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Constituent member of ANA The mission of the Delaware Nurses Association is to advocate for the interest of professional nurses in the state of Delaware. The Delaware Nurses
Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.Quarterly publication direct mailed to approximately 12,000 RNs and LPNs in Delaware.
Volume 43 • Issue 4 November, December 2017, January 2018
Reporter The Official Publication of the Delaware Nurses Association
Nurses Need Rest
page 7
Healthcare Worker Safety in Home and Community Health
Sarah Lewis, RN
Beth Redfield, OTR/L Gale Moore Bucher, MSN, RN, CPHQ, COS-C, FABC
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371
Karen Avino, EdD, RN, AHN-BC, HWNC-BC
Dr. Karen Avino is an Assistant Professor of Nursing at the University of Delaware (UD) with over 42 years of experience in Maternal-Child Health, Administration, Community Health and Holistic Nursing. Karen is a board certified Advanced Holistic Nurse and a Health & Wellness Nurse Coach. She is a Reiki Master, Stress Management Instructor, Acudetox Specialist, HeartMath, Clinical Meditation, and Imagery Practitioner. She has taught Holistic Nursing and Integrative Health at UD for the past 19 years. Karen is a founding leader of the Delaware Chapter of the American Holistic Nurses Association. She is an author and editor of Holistic Nursing: A Handbook for Practice (2016) and Core Curriculum for Holistic Nursing (2014).
Dr. Avino is a national and international speaker on health promotion, self-care, and integrative health topics. Karen is a consultant helping healthcare organizations create optimal healing environments, integrate holistic nursing practice and develop integrative health centers. She is faculty for the International Nurse Coach Association providing education and supervision of nurses who wish to integrate a new way of being into their practice. Dr. Avino can be reached at [email protected]
President’s Message . . . . . . . . . . . . . . . . . . . 3
Welcome New & Returning Members . . . . . . 3
Using Mindfulness to Improve Quality of Life and Nursing Care . . . . . . . . . . . . . . . . . 4
Holistic Nutrition . . . . . . . . . . . . . . . . . . . . . 5
Yoga: A Body, Mind, Spirit Approach . . . . . . . 6
Nurses Need Rest . . . . . . . . . . . . . . . . . . . . . 7
Healthcare Worker Safety in Home and Community Health . . . . . . . . . . . . . . . . 9
Stepping Into a Culture of Safety . . . . . . . . 10
New Medicare Cards Offer Greater Protection to More Than 57.7 Million Americans . . . . 11
InsideDNA
REPORTER
Executive Director’s ColumnGuest Editor
Karen Avino
Welcome to the DNA Reporter with a topic focus on the Healthy Nurse. The American Nurses Association (ANA) has designated 2017 the Year of the Healthy Nurse. ANA defines a healthy nurse as someone who “actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing” (ANA, n.d.). If nurses care for themselves, they are the best role models, educators, and advocates of health, safety, and wellness to others. This focus came about as a result of the Nurses’ Health Study that found nurses’ health is worse than
Guest Editor continued on page 2
Sarah Carmody
Welcome to fall! One of the best times of the year. Where we gear up to give thanks and celebrate the holiday season. I would like to close the year by saying thank you! to the many members who serve on committees and the Board of Directors. Without their commitment to the work, DNA could not fulfill its mission and goals. A big thank you also goes out to our many members for their financial support.
Next year will be the Delaware Today Magazine’s fifth year of recognizing Top Nurses in our state. To participate could not be easier! Review the categories on the DNA website (www.denurses.org), consider a nursing colleague you feel best fits the qualifications for each category before voting, enter their name and contact information, your information and you’re done! There is even an available checklist for download to keep track of your selections. Voting closes February 5, 2018.
While DNA would appreciate having you as a member, DNA membership is not required for participation. The 2018 celebration of Top Nurses will be held at the Bella Vita at Cavaliers Country Club in Newark on May 17, 2018. Please take the time to show your support for your nursing colleagues by voting for them as a Top Nurse.
Start the new year off right! Update your membership information with DNA by logging on to “My ANA” at NursingWorld.org. From there, click on the link in the blue section in the middle of the page to “Modify Profile.” There you will be able to update your address, phone, email, and demographics. This will help assure that you are receiving all the information and alerts that are included as a benefit of membership. You can also update your information by sending an email to [email protected].
Also, stay connected to DNA on Facebook. Stories, information, and programs are posted here to keep you informed.
Best wishes for a beautiful, happy, and safe holiday season!
VOTING IS NOW OPEN!
SEE PAGE 8 FOR MORE INFORMATION
Page 9
Page 2 • DNA Reporter November, December 2017, January 2018
OFFICIAL PUBLICATIONof the
Delaware Nurses Association
4765 Ogletown-Stanton Road, Suite L10Newark, DE 19713
Phone: 302-733-5880Web: http://www.denurses.org
The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.
EXECUTIVE COMMITTEE
President TreasurerLeslie Verucci, RN, MSN, Felisha A. Alderson, CNS, CRNP-A, APRN-BC MSN, RN, CRRN
SecretaryChristopher E. Otto, BSN, RN, CHFN, PCCN, CCRN
COMMITTEE CHAIRS
Continuing Education CommitteeKathleen Neal, PhD, RN on Nomination Jon M. Leeking, MSN, RN
Professional DevelopmentMay Oboryshko, DNP, RN
LegislativeMembers of the Board of Directors
CommunicationsWilliam T. Campbell, Ed.D, RN
Karen Panunto, Ed.D, MSN, RN, APRN
Executive DirectorSarah J. Carmody, MBA
Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local associations.
Managing EditorsWilliam T. Campbell, Ed.D, RN
Karen Panunto, Ed.D, MSN, RN, APRN
The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Sarah J. Carmody, MBA @ [email protected].
Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.
Reporter
Published by:Arthur L. Davis
Publishing Agency, Inc.
http://www.denurses.org
Vision: Delaware Nurses Association is the leading voice, authority, and advocate for the nursing professional in the state of Delaware.
