardship.
While the topics and the speakers were extremely interesting and provided oversight of what was on the horizon for the 80th Legislative session, it was the personal stories that many speakers shared on how as nurses, they were able to find their voices and make a difference.
Heidi Johnston and Karen Bearer near the Nevada Nurses Foundation sponsor table.
Thank you to Vania Carter, MSN, APRN, FNP-BC with NAPNA for coordinating the pre-event dinner on February 25, 2019. Many went through closed roads and flight delays to attend.
Nurses Day at the Legislature could not have been successful without the help of some incredible volunteers. A huge thank you to Pat Fries and Becky Gebhardt for their help with registration. Dave Tyrell and Donna Miller jumped in at the last minute when we received information at 8:00 pm on the night before that the key note speaker was unable to attend due to cancellation of flights. Dave and Donna came up with a great plan to save the day. A big thank you to the presenters who were asked to sit on a panel 10 minutes before the panel began. This speaks volumes to the leadership qualities that NNA members possess. Had these individuals not jumped in at the last minute, NDAL might not have happened.
Becky Gebhardt and Pat Fries registering nurses
Nevada Nurses Association hopes that “Nurses Day at the Legislature 2019” was a memorable event for those who braved the uncooperating weather and attended. Those who couldn’t attend were missed. NNA is already looking forward to planning the next NDAL event in 2021. Many photographs were taken, however, due to the time constraints of meeting the deadline of this publication, photos were not available. Photos will be included in the 2019 NNA Yearbook which will be sent out in July. NDAL handouts can be found on NNA’s website under the Legislative section.
And finally, thank you to NDAL’s generous sponsors – Nevada Nursing Foundation, Nevada Advanced Practice Nurses Association, Carson Tahoe, University of Nevada, Reno Orvis – School of Nursing and University of Las Vegas – School of Nursing.
Another huge THANK YOU goes out to Harvey Dunbar from Grifols and Kane Furey from Respitech who sponsored the pre-event dinner on Monday, February 25, 2019.
May, June, July 2019 Nevada RNformation • Page 5
By Kathy Ryan
In the United States, most of us are blessed with an abundance of health care opportunities. Many of us have a doctor for this, a doctor for that, a nutritionist for this, a physical therapist for that, and high tech specialty services are just a referral away. But for those less fortunate, health care practitioners and facilities, and the healing and hope they provide, may be scarce or even absent altogether.
Enter “Some kind of wonderful:” Church Family MissionsIn the 1980’s, Bill and Liz Gieg traveled from South Lake Tahoe, California, to
Central America. Liz recalled the world they discovered “was full of dirt streets…deserted cars…and signs I couldn’t understand. Tons of looped wire hung from telephone poles…bunches of wire ran from pole to pole to bring electricity to each cement house…garbage [was] scattered everywhere.” Bill and Liz learned first-hand of the crushing poverty and overwhelming need of those Guatemalan residents, and their lives were forever changed.
Returning year after year to Central America, Liz carried a first aid kit “stocked with more than the ordinary first aid items. In one situation I was able to supply medicine and treatment to a diabetic man with ulcerated feet.” After serving on a health care team to Bonete, Liz began to organize health care teams through Church Family Missions, and that service opportunity continues today. To date, over 300 volunteers have traveled to El Salvador, Guatemala, Honduras, and Nicaragua, and thousands have received loving health care.
In April 2019, Church Family Missions will travel once again to Guatemala (April 29 – May 10). These days the health care teams include doctors, nurse practitioners, nurses, dentists, and volunteers providing services based on their education and gifts. Chiropractors, massage therapists, occupational and physical therapists: all are welcome and their essential treatments are so very much appreciated. Regarding volunteering: if you’re willing, you’re able!
A “typical” day unfolds like this: we walk to a breakfast location, and share the ground we walk on with cats and chickens. The bus driver may require we walk up the rocky slope where the road used to be – here’s hoping it doesn’t rain today! We know we’re approaching our clinic location by all the donkeys and horses “parked” along the shaded fences.
The crowds of people awaiting us may number between four and five hundred. Sometimes health care representatives from the national government join us to perform registration, screening, or immunization surveillance. Our patients then progress from triage (vital sign and blood sugar measurement, and anti-parasite medication administration), to physical assessment with recommendations for treatment and medication, to a variety of treatment stations, and finally to pharmacy. In addition, there are usually several hundred who visit with the dentists. Thankfully translators assist every step of the way.
Days can be demanding, just as the smoke, heat, and dust are demanding. But more than once a woman shedding tears of gratitude has said to me “I know you could take a vacation anywhere, but here you are, with me.” Our eyes locked, our hands reached for one another… a perfect and magnificent joining of hearts and souls…
If you’re looking for something new, some kind of wonderful, please check out Church Family Missions. The rewards are endless and eternal, and the life you change may be your own!
For more information please visit Church Family Missions at www.cfmministries.org or email [email protected]
Check It Out!Some Kind of Wonderful
Submitted by Susan S. VanBeuge, DNP, APRN, FNP-BC, FAANP
Nurse practitioners or advanced practice registered nurses (APRN) are one of the hottest professions in the current US job market. According to the US News and World Report, nurse practitioners rank #5 in Best Health Care Jobs. With the median salary listed as $103,880 and an unemployment rate of 1.1%, job security and the ability to earn a living is achievable (US News, 2018).
Advanced practice nurses have different roles and populations of foci they may be trained and practice. The four roles include nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. Population of foci include family/individual across the lifespan, adult gerontology, women’s health/gender related, neonatal, pediatrics, and psych/mental health (NCSBN, 2008). Additional opportunities for APRNs are in specialty areas such as oncology, nephrology, palliative care, orthopedics, and critical care. Educational credentials and licensure of the individual advanced practice nurse will define their scope of practice.
It is a great time to be an advanced practice nurse. There are more than 240,000 APRNs in the United States with just over 2,000 of these licensee’s in Nevada. APRNs can be found practicing in hospital settings, primary care, specialty care, outpatient clinics, rural health, palliative care, and higher education.
In Nevada, modernization of laws and regulations governing APRN practice have changed positively in time since this role was created. The first Nevada nurse practitioners were established in 1973 and formally granted a “Certificate of Recognition” in 1979. From the time of initial recognition to current 2019 practice, 46 years after the profession was recognized, APRNs in the state have made great strides to provide safe, professional, and compassionate patient care. A milestone reached in 2013 changed practice as APRNs achieved full practice authority. One of 23 states in the US, Nevada leads the way in providing care to patients throughout the state. Since gaining full practice authority, the number of APRNs have more than doubled in five years.
Given the positive practice environment, opportunities are abundant for APRNs in Nevada and across the US. In Nevada, opportunities for employment, consulting, building a practice, and providing direct patient care are available. The winners in this environment are our patients. APRNs provide safe, comprehensive, and compassionate care across the lifespan in the roles they are trained. Most APRNs are trained in primary care and offer these services in the care of patients in acute, chronic, and tertiary care. Training includes treating patients in a holistic patient-centered model of care to encourage health promotion, provide education, and evidence-based care.
It’s a good time to be an APRN in Nevada and across the US. Opportunities for employment, service to others, and an ability to practice independently create an excellent work environment for our profession.
References:National Council State Boards of Nursing (2008). Consensus Model for APRN Regulation:
Licensure, Accreditation, Certification, and Education. Downloaded from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
U.S. News and World Report (2018). 2018 Best Jobs Report. Downloaded from https://money.usnews.com/careers/best-jobs/nurse-practitioner
What a Great Time to be a Nurse Practitioner!
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Page 6 • Nevada RNformation May, June, July 2019
primer (lead styphnate) to start the combustion of the gun powder, which propels the bullet down the barrel. Powder and particles are shed by friction of the bullet moving through the barrel during firing. The inhalation exposure primarily occurs when the lead-containing vapors of shooting blow back into the breathing zone of the shooter, especially in the prone position. Secondary exposure also occurs from the environment of the firing range, especially indoor ranges with poor ventilation. Lead can collect on finely-sized dust particles and be inhaled. Ingestion of lead occurs from handling the bullets, eating or drinking at the shooting range, contaminated soils or floors, and contaminated clothing and shoes of the marksman. Furthermore, if dry sweeping is used for cleaning, this action can resuspend lead-ladened particles. Goldman et al. (2017) have been advocates to bring awareness and offer personal protective and hygiene measures for shooters, as well as environmental measures to reduce exposure of lead at firing ranges.
Brain development is a fragile process of myelinogenesis that continues until about age 25. Lead exposure is believed to affect the health of myelin coating on the neurons in the brain. Hence, adolescents with lead exposure may be facing associated long-term risks that present in adulthood. These include a decrease in renal function, blood pressure and cardiovascular effects, hematological effects, essential tremor and cognitive effects overtime (Goldman et al., 2017).
Nevada’s Low Blood Lead Testing Rate
Alarmingly, only 3% of Nevada's 217,000 children <6 years of age have been tested for lead. A recent study (Haboush-Deloye et al. 2017) assessed barriers to lead screening by Clark County physicians. They found that these providers believed it was not necessary, was not a state mandate nor a standard practice for Nevada, and that only children in high-risk housing should be tested.
Efforts are currently underway to protect Nevada’s children! The Nevada Childhood Lead Poisoning Prevention Program (NCLPPP) aims to reduce the long-
term health risk of childhood lead poisoning through improved methods of surveillance, education, and intervention. Guidance for clinicians across the state is available, along with parent educational resources.
Nursing Clinical Practice & Advocacy Role
Nevada’s nurses and APRNs can make a difference to reduce lead poisoning in children and promote early testing to help reduce these adverse effects. With this updated knowledge about lead sources of exposure, revisit how you (or your clinic) have been routinely screening for lead poisoning. Think environmental exposure in a broader way! Advocate for in-clinic finger stick lead screening for those at risk, and make sure there is case management and follow-up for these vulnerable children and their families. Some states fund in-home assessments to identify and remediate lead contamination sources in homes. School nurses can screen for adolescents involved in marksmanship activities and increase awareness with those students, coaches and their families. Let’s help keep Nevada’s children in the best health to be successful in their academic goals and long-term health.
NNA Environmental Health CommitteeWhat’s new about Pediatric Lead Poisoning?
Bernadette M. Longo, PhD, RN, CNL, PHNA-BC,
FAAN
As nurses we know that young children are most vulnerable to the toxic effects of lead and can suffer profound and permanent adverse health effects, particularly on the development of the brain and nervous system (WHO, 2018). Over the last 40 years in the United States there has been a significant reduction of lead in the environment due to the removal of lead in gasoline and paint. Typical pediatric screening asks about living in a home constructed before 1978 for a basis of exposure (thinking of paint sources as contamination). However, homes and buildings built between 1982 - 1988 are likely to have lead in pipes, fixtures and solder resulting in the drinking water as a source of exposure. In 2011, Congress passed the Reduction of Lead in Drinking Water Act revising the definition of lead free by lowering the maximum lead content of plumbing products from 8% to 0.25% (EPA). In addition to environmental sources of lead, starting in the 1990’s the FDA, the California Department of Health Services, and independent laboratories had identified that certain imported candies contained hazardous levels of lead. Candies with elevated lead levels appeared to primarily be imported from Mexico, Malaysia, China and India. All these efforts were making progress on reducing the risk of exposure to children.
Suddenly, lead poisoning was again in the forefront as the Flint (Michigan) water crisis resulted in ~140,000 individuals being exposed to lead and other contaminants in their drinking water for 18 months. Yet, each day in our country children continue to be exposed to lead and suffer with the adverse effects. According to Healthy People 2020, no safe blood lead level has been identified for children. Nearly 500,000 U.S. children ages one to five have blood lead levels ≥ 5 micrograms per deciliter (µg/dL), which is currently the reference level at which the Centers for Disease Control recommends public health actions be taken. Even blood lead exposure levels as low as 2 µg/dL can affect a child’s cognitive function.
New Considerations on Exposure to Lead
Exposure to lead occurs from two routes: (1) inhalation of lead particles (dust, fumes), and (2) ingestion of lead-contaminated dust/soil, water (leaded plumbing), and food, materials or contaminated hands. As you are already aware, young children explore by touch and hand-to-mouth behaviors potentially resulting in exposure to lead. Recently, attention has been given to unexpected new sources of lead exposure and provide an opportunity for nurses to revise their screening criteria for which children should be tested.
Lead-contaminated Spices, Herbal Remedies, and Ceremonial Powders
Recent studies found that spices in the homes of lead-positive children had elevated lead concentrations
and suggested that these contaminated products might represent an important source of childhood lead exposure (Angelon-Gaetz et al., 2018; Hore et al., 2019). The potentially lead-contaminated spices included: saffron supplement, turmeric, and paprika. A study by Hore et al. (2019) found spices and spice mixes commonly used in South Asian cuisine (curry & masala) contained elevated lead levels. The researchers further identified various other seasonings used in different cuisines, such as bouillon cubes and powders, broth, or soup spices, as well as hot pepper, chili powder, and paprika. They concluded that spices purchased abroad were more likely to have elevated lead concentrations compared with similar spices purchased locally in the United States (Hore et al., 2019). The countries included Georgia, Bangladesh, Nepal, Pakistan, Morocco, Mexico and Jamaica. In comparison, another study by Angelon-Gaetz et al. (2018) found some lead-contaminated products were purchased in the US.
Contamination of spices can occur at any point along the supply chain due to intentional or inadvertent addition of lead. Intentional adulteration includes adding a lead-based coloring agent or adding weight for products sold by weight. Unintentional contamination can occur by growing the spice plant in lead contaminated soils and enters the plant/spice by contaminated water or dust. Lead can also be introduced during the grinding process of the spice from lead-based equipment.
Non-food items can also be sources of lead exposure to children. These include ceremonial powders and topical remedies such as kumkum, sindoor, surma, Balguti Kesaria (an ayurvedic medicine) and turmeric (Angelon-Gaetz et al., 2018). In 2017, the U.S. FDA issued a warning about Balguti Kesaria when it confirmed it contained lead in addition to arsenic, and mercury. Although ceremonial powders are not food, they might be accidentally ingested by children.
MarksmanshipShooting for sport and competition requires
commitment to training, discipline and regular practice. Competitive shooting, from high school teams to the Olympics, requires shooting excellence in three positions, including the prone position on the ground. Training usually begins around 8 to 10 years old. Exposure to lead is from both inhalation and ingestion routes and can occur from a variety of shooting-related activities. Many bullets are made of lead, which is vaporized at the base of the bullet when it is released at the muzzle of the gun. Lead is also involved in the
Neurotoxic Effects from
Lead Poisoning• Executive functions: remaining on task• Visual-spatial skills• Speech & language deficits• Fine & gross motor skills• IQ• Long term: academic performance &
class rank
NURSING INTERVENTIONSProvider engagement with patients and
community education are successful methods to increase lead screening rates!
Spices and herbal remedies are a part of many children’s diets and might be a source of lead exposure. Therefore, communicate the risks for lead contamination in spices, especially those purchased abroad.
Identify children/adolescents involved in marksmanship activities – add them to your screening list!
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May, June, July 2019 Nevada RNformation • Page 7
NNA Environmental Health Committee
Strategies to Improve Lead Testing1) Audit your own clinical performance
& that of your team. Time pressures and simple forgetfulness are common reasons many children who should be tested are falling through the cracks. The majority of lead poisoned children do not exhibit any outward symptoms of illness, or symptoms so vague as to be mistaken for any number of minor childhood illnesses. As nurses, we can do better!
2) Simplify the system to screen for lead. Make sure screening questions for testing are in an EMR or form used at annual exams for children. Offer point-of-service testing by purchasing in-clinic capillary lead screening equipment and use it.
3) Update your “at risk” profile for who should be tested. Update according to current guidelines (see NCLPPP resources). Add marksmanship and families who may use imported spices to the screening list. Also, consider homes built before 1988, instead of 1978.
4) Follow-up & case manage lead-positive children. Develop a system in your clinic to
Fumes from shooting contain lead, a newly recognized source of exposure.
Spices and herbal remedies may contain lead.
track and reach out to these patients for long-term health maintenance.
5) Offer Parent Education materials. Obtain from free websites such as the NCLPPP & CDC. Place in waiting rooms or a poster on the wall in treatment rooms. Include in your educational material packets given out at annual exams.
6) Partner with “The Nevada Childhood Lead Poisoning Prevention Program” and your local Nevada Health Department!
References & ResourcesAngelon-Gaetz, K.A., Klaus, C., Chaudhry, E.A., & Bean,
D.K. (November 23, 2018). Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home Investigations for Children with Elevated Blood Lead Levels - North Carolina, 2011-2018. Morbidity and Mortality Weekly Report, 67(46), 1290-1294.