Mission: Delaware Nurses Association provides leadership for the nursing profession and promotes quality health care for consumers through education, advocacy, and influencing health care policy in the state of Delaware.
Goals: Delaware Nurses Association will:• Promote and lead the nursing profession
on issues and trends that affect professional practice
• Promote and support excellence for nurses in practice, education, and research
• Promote professional development and respond to the changing needs of nurses in Delaware
• Maintain and strengthen nursing’s role in client advocacy for consumer safety and quality healthcare
Updated July 2016
the average American. Factors such as obesity, increased stress levels, lack of sleep, workplace violence, and musculoskeletal injuries are some of the concerns. Participating in the Nurses’ Health Study allows researchers to examine a variety of variables, for example, it was found that the longer duration of rotating night shift work was associated with a statistically significant increase in Coronary Heart Disease risk (Vetter et al., 2016). Support the continued research on nurses and enroll in the confidential Nurse Health Study 3 at http://www.nhs3.org/
Nurses’ health is not only a national problem but a global phenomenon. Oyama & Fukahori (2015) reported that in Canadian nurses, there is a prevalence of specific chronic conditions such as back problems, migraines, and sleep disorders; European nurses report that they suffer from musculoskeletal disorders and mental disorders; and Japanese hospital nurses reported physical symptoms such as back pain, chronic sleep deprivation and chronic fatigue.
Nurses as caregivers sacrifice their own health and wellness to care for others both on and off the job. Given the daily stress of this profession, it is
important to make self-care a priority. Self-care is important to quality of life and overall well-being. Self-care enables nurses to effectively continue the day-to-day practice of healing and caring for others. The hope is this edition provides information to help guide or begin nurses in a self-care journey.
The ANA began the Healthy Nurse Challenge 2017 focusing on Quality of Life, Nutrition, Activity, Sleep, and Safety. This publication brings you information on each of these topics submitted by professionals in our state who have a special interest, additional training, or certifications in these areas. Some authors use their health promotion efforts and holistic interests within their job and others have a practice outside of their traditional work setting. Kathy Pisani, RN, AHN-BC, a nurse coach for the Women Supporting Women organization, discusses the importance of holistic nutrition; Kim Blanch, RN, LMT, AYS, HHC, in a private wellness practice and nurse in population health at Beebe Healthcare, discusses yoga as a body, mind and spirit approach to health; Sarah Lewis, RN, a BSN student and medical-surgical nurse for 3 years at Beebe Healthcare discusses the need for rest in nurses; and Beth Redfield, OTR/L and Gale Moore Bucher, MSN, RN, CPHQ, FABC of Christina Care Visiting Nurses discusses healthcare worker safety in community health.
Be sure to visit, http://anahealthynurses.com/Menu/Be-a-Healthy-Nurse.html for more Healthy Nurse resources and activities to start your journey to be a Healthy Nurse.
ReferencesAmerican Nurses Association. (n.d). I am a healthy nurse.
[Website]. Pfizer Canada, Inc. http://anahealthynurses.com/default
Oyama, Y. & Fukahori, H. (2015). A literature review of factors related to hospital nurses’ health-related quality of life. Journal of Nursing Management, 23, 661–673.
Vetter, C., Devore, E. E., Wegrzyn, L. R., Massa J., Speizer, F. E., Kawachi, I., Rosner, B., Stampfer, M. J., Schernhammer, E. S. (2016). Association between rotating night shift work and risk of coronary heart disease among women. JAMA, 315(16), 1726-34.
Guest Editor continued from page 1
Did you know the DNA Reporter goes to all registered
nurses in Delaware for free?
Arthur L. Davis Publishing does a great job of contacting advertisers, who support the publication of our newsletter. Without Arthur L. Davis Publishing and advertising support, DNA would not be able to provide the newsletter to all the nurses in Delaware.
Now that you know that, did you know receiving the DNA Reporter does not automatically provide
membership to the Delaware Nurses Association?
DNA needs you! The Delaware Nurses Association works for the nursing profession as a whole in Delaware. Without the financial and volunteer support of our members, our work would not be possible. Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels. The DNA works hard to bring the voice of nursing to Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education.
At the national level, the American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/regulators, supports continuing education and provides a unified nationwide network for the voice of nurses.
Now is the time! Now is the time to join your state nurses
association! Visit www.denurses.org to join or call (302) 733-5880.
November, December 2017, January 2018 DNA Reporter • Page 3
Leslie Verucci, RN, MSN, CNS, CRNP-A, APRN-BC
As winter is here, we need to consider the fol lowing when car ing for our patients. There are many illness that are just viruses not bacterial infections. The CDC and ANA wants reg istered nurses in the United States to know about the problem of antibiotic resistance and facilitate their embracing an expanded and clearly recognized role in hospital antibiotic stewardship programs (ASPs) and activities. The following has been taken from a White Paper put forword from both the Centers for Disease Control and the American Nurses Association. They note that the need to improve antibiotic use is fundamentally a patient safety issue. Like all medications, antibiotics have side effects. Patients exposed to antibiotics can develop a variety of adverse drug reactions specific to individual agents, such as nephrotoxicity. However, patients exposed to antibiotics are also at risk for a variety of unique adverse reactions due to the antibacterial effects of the drugs, which can indiscriminately alter a patient’s bacterial population (known as the microbiome). This disruption is known to increase risks for diarrhea, including a diarrheal super-infection caused by Clostridium (C.) difficile, which can be serious and even fatal. Moreover, there is growing evidence that disruption
President’s Message
Leslie Verucci
of the microbiome can lead to other serious adverse outcomes, such as sepsis. When patients have serious bacterial infections, like sepsis, the benefits of prompt antibiotic therapy outweigh the risks. However, when patients get antibiotics they do not need, they are put at risk for totally avoidable adverse reactions. Unfortunately, many studies done in every practice setting have shown that antibiotics are often used when they are not needed. Exposure to antibiotics also poses the additional risk of antibiotic resistance. This makes antibiotics unique in that their effectiveness wanes over time because bacteria inevitably develop resistance to them. Over the past several decades, antibiotic resistance has increased and spread dramatically throughout the world. The loss of effective antibiotic therapy jeopardizes not only the health of patients with infections, but also the capacity to safely deliver other medical care.
In a consensus statement from the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), and the Pediatric Infectious Diseases Society, antibiotic stewardship has been defined as “coordinated interventions designed to improve and measure the appropriate use of [antibiotic] agents by promoting the selection of the optimal [antibiotic] drug regimen, including dosing, duration of therapy, and route of administration.” Nurses are in the hospital, in the home, and in the community. As such, they can be educators, advocates, and ambassadors for widespread behavioral change to more vigilant antibiotic awareness in our society. An urgent need exists to engage nurses in front-line ASPs, as well as patient education efforts. The background
information and recommendations contained in this White Paper provide an outline for strengthening the role of nurses in antibiotic stewardship. With an estimated 3.6 million workforce, nurses represent a powerful voice and cohort, enhancing patient safety and minimizing the spread of antibiotic resistance. To see the full white paper, go to the Delaware Nurses Association Website at denurses.org.
Delaware Today Top Nurse voting has opened and will continue until February 5th, 2018. The Delaware Nurses Association works to promote and support the nursing profession throughout the state of Delaware regardless of practice setting. Delaware Today magazine is the lifestyle authority in the First State and helps readers make informed decisions to enhance their lives. Together Delaware Today magazine and the Delaware Nurses Association bring you Delaware Today’s Top Nurses. Top Nurses are featured in the May edition of the magazine to coincide with Nurses Week. Please consider someone you work with or had mentored you or has shown to be a great nurse and nominate them. All registered nurses in the state can participate. DNA membership is not required. See the DNA website to nominate your candidate. We have such a vast wealth of nursing in this state – lets show them off.
Also as we move into the winter months, I stole this paragraph from Web MD – 8 Winter Tips for Healthy Living. Whichever healthy steps you take this year – eating better, exercising more, saving – remember they’re an investment in you and your future. Bank a little more sleep this year. Set aside stressful differences. Stock a healthier pantry. Salt away ... a little less salt. It’s your body – and your future!
Welcome New & Returning MembersPamela Arango-Gallego Newark
Constance Ayang Dover
Deborah Bartell Newark
Sydney Baylor Bear
Tyairr Boyd Frederica
Shameka Brown Newark
Daintry Buckman Wilmington
Kimberly Cano Marydel
Allison Carbine New Castle
Karen Carmody Wilmington
Sharia Chancey New Castle
Alexis Cutonilli Newark
Deborah Dowling Wilmington
Karen Ellis-Brisbon Newark
Jeannette Gemignani Newark
Melanie Grier Camden Wyoming
Jennifer Henry Newark
Kimberly Holston Magnolia
Christopher King Dover
Sarah Lewis Milton
Janae Magnusson Newark
Michelle Michalowski Hockessin
Jessicah Michira Newark
Joseph Obasanya Bear
Sheila Payne Bear
Hannah Pilong Middletown
Kiernan Quay Rehoboth Beach
Elizabeth Rhodes Wilmington
Cheryl Richardson Middletown
Timah Ricketts Seaford
Kathleen Salati Middletown
Morgan Santone Harrington
Allene Sappington Newark
Jonathan Scott Wyoming
Lindsey Seedorf Milton
Amber Sharp Milford
Marlo Silverio Milford
Khaliel Slater Bear
Dawn Snyder Milton
Megan Sungail Avondale, PA
Patricia Thornton Rehoboth Beach
Fall into a GREAT new job!Visit our website below
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Page 4 • DNA Reporter November, December 2017, January 2018
Karen Avino, EdD, RN, MSN, AHN-BC, HWNC-BC
See Guest Editor for complete bio on page 1
Quality of Life (QOL) is defined as a multidimensional construct that includes the physical, mental, and social domains that can affect health over time (CDC, 2017a) and is assessed through happiness and life satisfaction tools. QOL is a Healthy People 2020 public health goal and is related to both chronic diseases (diabetes, breast cancer, arthritis, and hypertension) and their risk factors (body mass index, physical inactivity, and smoking status) (CDC, 2017b). Focusing on all the domains of QOL can be the bridge to a healthy and satisfying happy life.
Nurses who reported a low QOL also reported low satisfaction with their job and have a higher incidence of sick leave and earlier retirement (Wu, Li, Yang, Zhu, & Wang, 2012). Organizations would benefit by working to improve nurses QOL and maintain nurses’ job satisfaction (Duffield, Roche, Homer, Buchan, & Dimitrelis, 2014), as this can reduce turnover and burnout (Morrissy, Boman, & Mergler, 2013). It was reported that nurses who report lower satisfaction with their job, also provide lower quality care (Papastavrou, Andreou, & Efstathiou, 2014). These factors directly impact nurse and patient satisfaction as well as patient outcomes. Studies that explored found that the presence of work stress resulted in burnout or personal strain and had a negative effect on nurses’ Health Related Quality of Life (Wu, Li, Wang, Yang &Qiu, 2011).
Mindfulness InterventionsStudies suggested that mindfulness can be an
effective and inexpensive way to reduce symptoms of nurse stress and burnout, improve quality of life, increase self-compassion, and strengthen professional improvement and personal fulfillment leading to a higher level of life satisfaction and a better quality of service to patients (Pipe et al., 2009).
Mindfulness enables one to attend to experiences in a nonjudgmental and nonreactive way, which in turn helps cultivate clear thinking, equanimity, compassion, and open-heartedness (Ludwig & Kabat-Zinn, 2008). Through increased awareness, unhelpful habitual thoughts and behaviors can be recognized allowing for new and creative ways of responding that leads to a greater sense of emotional balance and well-being. The ability to recognize thoughts, emotions, and physical sensations of impending stress allows for a more adaptive response to stressful events.