Goldman, R. H., Woolf, A. D., & Karwowski, M. P. (2017). Gun Marksmanship and Youth Lead Exposure: A Practice-Oriented Approach to Prevention. Clinical Pediatrics, 56(11), 1068–1071. https://doi.org/10.1177/0009922817701177
Haboush-Deloye, A., Marquez, E., Marshall, M., & Gerstenberger, S.L. (2019). Evaluation of the blood lead screening component of the Southern Nevada Childhood Lead Poisoning Prevention Program. Journal of Public Health Management and Practice, 25, S37-S43. doi: 10.1097/PHH.0000000000000882
Haboush-Deloye A, Marquez E, Gerstenberger S. (2017). Determining childhood blood lead level screening compliance among physicians. Journal of Community Health, 42(4), 779-784.
By Camille CateloUNLV Student Nurse
Vice President, Nevada Nursing Student
Association
The Nevada Nursing Student Association (NVNSA) is the first state student nurses’ association chapter for Nevada. It was recently founded last April 2018 to allow all nursing schools in Nevada to come together and work towards common goals. NVNSA’s mission is to bring together various student nurses’ associations in Nevada to create a network that will ensure the proper education of nursing students and result in the highest quality professional healthcare. Its goals include promoting community engagement through outreach opportunities, becoming involved in the Nevada legislature by advocating for bills that will affect the future of nursing practice, the creation of scholarships to advance nursing education, and provide leadership opportunities for nursing students. Additionally, NVNSA plans events to allow nursing students to network, hone their leadership skills, and help them transition from undergraduate nursing students to professional nurses.
NVNSA helped organize the Future of Nursing in Nevada (FONN) awards gala and the Shining Stars of Nursing event in Nevada last October 6th, 2018. The FONN awards gala is a fundraising event to support the work of the Nevada Action Coalition (NAC) which is the driving force for transforming health care through
Nevada Nursing Student Association
Hore, P., Alex-Oni, K., Sedlar, S., Nagin, D.A. (2019). A spoonful of lead: A 10-Year look at spices as a potential source of lead exposure. Journal of Public Health Management and Practice, 25, S63-S70. doi: 10.1097/PHH.0000000000000876
The Nevada Childhood Lead Poisoning Prevention Program. https://nvclppp.org/
EPA Drinking Water Contaminants – Standards and Regulations & The Federal Lead and Copper Rule. https://www.epa.gov/dwstandardsregulations
World Health Organization. (2018). Lead poisoning and health. https://www.who.int/en/news-room/fact-sheets/detail/lead-poisoning-and-health
Household interventions for preventing domestic lead exposure in children. Cochrane Systematic Review – Intervention, 2016. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006047.pub5/full
Bernadette M. Longo, Ph.D., RN, APHN-BC, CNL, FAANChair of NNA’s Environmental Health CommitteeEmerita Professor at the Orvis School of Nursing, University of Nevada Reno
nursing in our state. The NAC’s goal is to improve the health of Nevada residents, remove scope-of-practice barriers, prepare nurses to lead in the changes to advance health, and expand opportunities for nursing students by providing scholarships and grants. This event aimed to honor nurses in Nevada and all proceeds went to nursing scholarships and grants. NVNSA is currently leading the Vegas Roots Project which helps low-income Nevada residents eat fresh fruit and vegetables while supporting family farmers and growing economies. This volunteer opportunity happens on the first day of every month, and interested individuals can contact [email protected].
My name is Camille Catelo, and it has been a wonderful experience to serve as the first Vice President of NVNSA, I am delighted to have this opportunity to invite you to our exciting event: “Meet and Greet” with our board of directors and first annual convention to elect our next officers. The NVNSA 1st annual convention will be held on Saturday, May 11, 2019, at 12pm-4 p.m. at the Nevada System of Higher Education (NSHE) building located at 4300 S. Maryland Parkway in Las Vegas. Please join us if you want to learn about what we do, or have interest on how to get involved with community health events, breakthrough nursing events, and leadership opportunities. RSVP by May 3, 2019 at [email protected] to assist with planning this exciting event.
Additionally, we are also co-organizing the Nevada Nurses Association convention on September 14th, 2019. Please plan to attend this event if you would like to support NVNSA, the first state student nurses’ association chapter for Nevada. There will be keynote
speakers, poster presentations, opportunities to get Continuing Education (CE) credits, and fundraising silent auctions with raffles. There will be more information available soon. We look forward to seeing you all at our future events.
Thank you all for your support!
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Look on page 11 of RNFormation for answer!
Page 8 • Nevada RNformation May, June, July 2019
By Tracey Long PhD, RN, MS
Three years ago, Cassi Gonzales, RN and a few friends created a Healthy Athletes program for Special Olympics in Nevada. Nevada was one of the few states that didn't have a Healthy Athletes program in conjunction with the National Special Olympics program. Their goal was to have a health fair twice a year in northern and southern Nevada where special needs athletes could get physicals, meet with healthcare professionals for education, referrals, and various services. The services now offer screenings and education to the athletes to help promote a healthy lifestyle. The five programs are:
• Health promotion: a nurse-run program that offers education on nutrition, healthy living and exercise
• Med fest: offers physical exams for the athletes and provides referrals to specialists as needed
• Fun fitness: physical therapists teach stretches, balance and exercises• Strong minds: provides education on relaxation and stress control techniques • Special smiles: provides dental screenings, referrals and education on oral
hygiene
All of the clinical directors volunteer their time and have been trained by Special Olympics International on how to run their discipline. The growth in the programs have grown exponentially. In addition to the biannual health fair, they have started a fitness class where athletes can work with a fitness instructor weekly. Fitness challenges throughout the year are offered for athletes who may not be able to attend classes.
Cassi Gonzales - A Special Catalyst for Health
BINGOBLANKETSCANDYCOMFORTCOMPASSIONDIGNITYFAMILY
Dementia Word Search Puzzle
FEELHOLDHUGSLISTENMEMORIESMUSICPLAYRESPECT
SLEEPSLOWERSMILETEARSTIMETOUCHWARMTH
Gonzales humbly stated “When I first started volunteering for Special Olympics, my first thoughts were “I’m going to make such a difference in the lives of these athletes. I’m going to help them get healthier; I’m going to help educate them and I’m going to improve the quality of life.” It didn’t take me long to realize that while I was trying to change their lives, the athletes were changing mine. They have taught me to always do my best, to always be positive and encouraging to others, and to do my best to enjoy the moment that I’m in.” Bringing in new volunteers and showing them just how rewarding volunteering with Special Olympics can be is a special joy for Gonzales. They are always looking for new volunteers to serve as program directors and volunteers in any capacity to help the athletes and programs in Southern Nevada.
For more information about this program and to become a volunteer contact Cassi Gonzales @ [email protected] or visit the website for Special Olympics of Southern Nevada at https://www.sonv.org/
ANSWERS on page 13
May, June, July 2019 Nevada RNformation • Page 9
Denise Rowe DNP, MSN, APRN, FNP, BC
Post traumatic stress disorder (PTSD) is a debilitating mental disorder with a significant public health burden in the United States (US).1-2 Veterans are at heightened risk for PTSD due to military combat and exposure to other traumatic events.3 The prevalence of PTSD among US Veterans is estimated to vary between 5% and 32% compared to the annual prevalence of 3.5% among the general US adult population.4-9
The diagnostic criteria for PTSD includes an exposure to an actual or threatened death, serious injury, or sexual violence through: direct experience, witnessing, learning about traumatic events that occurred to others, or experiencing repeated or extreme exposure to the unpleasant details of the traumatic events.10 Several weeks or months after the events, individuals may experience intrusive symptoms (including flashbacks, nightmares and intrusive thoughts of the incident), avoidant behaviors (such as avoiding situations, people, stimuli that remind them of the traumatic event), negative mood including self-blame for the traumatic incident, isolation and detachment), and alterations in arousal (including hypervigilance, exaggerated startle response, poor sleep and concentration).10 People with PTSD can have other mental health problems - like depression, anxiety, alcohol and drug abuse. Consequently, these individuals are at risk for harming themselves or others.11
VA Southern Nevada Healthcare System provides a wide array of mental health services to Veterans with PTSD. These services include psychotherapies, medications and classes / support groups. Psychotherapies focus on techniques to address the underlying symptoms from traumatic events and are proven to treat PTSD.11
PsychotherapiesPsychotherapies are available to treat the symptoms of PTSD. Psychotherapies
include: • Prolonged Exposure Therapy (PE) – PE exposes individuals to the traumatic
thoughts, feelings and situations they are avoiding while helping them to manage their thoughts and feelings more effectively
• Cognitive Processing Therapy (CPT) - CPT teaches individuals how to identify traumatic thoughts and feelings and utilize techniques to change them
• Eye Movement Desensitization and Reprocessing (EMDR) – EMDR utilizes a specific sound or movement to trigger traumatic memories and work through the process of eliminating the associated negative thoughts, emotions, and feelings
MedicationsIn addition to psychotherapy, a variety of medications are available to treat PTSD.