Mindfulness intervention results show significant improvement in full attention; general health; mental well-being; life satisfaction; perceived stress symptoms; burnout; self-compassion; and better clinical practice in healthcare practitioners (Goodman & Schorling, 2012; Bazarko, Cate, Azocar, & Kreitzer; 2013; Smith, 2014). Foureur, Besley,
Using Mindfulness to Improve Quality of Life and Nursing CareBurton, Yu, and Crisp (2013) found significant improvement in overall health and in cognitive and emotional stress, as well as a more positive attitude towards life in mindful participants.
Quality of Life Nurses generally perceive their work as
meaningful (Grossman, Niemann, Schmidt, & Walach, 2004). Nurses face the challenge of finding the balance as wounded healers that allows them to resonate with their patients’ suffering without bringing suffering from their own lives into their patient care (Daneault, 2008). A misbalance leads to nurses being unaware of subconscious behaviors and leads to burnout and compassion fatigue. Teaching nurses self-compassion and self-care skills, to feel interconnected with other people, and to hold negative experiences with mindful awareness, is an important component that aims to reduce burnout and compassion fatigue.
Duarte, Pinto-Gouveia, & Cruz (2016) explored how self-compassion relates to different aspects of professional quality of life. It has been found that self-compassion may be an essential skill to prevent nurses from developing burnout and compassion fatigue (Raab, 2014). Self-compassionate people have psychological characteristics that make them more able to regulate their emotions and negative states and thus experience less compassion fatigue. There is an association between empathy and negative aspects of professional quality of life (Gleichgerrcht & Decety, 2013), and the effects of self-compassion on well-being (MacBeth & Gumley, 2012). Mindfulness has been shown to be an effective way not only to develop self-compassion (Birnie, Speca & Carlson, 2010), but also compassion for others (Wallmark et al., 2013).
An eight-week meditation program significantly improved nurses’ power and quality of life and found that positively perspective taking, empathic concern, and mindfulness and negatively personal distress were closely associated with compassion satisfaction (Chang et al., 2016). Another study found similar results for empathy and indicated that empathic feelings of concern for others in distress, with an understanding that those feelings are different from one’s own, and the ability to hold negative experiences in mindful awareness, seem to contribute to the positive experiences that come from caring for others (Gleichgerrcht & Decety, 2013).
Mindful based programs have reported to promote well-being in healthy individuals as well as in those with various clinical conditions (Zeller & Lamb, 2011). The effectiveness of these programs has been attributed to reduced sympathetic nervous system activation (Lush et al., 2009) increased activity in centers of the brain associated with positive emotions (Davidson et al., 2003) and improvement in working memory capacity, which is critical for cognitive and emotional regulation ultimately needed by nurses for awareness of potential clinical errors and increased empathy of patients (Pipe et al., 2009).
Mindfulness training, which cultivates a practice of being present in the moment, recognizing stressful situations when they arise, and responding to stress in an adaptive manner holds promise as a simple, inexpensive approach to reduce stress and improve quality of care and quality of life. Healthcare organizations, as well as individuals, could easily integrate mindfulness practice as a self-care activity before or after shifts, during unit meetings, and encourage taking breaks in an environment that promotes mindfulness. Focused grand rounds and conferences providing continuing education on self-care activities to improve quality of life are essential. There are a variety of mindful apps that are free for use, Stop, Breathe, Think; Omvana; Calm; Aura; and Insight Timer, and provide both short and long mediations depending to meet all needs. Improving nurses’ quality of life is essential to organizational effectiveness, improves nurses’ health, and the health outcomes of patients.
ReferencesBazarko, D., Cate, R. A., Azocar, F., Kreitzer, M.J. (2013).
The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal Workplace Behavioral Health, 28(2), 107– 133.
Birnie, K., Speca, M., Carlson, L.E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress Health 26(5), 359–371, http://dx.doi.org/10.1002/smi.1305
Center for Disease Control and Prevention (CDCa). Health
Related Quality of Life Concepts. Retrieved July 17, 2017 from https://www.cdc.gov/hrqol/concept.htm
Center for Disease Control and Prevention (CDCb). National Center for Health Statistics. Retrieved July 17, 2017 from https://www.cdc.gov/nchs/healthy_people/hp2020.htm
Chang, S. J., Kwak, E.Y., Hahm, B., Seo, S.G., Lee, D & Jang, S.J. (2016). Effects of a meditation program on nurses’ power and quality of life. Nursing Science Quarterly, 29(3), 227–234.
Daneault, S. (2008, September). The Wounded Healer: Can this idea be of use to us as family physicians? Canadian Family Physicians, 54(9), 1218-1219.
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-70.
Duarte, J., Pinto-Gouveia, J. & Cruz, B. (2016). Relationships between nurses’ empathy, self-compassion and dimensions of professional quality of life: A cross-sectional study. International Journal of Nursing Studies, 60, 1–11. http://dx.doi.org/10.1016/j.ijnurstu.2016.02.015
Duffield, C.M., Roche, M.A., Homer, C., Buchan, J. & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal Advanced Nursing, 70, 2703–2712.
Foureur, M., Besley, K., Burton, G., Yu, N. & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse, 45(1),114–125.
Gleichgerrcht, E. & Decety, J. (2013). Empathy in clinical practice: How individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One., 8(4). doi:10.1371/journal.pone.0061526.
Goodman, M.J., & Schorling, J.B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. International Journal Psychiatry Medicine, 43(2),119–128.
Grossman, P., Niemann, L., Schmidt, S. & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta- analysis. Journal Psychosomatic Research, 57, 35-43.
Ludwig, D. S. & Kabat-Zinn, J. (2008). Mindfulness in medicine. JAMA, 300(11). 1350-2. doi:10.1001/jama.300.11.1350.
Lush, E., Salmon, P., Floyd, A., Studts, J.L, Weissbecker, L. & Sephton, S.E. (2009). Mindfulness meditation for symptom reduction in fibromyalgia: Psychophysiological correlates. Journal Clinical Psychology Medical Settings, 16, 200-207.
MacBeth, A. & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32 (6), 45-552.
Meyer, S., Eilertsen, G., & Ytrehus, S. (2010). Meaningful work at nursing homes: Perspective of experienced nurses. Sykepleien Forskning, 5, 148–154.