While they are not the only pharmacotherapy available, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are types of antidepressant medications commonly used in treating depression and anxiety associated with PTSD.11 SSRI and SNRI control neurotransmitters (serotonin and norepinephrine) in the brain to relieve the symptoms of depression and anxiety by elevating mood and promoting a sense of well-being. Four SSRIs/SNRIs that are recommended for PTSD include Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac) and Venlafaxine (Effexor).
Support GroupsVA Southern Nevada Healthcare System offers many support groups and classes
to veterans with PTSD.
Classes / Groups Classes / Groups
(ACT Orientation) Introduction to Acceptance and Commitment Therapy
PTSD Phase I – Combat PTSD Group
ACT for Depression and Anxiety PTSD Phase I – Non-Combat Group
ACT for PTSD PTSD Phase I – Military Sexual Trauma
Mantra Repetition for Veterans: Meditation Techniques for Veterans with PTSD
PTSD Phase II – Military Sexual Trauma
Pathways to Recovery Group Evidenced Based Therapy preparation
PTSD support Group Imagery Rehearsal Therapy for Nightmares
HU Meditation and Guided Imagery for Healing and Peaceful Energy
Cognitive Behavioral Therapy for Insomnia
Anger Management Group Vet to Vet Peer Support Group
Managing Your Anger Recharge Group for Improving Sleep
Anger Management Series for Women Veterans
Pathways to Recovery – Women’s Peer Support Group
Women’s Mind Body Group Post Traumatic Growth Group
Winning Against Depression Brief Cognitive Behavioral Therapy for Depression
Tai Chi & Chi Gung Class Mindfulness Based Stress Reduction Group
Yoga for PTSD-Mind Body Group Therapy
PTSD Stress Management Group
Bass Guitar Group Acoustic Guitar Group
Veterans may schedule appointment for classes/groups at VA Southern Nevada Healthcare System by contacting:
• VA Medical Center PTSD Program: 702-791-9062• Veterans Recovery Center: 702-791-9060• Women’s Health Center: 702-791-9176 • Northwest Clinic Mental Health: 702-791-9020• Northeast Clinic Mental Health: 702-791-9050• Southwest Clinic Mental Health: 702-791-9040• Southeast Clinic Mental Health: 702-791-9030 • VA Medical Center Call Center: 702-791-9024
References:1. Alonso J, Petukhova M, Vilagut G, et al. Days out of role due to common physical
and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2011;16 (12):1234 –1246 . doi:10.1038/mp. 2010.101 PubMed
2. Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc.2009;18(1):23–33. doi:10.1017/S1121189X00001421 PubMed
3. Wisco BE, Marx BP, Wolf EJ, et al. Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2014;75(12):1338 –13 46 .
4. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295(9):1023–1032. doi:10.1001/jama. 295.9.1023-1032.
5. Kulka RA, Schlenger WE, Fairbank JA, et al. Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. Vol 18: Brunner/Mazel New York; 1990.
6. Dohrenwend BP, Turner JB, Turse NA, et al. The psychological risks of Vietnam for US veterans: a revisit with new data and methods. Science. 2006;313(5789):979–982. doi:10.1126/science.1128944 PubMed
7 Kok BC, Herrell RK, Thomas JL, et al. Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies. J Nerv Ment Dis. 2012;200(5):444–450.
8. Kessler RC, Berglund P, Delmer O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005; 62(6):593–602. [PubMed: 15939837]
9. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:617–627. [PubMed: 15939839
10. Diagnostic and Statistical Manual of Mental Disorders. (DSM-5®). Arlington, VA: American Psychiatric Association; 2013.
11. US Department of Veterans Affairs. Understanding PTSD and PTSD treatment. https://www.ptsd.va.gov/publications/print/understandingptsd_booklet.pdf. Accessed November 14, 2018.
VETERANS CORNERMental Health Services for Veterans with Post Traumatic Stress Disorder (PTSD)
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Visit www.bannerhealth.com.careers or contact Christen Files at [email protected] or 970.506.6539 to begin your Banner journey today!
Page 10 • Nevada RNformation May, June, July 2019
Many nurses who read RNformation are not members of the Nevada Nurses Association (NNA) or the nationwide American Nurses Association (ANA) and, before I continue, the question at hand is:
“What is your responsibility to prevent antimicrobial
resistance?”
ANA’s periodical, The American Nurse, published the article: “Strengthening nurses’ role in antibiotic stewardship” in October 2017. It begins; “The recent worldwide outbreak of Candida auris, a multidrug-resistant fungus, underscores the criticality of robust institutional and community-based antibiotic stewardship programs. Improving antibiotic use is a patient safety issue.” The article focuses on what nurses can do to halt antimicrobial resistance.1
The January 2019 edition of The American Nurse updated the ANA’s 2017 concerns and the cover photo/text defines Candida auris as an emerging threat. The accompanying article: “Nurses’ response to an emerging threat” emphasizes the potential dangers of multidrug-resistant (MDR) Candida auris as a new world-wide peril.2
Also, in January 2019 Lei Chen, Ph.D. Sr. Epidemiologist at the Washoe County Health District sent out a bulletin instructing: “If your healthcare facility is located in Washoe County, should you have any suspected case of Candida auris, please call us immediately at 775-328-2447.”
A Nurse’s ResponsibilityBy Norman Wright, RN, BSN, MS
Antibiotic Stewardship
HistoryAnyone who has followed this column since 2016
knows the problem of Antimicrobial Resistance (AR) is more extensive than the recent concerns with Candida auris, which is fungal not bacterial. Fungal Candida auris alarms go way beyond MRSA, VRE or other familiar MDR pathogens. Likewise, MDR organisms (meaning resistant to just three classes of antimicrobial agents) are now overshadowed by Carbapenem-resistant Enterobacteriaceae (CRE) that can be PDRO (Pan Drug Resistant) meaning resistant to all classes of antibiotics.
Recognizing AR is an ever-expanding global threat you may ask yourself - “What can one nurse do to avoid AR?” After all, you are a single person in a vast network of health care providers and, unless you are an APN, you cannot write an antibiotic order. You may feel powerless, so why try? Which brings us to one of the basic mandates of nursing – do no harm.
The May, 2016 edition of ANA’s The American Nurse includes the article “Antibiotic stewardship for staff nurses”3 which, under the heading of: “Role of the staff nurse” highlights these five actions:
1. Ensure pertinent information about antibiotics is available at the point of care
2. Question the antibiotic administration route3. Reassess antibiotic therapy in two to three days4. Review antibiotic therapy when your patient
develops a new C. difficile infection5. Reconcile antibiotics during all patient-care
transitions
To rephrase, the first action is: Obtain and communicate accurate information about your patient’s symptoms to the prescriber. I recommend using SBAR.
The second step, you must re-evaluate and question the prescribers’ initial antibiotic order, then three review subsequent C&S reports to determine if the antibiotic/antifungal is appropriate, or needed at all. Number 4 asks you to determine if an allergic reaction, or C-diff, develops. Finally, if the C&S report shows an antibiotic is not needed, or the bacteria is resistant, you must communicate this information to the prescriber and get the initial order changed.
Let’s get realReality is some prescribers do not want to be
questioned and any nurse who questions them gets bullied. When confronted by this type of behavior you have a decision to make, do you say, “I am sorry I will never question your order again,” or do you stand up and continue questioning?
If you adhere to the premise of “Do No Harm” it is your responsibility to continue questioning, which admittedly may be difficult. Depending on the politics of the institution you work at, raising concerns have been known to place a nurse’s job in jeopardy. But this is a topic for another day.
Back to basicsEach time you neglect to perform proper hand
hygiene you potentially cause harm. Likewise, if you observe someone failing to use proper transmission-based precautions (isolation), it does not matter if they are a nurse, visitor, RT, PT, CNA, or a physician, call them out because they place your patient at risk for infection.
Preventing an infection achieves two goals. Your patient was not harmed, and, if there is no infection there is no need to order an antibiotic.
Be observant, explore your environment and find items harboring germs. For example, let’s look at privacy curtains. The American Journal of Infection Prevention published a study on how quickly a bedside curtain gets contaminated. The study found that 14 days after freshly laundered hospital curtains were hung five of eight curtains were contaminated with MRSA.4
Now ask yourself - during patient care, did you ever realize the curtain was not providing enough privacy and you quickly close it with your soiled gloved hand? If yes you just contaminated the curtain. Later, before tending to the patient in the next bed you wash your hands, put new gloves on and again close the curtain! You have just contaminated your clean gloves with pathogens from the patient you previously cared for!!!
Cross-contamination happens that quickly. Explore your environment for other similar scenarios to resolve.
For additional information on preventing antimicrobial resistance go to www.nvasp.net – The website of the Nevada Antimicrobial Stewardship Program. We must preserve the power of antibiotics for future generations.
Become involved and join the American Nurses Association, which enrolls you in Nevada Nurses Association. These organizations provide resources that will promote your nursing career, and antimicrobial stewardship.
Citations:1) https://www.americannursetoday.com/nurse-role-
antibiotic-stewardship/ 2) https://www.americannursetoday.com/candida-auris-
emerging-threat/ 3) https://www.americannursetoday.com/antibiotic-
stewardship-staff-nurses/ 4) h t t p s : / / w w w. a j i c j o u r na l .o rg /a r t i c l e / S 019 6 -
6553(18)30155-X/fulltext
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May, June, July 2019 Nevada RNformation • Page 11
Lisa McKinney, BSN, RN
Cycling can be a fun form of recreation, exercise and transportation for the whole family to enjoy. However, cycling is not without risks. There were 840 bicyclists killed, in the United States, in 2016, (National Highway Traffic Safety Administration, NHTSA). Seven of these fatalities were in Nevada and accounted for 1.8% of total traffic fatalities (NHTSA, 2018). The Nevada Department of Transportation shows 58% of these accidents were in the roadway, 13% on sidewalks and another 13% in intersections (2017). The majority of bicycle related deaths and one-third of non-fatal injuries are related to traumatic brain injuries (TBIs). TBIs tripled when injuries happened to riders not wearing helmets. In 2012, over 80,000 bicycle related head injuries were treated in emergency departments across the US. Helmets have been shown to decrease the risk of severe head and brain injury by 63-88% (Graves et al. 2014).
AGE & GENDER RELATED STATISTICSWhile one might think children are the ones to
most benefit from helmet use, children accounted for only 7% of bicyclists killed in traffic collisions in 2016. In this same time frame, men accounted for 84% of bicycle fatalities. The largest group of men were 50 to 54 years old and 12% were 55 to 59. Men’s bicycle fatalities were 5.6 times higher than women’s (NHTSA, 2018). A study conducted between 1997-2013 reported 3.8 million bicycle injuries not ending in death. These numbers are thought to be just an estimate as only a fraction of accidents causing injuries are ever reported. The costs to society related to these statistics include medical costs, loss of work as well as life or quality of life. This study found the cost of non-fatal injuries to be $209 billion and fatalities $28 billion (Science Daily, 2017). Joseph et al. (2017) found that over $2 billion US healthcare dollars are spent on TBI’s annually.
CDC RECOMMENDS HELMETSThe CDC recommends the use of a properly fitted
helmet, when riding a bicycle, for all ages, to prevent head and brain injury in case of a crash (2017). Helmets not only protect against head and brain (TBI) injuries, which are the leading cause of morbidity and mortality, but other facial, ocular and dental injuries as well. Those wearing helmets during a wreck were found to have a 51% lower risk of TBI, 31% lower risk of facial fracture and 27% decrease in facial contusions and lacerations (Joseph et al. 2017).
HELMET SAFETY & FITFor helmets to be effective in protection, they must
be a Consumer Product Safety Commission (CPSC) approved helmet. The CPSC is the standard required by law, in the United States, for bicycle helmets. This standard was put in place by the government in 1994 and covers all helmets produced for the US, since 1999 (Bicycle Helmets, 2017).
The CPSC helmet must be properly fit and adjusted. If the helmet is not properly adjusted it is unstable and may wobble or rotate. Helmets are made with adjustable straps, many with an adjustment at the nape of the neck as well as under the chin affecting stability. Poor stability compromises the efficacy of the helmet on impact. In one particular study, children and adolescents were found to more often wear helmets incorrectly. The correct size, adjustments, angle or tilt and width of the helmet worn, was found to be detrimental in its effectiveness. The helmet should be adjusted to take out the instability, with straps fastened securely under the jaw.
It is worth seeking fit guidance from a bicycle technician, in one of the many sports or bicycle shops in the area. Sufficient helmet fitting was found in less than half of retail stores (Thai, McIntosh & Pang, 2015).
NURSES GET INVOLVEDNurses may get involved in one of the many school
bicycle programs or create bicycle safety programs where they do not exist. Nurses have a wide range of outreach to educate patients, families and schools within our communities. For example, one trauma center was instrumental in developing a program to keep kids healthy and safe in their community. The program consists of bicycle safety books, DVD’s, video games, classroom educational programs as well as organizing an interactive bicycle safety rodeo. The safety program provided patients presenting to the emergency department after crashing, safety awards for wearing helmets. The positive recognition reinforces safe behavior (Elwell, Kulp & McCue, 2014). Nurses may provide printable education brochures available at Nevada’s Source for Bicycling Information, BicycleNevada.com (n.d.): Kids Bicycling Guide https://www.nevadadot.com/home/
showdocument?id=3684 Kids Bicycling Guide in Spanish https://www.nevadadot.com/home/
showdocument?id=3686
Bicycle Safety
BE SAFE• Wear a Proper Fit Helmet• Wear Light Reflective Clothing• Be Aware of Your Surroundings• Know the Law (NRS 484B.760-783)
Bicyclists have the same rights and responsibilities as other drivers.
A Guide to Frequently Asked Questions https://www.nevadadot.com/home/
showdocument?id=3682 A Guide to Frequently Asked Questions https://www.nevadadot.com/home/
showdocument?id=3692
Grab your helmet, friends and family and get out there and ride Nevada!
ReferenceBicycle Helmet Standards. (2017). Retrieved from https://
helmets.org/standard.htm#CPSCBicycleNevada.com (n.d.). Nevada’s Source for Bicycling
Information. Retrieved from https://www.nevadadot.com/mobility/bicycle
Centers for Disease Control and Prevention. (2017). Bicycle safety. Retrieved from https://www.cdc.gov/motorvehiclesafety/bicycle/index.html
Elwell, S., Kulp, H. & McCue, J. (2014). Creating a comprehensive bicycle safety program. Journal of Trauma Nursing, 21(6), 309-313.
Graves, J., Pless, B., Moore, L., Nathens, A., Hunte, G., & Rivara,F. (2014). Public bicycle share programs and head injuries. American Journal of Public Health, 104(8), 106-111.
Joseph, B., Azim, A., Haider, A., Kulvatunyou, N., O’Keefe, T. Hassan, A., Gries. L. Tran, E., Latifi, R. & Rhee, P. (2017). Bicycle helmets work when it matters the most. The American Journal of Surgery, 213(2), 413-417.
National Highway Traffic Safety Administration. (2018). Bicyclists and other cyclists (DOT HS 812 507). Retrieved from https://crashstats.nhtsa.dot.gov
Nevada Department of Transportation. (2016). Public safety. Retrieved from https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/nevada_fy2017_ar.pdf
Science Daily. (2017). Soaring medical costs from bicycle accidents. Retrieved from https:www.sciencedaily.com/releases/2017/06/170601082236.htm
Thai, K., McIntosh, A. & Pang, T. (2015). Bicycle helmet size, adjustment and stability. Traffic Injury Prevention,16, 268-275.
NNA EHC Answers
puzzle on page 7
Page 12 • Nevada RNformation May, June, July 2019
Tracey Long PhD, RN, MS, MSN, CDE, CNE, CCRN
Nevada Nurses in the NewsJoyce Malaskovitz has been named the new CNO for
Desert Springs Hospital in Las Vegas, Nevada. She brings to the position a long legacy of leadership with the Diabetes Treatment Center at the hospital, which due to her leadership is the only accredited diabetes education program in Nevada. Her leadership in the Valley Health system will continue to promote the hospital’s accredited programs of CHF, Diabetes, Bariatrics, and Stroke care, which she also created. Desert Springs Hospital sent five members from the emergency department to Alabama this past summer for disaster training. Participants included (pictured) Travis Legrand, RN, ER manager, David Barrett, RN Clinical Supervisor, Brooke Backer, RN Joanne McCready, RN, and John Kay, EMT-P. After the Las Vegas October 1 shooting, emergency department personnel have received advanced training in triage tools to hazmat suit decontamination. “Personally, this was one of the most memorable educational experience I’ve had in my 13-year nursing career,” Backer stated.
National Nurses in the NewsLeading articles of nurses in the news nationwide
have featured stories of male nurses sexually assaulting patients in nursing homes. One disabled patient in a vegetative state in an Arizona nursing home facility gave birth, to the surprise of the nursing staff who were unaware she was pregnant as they responded to her labor. The father of the baby was confirmed by DNA tests to be a male nurse who worked with her. The Arizona Governor has called for severe investigation of such conduct. This issues a strong call to all nurses nationwide to honor the legal and ethical duty to honorably respect those entrusted to our care.