Morrissy, L., Boman, P. & Mergler, A. (2013). Nursing a case of the blues: An examination of the role of depression in predicting job-related affective well-being in nurses. Issues Mental Health Nursing, 34, 158–168.
Papastavrou, E., Andreou, P., & Efstathiou G. (2014). Rationing of nursing care and nurse–patient outcomes: A systematic review of quantitative studies. International Journal Health Planning Management, 29, 3–25.
Pipe, T.B., Bortz, J.J., Dueck, A., Pendergast. D., Buchda. V., Summers, J. (2009). Nurse leader mindfulness meditation program for stress management: A randomized controlled trial. Journal Nursing Administration, 39(3),130–137. http://dx.doi.org/10.1097/NNA.0b013e31819894a0
Raab, K. (2014). Mindfulness, self-compassion, and empathy among health care professionals: A review of the literature. Journal Health Care Chaplain, 20(3), 95–108. http://dx.doi.org/10.1080/08854726.2014.913876
Smith, S. A. (2014). Mindfulness-based stress reduction: An intervention to enhance the effectiveness of nurse’s coping with work-related stress. International Journal Nursing Knowledge, 25(2), 119–130.
Wallmark, E., Safarzadeh, K., Daukantaite, D. & Maddux, R.E. (2013). Promoting altruism through meditation: An 8-week randomized controlled pilot study. Mindfulness 4(3), 223–234. http://dx.doi.org/10.1007/s12671-012-0115-4
Wu, S.Y., Li, H.Y., Wang, X. R., Yang, S.J., & Qiu, H. (2011). A comparison of the effect of work stress on burnout and quality of life between female nurses and female doctors. Archives Environmental Occupational Health, 66, 193–200. doi:10.1080/19338244.2010.539639
Wu, S.Y., Li, H.Y., Yang, S. J., Zhu, W., & Wang, X.R. (2012). The mediating and moderating role of personal strain and coping resource in the relationship between work stressor and quality of life among Chinese nurses. International Archives Occupational Environmental Health, 85, 35–43.
Zeller, J. M., & Lamb, K. (2011). Mindfulness meditation to improve care quality and quality of life in long-term care settings. Geriatric Nursing, 32(2):114-8. doi:10.1016/j.gerinurse.2010.11.006
November, December 2017, January 2018 DNA Reporter • Page 5
Holistic Nutrition
Holistic Nutrition is the awareness of everyday nutrition and eating habits for optimum health and well being. Healthy food should be consumed as close to its natural state as possible. Hallmarks of holistic nutrition include unrefined, unprocessed, non-GMO, organic, and locally grown whole foods. Most people do not consider that food can be used to maximize the potential for health benefits and even reverse dysfunction or disease. The concept of Holistic Nutrition requires an individualized approach, which takes into account the whole person, body, mind, and spirit. Hippocrates stated “Let food be thy medicine and medicine be thy food” (Gorski, 2015). Health promotion as the core of nursing practice includes educating patients on best eating practices.
We are what we eat, digest, and assimilate. Our modern day food supply has been dramatically altered, although our biological nutrient needs have not. Food manufacturers have altered our food to increase their profits and shelf life by using chemical additives, genetically modified organisms (GMO), steroids, and antibiotics that has changed our food supply. GMOs are any type of organism, plant, or animal whose genetic material has been manipulated through genetic engineering. GMO altered food has DNA from another organism, such as bacterium, plant, virus, or animal that does not normally occur in nature. This increases its herbicide tolerance to increase crop yield and financial gain. Great controversy surrounds GMO food based on it not being tested on humans prior to sale (Pusztai & Bardocz, 2006). Since the 1950’s steroids have been used in beef and sheep to help them gain weight faster. Antibiotics are routinely administered to animals raised for food to encourage weight gain, protect them from unsanitary living conditions, and counter effects of other treatments (Center for Food Safety and Applied Nutrition, 2011). Many consumers are not aware that the U.S. Department of Agriculture does not allow the use of hormones in raising hogs, chickens, and turkeys. As nurses we understand the outcomes of antibiotic resistance from continual exposure to antibiotics and the risk of breast and prostate cancer from hormones in our food.
Nutrition is the most basic human need, but it has become confusing and convoluted. Products are marketed to the consumer and make health claims such as “healthy and nutritious” but in reality they are “processed and insidious” with grave effects. There is a common but wise saying, “don’t eat what your grandmother would not recognize as food.” The bottom line is to be wary of any food that comes in a package and has ingredients that cannot be easily pronounced.
Good nutrition is integral to maintaining good health throughout the life cycle. It has a profound effect on disease prevention, health maintenance, and the aging process. For most people, even the modest weight loss such as 5-10 percent of total weight is likely to produce health benefits such as improvements in blood pressure, blood cholesterol, blood sugar, and sleep. Weight loss can also increase an individual’s energy level and physical activity, and improve mood and self-confidence.
Eating habits develop over the years starting during childhood. Children observe eating habits of family members which are often culturally related. Special occasions, such as holidays, trigger memories attached to specific foods. These foods tend to be high in fat and sugar. People tend to multi task and eat unconsciously when driving, watching TV, or working at their desks. Eating while distracted leads to many extra and empty calories. According to Outland, Madanat, and Rust (2013) “Beliefs and behavior patterns ‘Being stressed’, ‘having food within reach’ and ‘eating because everyone else is eating’ were given as reasons to override fullness” (p. 26).
These mindless and emotional eating patterns are very hard to break. Using mindfulness strategies while eating can help an individual change eating habits and improve diet. Having a designated place to eat such as a table will help to relax and improve the digestive process. Eating mindfully without distractions from TV or electronic devices and chewing thoroughly help reduce cravings, control portion sizes, and enhance the eating experience. Mindfulness Based Eating has been found to be an effective intervention for emotional eating (Levoy, Lazaridou, Brewer, & Fulwiler, 2017).
In the United States there is currently a health crisis with chronic diseases such as cardiovascular disease, stroke, type 2 diabetes, obesity, and metabolic syndrome. A National Institute of Health study found extreme obesity has reduced life expectancy up to 14 years (Oliveros, Somers, Goel, & Lopez-Jimenez, 2014). It is so common in adults and children that the World Health
Kathy Pisani, RN, HWNC BCKaren Avino, EdD, RN, MSN, AHN-BC, HWNC-BC
Kathy has 36 years’ experience in Acute Care (Critical Care, PACU, Ambulatory Surgery, Hospice), Population Health, and as a Holistic Nurse. She was instrumental in developing a Holistic Team at Good Samaritan Hospital in N.Y. with the guidance of Jean Watson. Kathy graduated from College of Staten Island. She completed the Integrative Healing Arts program through the Birchtree Center for Healthcare Transformation; the Integrative Nurse Coach Certificate and Advanced Nutrition programs through the Integrative Nurse Coach Association. Kathy is certified in Ambulatory Care, Holistic Nursing and as a Health and Wellness Nurse. She worked as a Nurse Coach for Beebe Healthcare, and is currently volunteering as a Nurse Coach and Mentoring Coordinator for Women Supporting Women organization. Kathy can be reached at [email protected]
Kathy Pisani
For Karen Avino’s complete bio See Guest Editor on page 1
Organization characterizes this condition as a global epidemic. Oliveros et al. (2014) suggested that if the government took firmer action, regulations could help to prevent people from becoming overweight or obese which may ultimately lead to conditions with serious long-term consequences such as diabetes, heart diseases, and cancer. Debate continues over the most efficient “diet” for weight loss and overall health. The newest thoughts are on “healthy eating” in general. Teaching healthy nutrition early in life will help to prevent complications from developing and result in reduction of chronic disease and healthcare costs. As nutrition research and information reach the public, there is a hunger for a new paradigm that explores and examines the relationship between nutrition and disease.
As nurses increase their knowledge of nutrition they can coach patients in their lifestyle and nutritional choices decision-making process using coaching strategies such as motivational interviewing and appreciative inquiry. When coaching a patient it is vital to explore how beliefs, attitudes, eating patterns, and food choices are influenced by one’s cultural, physiological, psychological, emotional, spiritual, genetic, socioeconomic, and environmental dimensions that guide choices and behaviors.
Dossey, Luck, & Schaub (2015) stated some powerful questions for nutritional exploration are:
• What does healthy eating mean to you?• What do you need to nourish your mind, body and spirit?• How do your emotions affect your eating choices and patterns? • How often do you focus on eating without doing other activities at the same
time? • What are your biggest challenges to change the way that you eat?
We live in a world where nutritional information is overwhelming. There are numerous books advertised, and friends and family claiming success of various diets. Diets alone are not enough for most people to make long lasting health changes. Effective nutrition programs integrate coaching skills as a highly individualized approach to shift long-term eating patterns into healthy lifestyle behavior change. Increasing self-awareness of how foods affect health and wellbeing are the key to sustained change.
Health Promotion is a core role in nursing practice. Nurses are in a prime position to guide and motivate not only individual patients toward healthy lifestyle behaviors but also our communities. Nurses must advocate for public health initiatives to educate and encourage bringing “whole, real, and fresh” food home to nourish our body, mind, and spirit. Nurses have the opportunity to be the role models to others for healthy nutritional patterns.
ReferencesDossey, B. M., Luck, S., & Schaub, B. G. (2015). Nurse coaching integrative approaches for
health and wellbeing. North Miami, FL: International Nurse Coach Association.Center for Food Safety and Applied Nutrition. (2011, November). Everything Added to
Food in the United States. Retrieved July 19, 2017, from https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm115326.htm
Fagan, J., Antoniou, M., & Robinson, C. (2014) GMO Myths and Truths. London: Earth Open Source. Retrieved from: http://earthopensource.org/wordpress/downloads/GMO-Myths-and-Truths-edition2.pdf
Gorski, D. H. (2015, June 1). Let Food be thy medicine & medicine by thy food? The obsessive worship of medical foods. Retrieved from: https://sciencebasedmedicine.org/let-food-be-thy-medicine-and-medicine-be-thy-food-the-fetishism-of-medicinal-foods/
Levoy, E., Lazaridou, A., Brewer, J., & Fulwiler, C. (2017). An exploratory study of Mindfulness Based Stress Reduction for emotional eating. Appetite, 109124-130. doi:10.1016/j.appet.2016.11.029
Oliveros, E., Somers, V. K., Goel, K., & Lopez-Jimenez, F. (2014). The concept of normal weight obesity. Elsevier, 56(4), 426-433. Retrieved from: http://www.sciencedirect.com/science/article/pii/S003306201300176X
Outland, L., Madanat, H., & Rust, F. (2013). Intuitive eating for a healthy weight. Primary Health Care, 23(9), 22-28. doi:10.7748/phc2013.11.23.9.22.e754
Pusztai A, Bardocz S. (2006). Biology of Nutrition in Growing Animals. Mosenthin R, Zentek J, Zebrowska T, (eds.), GMO in animal nutrition: Potential benefits and risks. (pp. 513–540) Elsevier.
United States Department of Agriculture (2015, August 10) Food safety and inspection service. Retrieved from: https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/food-labeling/meat-and-poultry-labeling-terms/meat-and-poultry-labeling-terms#15
Wesley College Department of Nursing
is celebrating 50 YEARS of Nursing Excellence!
* BSN* RN to BSN/MSN
Dual Degree* Online Post-Master’s
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Page 6 • DNA Reporter November, December 2017, January 2018
Yoga: A Body, Mind, Spirit ApproachKim Blanch, RN, LMT
Karen Avino, EdD, RN, MSN, AHN-BC, HWNC-BC
For Karen Avino’s complete bio See Guest Editor on page 1
The benefits of yoga span the entire human dimensions of the body, mind, and spirit. Studies on the benefits of yoga have shown its efficacy in the reduction of stress-related symptoms as well as establishing its ability to prevent, reduce, or alleviate structural, physiological, emotional, and spiritual pain, suffering, or limitations (Woodyard, 2011). Yoga continues to be widely used as a self-care tool practiced by millions of people globally. It is important for healthcare providers to possess knowledge of the fundamentals of yoga and its many therapeutic effects not only for patient care but also for self-care. This article will focus on yoga’s impact on stress, anxiety, and chronic pain, and associated symptoms of cancer treatment among other conditions.