New York nurses won a hallmark legislation to be eligible for retirement benefits in a $20.8 million settlement. Male dominated professions described as “physically taxing,” such as plumbers and construction workers entitled them to early retirement after working
What are you doing now that energizes you in nursing? (At this question, he physically got excited and his demeanor was full of energetic passion)
I started a non-profit called $5 for Change and our goal is to give back essentials of housing and food to our homeless youth in Southern Nevada. We have coordinated community food and clothing drives with many volunteers who served Noah’s animal house, the Ronald McDonald House, Three Square, Whitney Elementary School, Shade Tree, Well Care clinic and hospital children’s drives for several years. If everyone in Las Vegas donated just $5/month that could support the funding to help end youth homelessness in our city. We’re offering them a hand-up not a hand-out.
To learn more how you can volunteer or donate go to: https://fivedollarsforchange.com/
Arlene Blanco: In-patient wound care coordinatorWhy did you want to become a nurse? I want to make a difference in people's lives. I
was inspired by the nurses that took care of my grandmother when she was hospitalized. I admired how they touched my grandma's life, and how those nurses look fulfilled in what they're doing - serving sick people.
What is your current nursing position? In-Patient Wound Care Coordinator. I went To
Emory University in Atlanta, Georgia for my Wound, Ostomy, Continence Nursing Program. I specialized in Wound care and I'm board certified in Wound Care and a member of the WOCN Society.
What do you love about nursing? It allows me to enjoy the rewards of serving people
while growing professionally and personally. If you could improve the nursing profession what
would you do? My message is for nurses to uphold their profession
and increase their awareness of their significant part in the health care team.
What is your advice to new nurses? Don't give up easily. The first few months may be
overwhelming but give yourself time to adjust to your new role. Respect the knowledge and long years of experience of the experienced nurses. Be a team player and always establish rapport with your patients and families and other health care team members.
What is your advice to experienced nurses of how to
stay in love with nursing? Always go back to the time how enthusiastic they
were to become nurses. Never forget that they were once a new nurse, so be supportive with the new nurses. You can also learn from them. Keep yourself abreast in the new trends of nursing by attending conferences, trainings and classes. It is helpful in updating and improving your knowledge and skills.
Share with us an uplifting story about how you
made a difference for good in a patient's life. There's actually a lot of them. I took care of a
non-English speaking patient who had a dehisced abdominal surgical wound. I've been managing the wound vacs for several months, so I established a good relationship with her and her family. The wound was healing slowly as she had other comorbidities and a nutritional deficit. I remember the first time I met her, she was extremely terrified. I was able to lessen her fears and she and her family trusted me. She always thanked me every time I change her vac dressing and that kindness from her touched me.
Nurses in the News
25 years by age 50. Nurses lobbied to be qualified equally as a profession for benefits and won triumphantly recognizing the very physical demands of nursing.
National nurse shortages still estimate thousands of nurses are still needed in all areas of nursing as the baby boomer generation ages and requires medical attention and more patients have access to health care due to the Affordable Care Act. Community and mental health are put at risk due to the shortage. An estimated 92% of emergency rooms report patient overcrowding and often hold patients in hallways on gurneys waiting for available rooms. Additionally, efforts are being made in multiple states to recruit more minority nursing students to better serve the nation’s growing diverse populations. Scholarships and grants are available through various organizations and nurses are encouraged to promote the nursing profession to the younger generation.
Celebrating Nurses in NevadaDavid Barrett and Arlene Blanco were nominated
by Desert Springs Hospital as exemplary in their fields and worthy of celebration. Getting to know these nurses will give you a sense of pride in nursing as our colleagues demonstrate excellence in their corners of our nursing world.
David Barrett: ER Charge Nurse What is your background in nursing? I began as a CNA, then LPN, RN and now BSN RN
for the past eight years. It’s been a long journey and I have learned so much.
How do you maintain positivity while working in the challenging setting of an ER?
I think if you remember that most people make the best decision at the time with the information they have, helps you not to judge, but just to help them when the decisions produce negative outcomes.
How do you help your ER team to be effective and positive?
I will always remember my ER charge nurse mentor who had significant things stolen from his home the day before. He would have been justified coming to work angry, but he came to work and moved on positively through the work day, because people needed him to be at his best. That really impacted me.
The Clark County School District located in Las Vegas, Nevada is currently hiring School Nurses.
Interested candidates should visit our website www.teach.vegas or call us at 702-799-5427 to learn more.
In CCSD, more than 320,000 students are served in a unique combination of urban and rural schools. We are searching the globe for individuals who have extraordinary passion, the keen ability to connect with students, and a relentless
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Registered Nurse Care Manager, FT/Regular ($69,264-90,043 per yr DOE) – 8-hr shifts, M-F; no weekends; signing bonus available; loan repayment available. Acts as patient care coordinator for outpatient clinical services and participates in patient and family education. Minimum Requirements: RN Licensure; driver license; Bachelor degree preferred; 1-2 years case management experience preferred. Open until filled.
For an application, job description, and additional information, contact:
K’ima:w Medical Center (an ambulatory, rural clinic), an entity of the Hoopa Valley Tribe, is seeking applicants for the following positions:
K’ima:w Medical Center, Human Resources, PO Box 1288, Hoopa, CA, 95546
or call 530-625-4261, ext. 211 or 226, or email: [email protected]
for a job description and application. Resume and CV are not accepted without
a signed application.
Nurses in Albany, NY demonstrating this past summer to pass a minimum staffing law, which passed. Source: Mike Groll/Associated Press
May, June, July 2019 Nevada RNformation • Page 13
Tracey Long, PhD, RN, MS, MSN, CDE, CNE, CHUC, CCRN
“I hate my body.” “Where did all these ugly gray hairs and wrinkles come from?” “How could anyone find me attractive when I look like this?” “My body is such a burden.”
If you’re like 97% of the American population, you’ve probably said something like this to yourself. According to a repeat survey done by Glamour magazine 30 years ago and updated in 2014, 54% of women are unhappy with their body and 80% claim the mirror makes them feel bad about themselves. Even men admit to body image angst; from 1997 to 2001, the number of men who had cosmetic surgery increased 256%. Unhappiness about body image has been reported among girls as young as age six. Clearly, we need to evaluate the messages the mirror is sending to us.
Mirror, mirror, on the wallAlthough many of us rely on mirror messages as the
absolute truth, we need to be aware of the inherent distortions the mirror may hold. Ever since 8,000 B.C., when the mirror made its first appearance, people have been evaluating their personal worth based on their physical appearance. Two opposite attitudes exist: Some people are fixated by their own faces, as shown by an obsession with “selfies.” Others declare their body hatred throughout the day as we often see on social media. We have a love-hate relationship with the mirror—but the mirror may not always tell the truth.
People with anorexia nervosa see a distorted view in the mirror; some view themselves as fat even though they’re dangerously thin. The mere act of focusing on something, such as a nose or a mole, may make it look larger in the mirror. Even your mood may affect the way you see yourself. When you’re tired, angry, or anxious, the mirror may reflect your emotions more than your true physical image.
What the mirror tells youRelying on the mirror to tell you “who is the fairest
of them all” may not give you the whole truth. Despite potentially negative messages people get from the mirror, it can provide helpful information. It can tell you a lot about both the outside and the inside of your body. Although we focus on our exterior image, the mirror can provide information about the internal health of your body.
Using your nursing assessment skills, take an objective look at your skin and hair. The skin, the body’s largest organ, can provide a lot of feedback on your sleep (or lack thereof) and nutrition. Without adequate vitamin intake or sun, your skin may be pale and flaccid; without adequate essential fatty acids, it may be dull or dry. Stress, overwork, and lack of purpose in your life may reflect in the empty eyes that stare back at you.
What the mirror doesn’t tell youShakespeare’s Hamlet exclaimed, “What a
piece of work is man! How noble in reason, how infinite in faculty! In form and moving how express and admirable! In action how like an angel! In apprehension how like a god!”
The mirror doesn’t tell you about the amazing functions of your body systems, or that you and your body are the most brilliant creations in the universe. For instance, your endocrine system is an amazing creation of numerous
autonomic functions working through feedback loops of chemicals to regulate many systems. It also balances your energy levels through the thyroid gland. When is the last time you thanked your adrenal glands for helping regulate your blood pressure via cortisol and aldosterone?