HistoryYoga, a tradition over 3,000 years old, is recognized by the National Center
for Complementary and Integrative Health (n.d.) under the National Institutes of Health as one of the top 10 Complementary health approaches used in the U.S. and is commonly regarded as a holistic method for health promotion. The word yoga comes from Sanskrit, the language of the Hindu culture. Translated to English, it means yoke or union of mind, body, and spirit. Patanjali, an ancient Hindu sage, defined yoga as an 8-limb path and taught a progressive path of practices: yamas, the universal ethical principles; niyamas, the individual self-restraints; asanas, the physical postures; pranayama, the breath/energy regulating techniques; pratyhara, control/quieting of the senses; dharana, the aspect of concentration; dhyana, the meditation practices; and samadhi, the state of elevated consciousness (Satchidananda, 2012). Engaging the principles of these components is believed to bring an individual to a state of mental, physical, emotional and spiritual balance.
Stress and AnxietyThe morbidity and mortality due to stress-related illness is alarming.
Emotional stress is a major contributing factor to the six leading causes of death in the United States: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver, and suicide (Salleh 2008). Statistics from the American Institute of Stress (AIS) (2017) reported that 77% of U.S.
Kim began her health and wellness career at Baltimore School of Massage over twenty years ago. She pursued her ADN at Southern Maine Technical College and began her nursing career at Mercy Hospital in Portland, Maine. In her time there Kim represented Massage Therapy on the hospital’s Integrative Health Board, as well as Peggy Huddleston’s ‘Prepare for Surgery, Heal Faster’ program. Her interest in mind body therapies led to intensive studies in Myofascial Release, Healing Touch, Health Coaching, and Ayurveda Yoga Specialist certification. Kim now lives in coastal Delaware, operates a thriving wellness practice and enjoys her nursing role in a patient-centered, transitional care program in Population Health at Beebe Healthcare. Kim can be reached at [email protected].
citizens regularly experience physical symptoms caused by stress, and 73% regularly experience psychological symptoms that are stress-induced. Fatigue was the number one symptom for 51% of those surveyed, and the annual cost to employers in stress related health care and missed work is noted as $300 billion (AIS, 2017).
It is the practice of the physical postures of yoga with which Westerners are most familiar, and what has been most often studied. Hayes and Chase (as cited in Diamond, 2011) found evidence that the regular practice of yoga helps reduce anxiety and stress. Yoga increases vagal stimulation and turns off the hypothalamic-pituitary-adrenal (HPA) axis, thereby decreasing the sympathetic nervous system’s stress response and increasing the parasympathetic nervous system’s relaxation response. Daruna (2012) reported that as the parasympathetic response is induced, heart rate lowers, respiratory rate decreases, blood flow is directed toward the organs, and serotonin and dopamine levels rise. This creates a state of rejuvenation and cellular repair. Under stress, white blood cell counts are adversely affected. Given the importance of the body’s ability to use its natural killer cells in antigen production and disease prevention, Daruna (2012) suggested that managing stress is paramount to achieving an overall state of wellness.
It is common knowledge that nurses experience stress related symptoms that can lead to implications for patient care and work-life balance. Regular yoga practice was found to improve sleep quality and reduce work stress in staff nurses (Fang & Li, 2015). Alexander, Rollins, Walker, Wong, and Pennings (2015) reported that an 8 week yoga intervention with nurses found significantly higher levels of self-care and less emotional exhaustion and feelings of depersonalization. The American Nurses Association (ANA) Healthy Nurse Healthy Nation Challenge 2017 encourages nurses to include physical activities in daily living. Yoga will care not only for the body, but the mind and spirit of the nurse as well.
Chronic PainStudies have shown that asana (a sitting posture), meditation, or a
combination of the two reduced pain and disability while improving flexibility and functional mobility in people with arthritis, Carpel Tunnel syndrome, back pain, and other chronic pain conditions (McCall, 2007). Chang, Hart, Sklar, & Groessl (2016) reported on yoga’s effect of pain medication frequency and dosage reduction in addition to enhanced gait function and mitigation of age-related gait changes. According to Chang, Hart, Sklar, Groessl (2016) yoga can reduce pain and disability, can be practiced safely, and is well received by participants.
CancerYoga’s effects on cancer patients showed a decrease in post-chemotherapy
induced nausea frequency, intensity, anticipatory nausea, and anticipatory vomiting (Raghavendra, Nagarathna, Nagendra, Gopinath, & Srinath, 2007). A meta-analysis of 18 studies by Harder, Parlour, and Jenkins (2012) reported positive effects for treatment-related side effects in favor of yoga interventions, with the greatest impact on global quality of life scores and emotional well-being.
One of the main goals of yoga is to achieve tranquility of the mind and create a sense of well-being, feelings of relaxation, improved self-confidence, improved efficiency, increased attentiveness, lowered irritability, and an optimistic outlook on life. The practice of yoga generates balanced energy, which is vital to the function of the immune system (Arora, 2008). To date, research provides convincing evidence of yoga’s numerous therapeutic benefits and its potential to improve health outcomes.
ReferencesAlexander, G. K., Rollins, K., Walker, D., Wong, L., & Pennings, J. (2015). Yoga for self-
care and burnout prevention among nurses. Workplace health & safety: Promoting environments conducive to well-being and productivity. AAOHN, 63(10), 462 – 470. doi: 10.1177/2165079915596102
American Institute of Stress (AIS) (2017). Stress Research. Retrieved June 26, 2017 from https://www.stress.org/stress-research/
Arora, S., & Bhattacharjee, J. (2008). Modulation of immune response in stress by yoga. International Journal of Yoga, 1, 45–55.