Thanks to auto-regulation, your body can maintain its temperature within the same general range even when the environment around it changes constantly. Breathing is controlled by tissues in your carotid arteries that track carbon dioxide (CO2) concentration and send messages to the brain’s respiratory center. Your body breathes faster or slower to eliminate CO2 as needed, all without your conscious awareness.
Your pancreas produces both insulin and glucagon, which naturally oppose each other, but work in harmony to balance blood glucose levels. These levels affect the function of all three trillion cells in your body. Your glucose level rises in the morning to awaken you and give your cells energy to start the day automatically. Somatostatin regulates the endocrine system, balancing insulin and glucagon to work in complete balance without your attention. When is the last time you thanked your pancreas?
The mirror also doesn’t tell you how well your liver detoxifies drugs and chemicals and maintains your blood glucose level when you’re asleep. Nor does it reveal that your immune system constantly monitors and patrols your blood for foreign pathogens, which it then kills through a complex chemical cascade. Does the mirror tell you that your spleen has been working hard to store white blood cells and recycle red blood cells? When did you last thank your spleen?
What the mirror doesn’t tell you about your magnificent self is far more interesting and exciting than the cellulite you may glimpse in the mirror. It doesn’t let on that your body has innate abilities, such as auto-regulation, self-defense, and self-healing. Your body has the ability to detect injury and immediately goes into repair. Your natural self-healing includes the inflammatory process and movement of white blood cells to the site of damage to destroy pathogens that may have caused or entered the injury. Your body moves gracefully through tissue repair and healing autonomically, usually. We often treat our bodies so poorly and then expect them to perform without our support. An example is giving our bodies Styrofoam (such as poor food choices) and expecting it to repair like steel.
The nursing reflectionIronically, some nurses who care for sick patients
and help promote health and healing are unhealthy themselves. Research shows that occupational stress, poor coping behaviors, and lack of support create anxiety and depression in nurses. The longitudinal Nurses’ Health Study, which began in 1988, examines relationships among hormone replacement therapy, diet, exercise, and other lifestyle practices and chronic illnesses. It found female nurses’ health was no better than that of the general populace. Ideally, a nurse’s health should reflect their education and knowledge
of the human body. Unfortunately, knowledge alone doesn’t create vibrant health. We should sing along with the Disney character Mulan, who asks, “When will my reflection show who I truly am?”
You’re invited to join the American Nurses Association campaign for action improving nurses’ health and wellness. For more information please visit http://www.healthynursehealthynation.org/ and view the free webinar on the grand health challenge for nurses at https://campaignforaction.org/webinar/improving-nurses-health-wellness/
As nurses, we can do better to reflect the true inner beauty of our bodies—and project that beauty in our lifestyles. Balancing the mirror’s messages is the key. What the mirror doesn’t tell you can inspire you to honor your body. What it does tell you can motivate you to care for yourself, so you can better model healthy behaviors for patients.
Fixing the mirror’s reflectionIn our society of quick fixes and limited warranties,
it’s easy—and often necessary—to replace just about everything. Most material objects can be replaced when they’re worn out.
The only thing that can’t be replaced is the human body. We can misuse and abuse it or treat it with loving care. Despite the amazing advances of medical science (and plastic surgery), your body is still your physical essence. Although it comes with a lifetime warranty, its quality isn’t guaranteed; that’s up to you. Our decisions can determine our destiny with health. Saying you don’t have time for your health today may leave you with no health for your tomorrow.
What does your mirror say to you? Will you listen?
AUTHOR BIOTracey Long is a Professor of nursing in Las Vegas,
Nevada for Chamberlain and Arizona College. As an identical twin, she regards her twin sister as her better reflection.
Selected referencesCoditz GA, Manson JE, Hankinson SE. The Nurses’ Health
Study: 20-year contribution to the understanding of health among women. J Women Health. 2009;6(1):49-62.
Dove® Campaign for Real Beauty. www.dove.us/Social-Mission/campaign-for-real-beauty.aspx
Enoch JM. History of mirrors dating back 8000 years. Optom Vis Sci. 2006;83(10):775-781.
Mark G, Smith AP. Occupational stress, job characteristics, coping, and the mental health of nurses. Br J Health Psychol. 2012;17(3):505-21.
Cleveland Clinic. Fostering a better self-image. Retrieve from http://my.clevelandclinic.org/health/healthy_living/hic_Stress_Management_and_Emotional_Health/hic_Fostering_a_Positive_Self-Image
American Nurses Association health nurses campaign. Retrieved from http://www.nursingworld.org/healthynurse
Song, M. and Iovannucci, E. Nurses Health Study. JAMA Retrieved from http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2016.0843
What the Mirror Doesn’t Tell You
Dementia Word Search Answers
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Page 14 • Nevada RNformation May, June, July 2019
Submitted by Rebecca Gebhardt, APRN FNEForensic Nurse Practitioner & DNP studentWashoe County Human Services Agency
As a nurse participating in the Infant Fatality Review Board for Sudden Unexpected Infant Death (SUID), the tragedy is close to my heart. The Washoe County Infant Fatality Review has two sections including community response to sentinel events and public health improvements and the internal investigation of the specific factors of the SUID; both contribute to defining areas to affect positive change.
Nevada, not unlike the rest of the nation, has experienced a tragic increase in infant mortality related to unsafe sleep practices. In July 2018, the Clark County Coroner’s office reported that, across all demographics, "unsafe sleeping conditions kills a baby every two weeks." The 2016 records confirm this sad reality with 31 deaths due to modifiable risk factors. Washoe County is not far behind averaging one per month in 2018. Providers that have experienced the tragedy of an
infant loss in their practice setting or personally could not express how painful this is to a family. The pain is compounded when modifiable risk factors, grounded in good intention, led to the infant’s death (Mejia, 2018).
The Center for Disease Control and Prevention (CDC) divides SUID into seven different categories including sudden infant death syndrome (SIDS), accidental suffocation, neglect or homicide, hypothermia and hyperthermia, metabolic disorders, poisoning, and the unknown or undetermined. Unlike the broad category of SUID, SIDS became a diagnosis in 1969 and to the present day, is recognized only as a diagnosis of exclusion. The criteria for SIDS is that an infant is less than one year of age, all of the modifiable risk factors eliminated, thorough autopsy and genetic testing yielding no other cause, and the clinical and death scene is devoid of suspicion. Only then can the diagnosis of SIDS be used. For those particular cases, there may be potentially applied scientific research relating to the serotonin levels in the medulla oblongata or hippocampus associated temporal lobe epilepsy (CDC, 2014).
Unsafe sleep practice is often passed down generationally or culturally misinformed by individuals that don't know or understand the risk factors. Often healthcare colleagues are among the misinformed due to the age of their children or lack of knowledge regarding the actual number of healthy infant deaths related to SUID. The acronym SIDS has been familiar for generations; unfortunately, there are multiple inaccurate interpretations. Recently, the National Association of Medical Examiners, American Academy of Pediatrics, the American Academy of Nurse Practitioners, and many other pediatric healthcare stakeholders, have taken a closer look at the differentiation and standardization of diagnosis between accidental smothering or mechanical suffocation and the thymic causes (Haynes et al., 2016).
This author plans a study that will examine suffocation related to unsafe sleep practices as this number is on the rise as the SIDS rate decreases. Common factors and scene findings include prone or side position, soft bedding, pillows of all shapes, water beds, couches, miss-
fitting mattresses, bed frame distance to the wall, larger person rolling over onto the infant, and creating a wedge with a body part. Anything that decreases or restricts the oxygenated environment in or around the infant’s face can play a role. There is also a risk of strangulation between bed rails and pumper pads. Fortunately, there is a hopeful movement in Nevada to create legislation banning the sale of bumper pads.
Bairoliya and Fink (2018) identified that over 7,000 full-term infants died in the U.S .between 2010 and 2012. SUID was the leading cause of full-term infant death. These authors concluded that lower maternal education regarding unsafe sleep was associated with a higher risk of dying from SUID and quoted "a substantial proportion of these deaths are preventable" (p. 2).
This author has developed a survey to identify gaps and bias of education delivery by role models such as nurses and social workers. The identification of these issues may help focus future efforts in Nevada on the education of providers, adjusting the present in-place systems, and shift collectively in awareness. The information gathered may add to the body of knowledge in classification and reporting; it may also improve trend monitoring and lead to design interventions ending healthy infant mortality related to unsafe sleep.
ReferencesCenter for Disease Control (2014). Sudden Infant Death.
https://www.cdc.gov/sids/data.htmBairoliya, N. & Fink, N. (2018). Causes of death and infant
mortality rates among full-term births in the United States between 2010 and 2012: An observational study. Journal of Pediatric Medicine 15(3) 1-14. https://doi.org/10.1371/journal.pmed.1002531
Haynes, R., Folkerth, R., Paterson, D., Broadbelt, K., Zaharie, D., Hewlett, J., … Kinney, H. (2016). Serotonin receptors in the medulla oblongata of the human fetus and infant: The analytic approach of the international safe passage study. Journal of Neuropathology & Experimental Neurology 75(11) 1048-1057. https://doi.org/10.1093/jnen/nlw080
Mejia, H. (2018, July 24). Clark County Coroner: Unsafe sleeping conditions kill a baby nearly every 2 weeks. https://www.lasvegasnow.com/...coroner...baby.../1320163673
Safe Infant Sleep Practices
May, June, July 2019 Nevada RNformation • Page 15
Hello Everyone!
The Nevada Nurses Foundation (NNF) is grateful for establishing a professional and charitable presence in Nevada, collaborating with individuals, educational and health care institutions, and community organizations as well as carrying out its mission. With the federal recognition as a 501(c)(3) non-profit organization status in October 2014, the NNF has since awarded $80,526.00 dollars to Nevada nurses, certified nursing assistants, licensed practice nurses, and pre-nursing students. Because of the generous and charitable donations from people like you, the NNF will award over $100,000.00 in awards by the end of this year.
Maria D’Errico, APRN, RN, NNF Advisory Board member; Community Outreach Coordinator and previous two-time scholarship recipient and Dave Tyrell, BSN, RN, NNF Executive Board member, previous NNA President share ways to support the Nevada Nurses Foundation (NNF). Through the generous support of our donors, the NNF has granted scholarships to more than 80 nurses and nursing students across the state. By becoming a scholarship donor you have an important role in supporting the professional development of nurses and increasing access to quality healthcare for Nevadans. You can also sponsor grants that support nursing professional projects, and recognize the achievements of your nursing colleagues by nominating them for one of the many awards that NNF offers.
If you are a previous NNF scholarship recipient there are many ways to show your gratitude and foster a culture of giving back to the Foundation. You can volunteer to serve on the NNF Advisory Board, where members collaborate on ways to advance the mission and vision of the Foundation. You can also help to increase awareness of the NNF by sharing our scholarship opportunities with nursing students, and identifying potential community partners to support the Foundation. There is no effort too small, and the NNF appreciates all of your support. Together we can work to support the professional development of our nursing community so that we can increase access to quality care for all Nevadans.
“The Nevada Nurses Foundation had a very productive year in 2018” asserts Dr. Glenn Hagerstrom, NNF Chief Financial Officer. According to Dr. Hagerstrom, the NNF received approximately $11,000 in donations specifically for scholarships and $1,670 in other donations in 2018. Approximately $44,800 was earned from fundraising events such as the Big Hat High Tea and the Shining Stars of Nursing dinner. These amounts demonstrate that only 22% of our revenue for the year came from donations whereas 78% of our revenue came from our own fundraising efforts. The Foundation awarded a total of $18,908 in scholarships and grants in
2018, which represented 73% of the total expenses for the year. The remainder of our expenses were for operational and fundraising event costs. With your support, we look forward to another successful year in 2019.
Please consider attending the Crowns and Tiaras Big Hat High Tea on Saturday, June 1st, 2019 at the Nevada Governor’s Mansion catered by Yerington’s The Bakery Gallery. Entertainment by the University of Nevada, Reno Music Therapy Foundation and pianist Landon Flournoy, BSN, RN. Tickets are on sale NOW for $50.00 per ticket, $500 per table, and an additional $10.00 for gluten-free. Last year, we sold out, so purchase your tickets ASAP. Doors open at 1:00 PM! Silent auction, raffle, fun times with friends and family, delicious food, wonderful entertainment, and supporting three Nevada Foundations!
The Shining Stars of Nursing in Nevada will be held on Saturday, October 12th, 2019 at the exquisite Blind Center of Las Vegas, Nevada. If you would like to participate in the planning of this one of a kind state-wide Nevada nursing and student nursing awards and recognition event, please contact [email protected]. The Shining Stars of Nursing in Nevada Student Nurse Event, is a free student event held in the morning of October 12, 2019. Vendor and Exhibitor opportunities are available to support student nurses in Nevada.
The NNF is the charitable and philanthropic arm of the Nevada Nurses Association and our mission is to increase access of quality health care for Nevada citizens by promoting the professional development of nurses through scholarships, grants, and recognition. Please help us increase quality health care and visit us on social media; like and follow us on Facebook, Twitter, Instagram, and LinkedIn. When shopping on Amazon Smile, please select the Nevada Nurses Foundation as your charitable organization and Amazon will make a donation to NNF on your behalf.
On behalf of the Nevada Nurses Foundation, thank you for your support and collaboration!
Thank you and have great days,Sandy
Sandra M. Olguin, DNP, MSN, RNPresident/Chief Executive OfficerNevada Nurses Foundation
“Success has nothing to do with what you gain in life or accomplish for yourself, it’s what you do for others.” ~ Danny Thomas
Nevada Nurses Foundation EST 2014
Development of Patient Enrichment Program (PEP) for Patients withPsychiatric Behaviors in Acute Care
Danielle C. Craperi, DNP, RN, CNML, CNLUniversity of Nevada, Reno
Dr. Stephanie DeBoor/DNP Project Advisor
e
Develop a Patient Enrichment Program (PEP) for acute care can help bridge the gap. PEP will offer education for nurses, a daily routine and therapeutic activities for the patients, since these things have all shown to help with the care of this population.
The population includes adults that exhibit mental health behaviors that are caused by a mental or medical illness. Diagnosis's may include anything from bipolar or schizophrenia to Huntington's or frontal lobe trauma
Introduction and Problem ProjectAcute care settings often have a treatment gap for patients
that exhibit behaviors of a psychiatric/mental health illness (PMHI). This treatment gap is related to lack of proper knowledge and/or programs to care for patients with PMHI. Due to limited community-based resources, patients with PMHI have extended length of stay (LOS) compared to those without a PMHI. 7.74% of hospitalized patients will experience an undesirable event. Increased LOS causes higher risk to experience conflict eventConflict events: Aggression, verbal abuse, dependency issues, self-harm, noncompliance with medication regime, HAI, Falls, elopements.
Results Continued
Results
Family style mealsDaily Routines
Floral arrangingIndividual Music Therapy
Social Skills Activities
ReferencesTo request references email Danielle Craperi at [email protected]
Tai ChiDaily Walks
Movie NightsArts & CraftsPet Therapy
Pre-Implementation Conflict Events
Month Number of Events
with Greater Than 14
Days LOS
Number of Events
Involving Population of Interest
Percentage of Events
Involving Population of
Interest
Jul-17 25 19 (19/25) 76%
Aug-17 24 16 (16/24) 66%
Month Number of Events with
Greater Than 14
Days Length of Stay
Number of Events
involving population of interest
Percentage of Events involving
population of interest
Sep-17 18 15 (15/18) 83%
Oct-17 22 17 (17/22) 77%
Nov-17 18 15 (15/18) 83%
There was a statically significant decrease in the number of conflict events after the implementation of PEP
Pre and post nurse evaluations showed that staff gained
knowledge from provided education.
Month Number of
Security Events
Percentage of Security
Events
Other Types
of Events
Percentage of Other Events
Jul-17 17 (17/19) 89%
2- Skin break-down
(2/19) 11%
Aug-17 8 (8/16) 50% 8- Falls (8/16) 50%
Month Number of
Security Events
Percentage of Security
Events
Other Types
of Events
Percentage of Other Events
Sep-17 12 (12/15) 80% 3-Falls (3/15) 20%
Oct-17 12 (12/17) 71% 5-Falls (5/17) 29%
Nov-17 12 (12/18) 80%
3-Falls (3/15) 20%
Pre-Implementation Types of Events Post Implementation Types of Events
Pre-Implementation LOS Post-Implementation LOS
Month Patients Average LOS at Time of Event
(Days)
Units Overall Average LOS
(Days)
Jul-17 64 6.48
Aug-17 80 6.8
Month Average Length of Stay
at Time of Event (Days)
Units Overall Average
Length of Stay
Sep-17 41 6.94
Oct-17 50 6.20
Nov-17 104 7.44
LOS increase due to more patients that fit criteria being transferred to unit, from 8 to 15 patients. This occurred because the PEP programs promotion throughout the hospital. • PEP was presented to Nursing Leadership• Fliers were distributed • Formal and informal communication about PEP was
developed to many nurses, CNA’s, hospitalists and psychiatrists.
Project, Goals and InterventionPost Implementation Conflict Events
PEP Activities
Goals
Music TherapyArt & Movement
TherapyChair Yoga
Meditation