Chang, D.G., Holt, .J.A., Sklar, M., & Groessl, E.J. (2016, January 1). Yoga as treatment for lower back pain: A systemic review of the literature. Journal of Orthopedics and Rheumatology, 3(1) 1-8.
Diamond L. (2012, March). The benefits of yoga in improving health. Primary Health Care, 22(2), 16-19.
Daruna, J. (2012). Introduction to psychoneuroimmunology. Burlington, MA: Elsevier Academic Press.
Fang, R. & Li, X. (2015). A regular yoga intervention for staff nurse sleep quality and work stress: A randomized controlled trial. Journal of Clinical Nursing, 24: 3374–3379. doi:10.1111/jocn.12983
Harder, H., Parlour, L. & Jenkins, V. (2012) Randomized controlled trials of yoga interventions for women with breast cancer: A systematic literature review. Supportive Care in Cancer 20(12), 3055- 3064. doi:10.1007/s00520-012-1611-8
Hayes, M., & Chase, S. (2010). Prescribing yoga. Primary Care, 37(1), 31-47.McCall, T. (2007). Yoga as medicine. New York: Bantam Dell/ Random House Inc. National Center for Complementary and Integrative Health. (n.d). Yoga as a
complementary health approach. National Institute of Health. Retrieved from https://nccih.nih.gov/news/multimedia/infographics/yoga
Raghavendra, R.M., Nagarathna, R., Nagendra, H.R., Gopinath, K.S., Srinath, B.S., Ravi, B.D., … Nalini, R. (2007). Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. European Cancer Care, 16, 462–74.
Salleh, M. (2008, Oct). Life event, stress and illness. Malaysian Journal of Medical Science, 15(4), 9-18.
Satchidananda, S. S. (2012). The yoga sutras of Patanjali. Buckingham, VA: Integral Yoga Publications.
Woodyard C. (2011, Jul-Dec). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49–54.
Kim Blanch
November, December 2017, January 2018 DNA Reporter • Page 7
Nurses Need Rest
Perhaps you’ve heard the idiom, “no rest for the weary.” This saying might accurately describe what many nurses today are experiencing: sleep deprivation and insufficient or ineffective rest habits resulting in chronic fatigue. Fatigue is associated with a decline in judgement and the ability to navigate situations; slowing of motor responses and reaction times; impaired mood and ability to effectively communicate; and weakening of ability to cope (Antill, 2016). In a recent survey, 85% of nurses claimed that work is heavily associated with fatigue and 98% of nurses stated that nursing is difficult, both mentally and physically (Brooks, 2017). In fact, 93% of the nurses surveyed also suggested feeling mental and physical fatigue at the end of a shift (Brooks, 2017). Research has identified that shift work can have negative long-term effects on health, especially healthcare workers who work night shifts. Brooks (2017) identified several key concerns amongst nurses related to working 12 hour shifts (versus 8 hours) that may potentially contribute to accidental patient harm, such as not being able to take breaks during shifts, lack of adequate sleep between shifts, and anxiety related to fatigue. A combination of any or all of these common occurrences can contribute to burnout and other physical or mental health problems.
Blasche, Pasalic, Bauböck, Haluza, and Schoberberger (2017) found strengthening the nurse’s
Sarah Lewis, RN
Sarah is a Clinical Nurse III at Beebe Healthcare in Lewes, Delaware. She provides inpatient care on a medical-surgical unit, specializing in the care of oncology/hematology patients. Sarah is an active part of shared governance within the workplace and is a part of several initiatives to improve patient care and staff satisfaction, espec ia l l y t h rough holistic research and practices. She is a graduate of the Margaret H. Rollins, School of Nursing and will complete her BSN degree from the University of Delaware this coming Fall. Sarah is a member of the Delaware Nurses Association and the Oncology Nursing Society. Presently, Sarah’s passion for holistic health allows her to serve her peers and her community through health promotion practices. Sarah can be reached at [email protected].
Sarah Lewis
intention to take a break during work may help increase rest-break behaviors to avoid the buildup of fatigue and distress over a workday. Presently, it is commonly known that on the job, nurses take a break at their own discretion. This means that work-related fatigue and well-being are also individually determined. However, if organizations want to enhance performance and well-being of their employees, policies should be made to ensure there is support available to encourage self-care and rest breaks during the workday.
The American Nurses Association (ANA, 2017) issued the grand challenge, Healthy Nurses Healthy Nation, and rest has been identified as a significant health domain. Themes featured on the nurse-led discussion boards included questions such as “what is rest?”, “why is getting adequate rest so challenging?”, “do you feel you get enough rest?”, “is your workplace conducive or supportive of obtaining adequate rest,” and the list goes on. While the ANA’s grand challenge has given a voice to nurses as they commit to empowering themselves to find the answers to these “rest” questions, it is important that nurses understand rest practices and have the resources available to obtain adequate rest consistently in a way that will improve their overall health.
There are many definitions, opinions, ideas, and concepts surrounding the topic of rest …it can lead people to wonder: is there a perfect recipe for rest out there? Nurses could be the first to admit that they need a “rest for dummies” crash course. While there probably isn’t a perfect way for everyone to rest, individualized best rest practices can be discovered and crafted into daily living.
There are three different types or classifications of rest, including total, passive, and active rest (Brandon, 2014). Total rest is most commonly associated with sleeping and going through R.E.M. cycles during sleep (Brandon, 2014). However, total rest can also include complete mental and physical rest from all activities such as working, exercising, watching television, or socializing; this type of rest allows the body to “reset” itself, promoting healing and cellular repair (Brandon, 2014). Passive rest, commonly associated with the term “relaxation” is associated with improved quality of life (Hogan, 2016). This type of rest causes our parasympathetic system (the system responsible for “resting and digesting”) to take charge (Hogan, 2016). During relaxation, thought processes are diverted, even if only for a short period of time, and can significantly reduce stress hormone levels in the body (Brandon, 2014). If an individual is fairly active, passive rest can simply be a change in activity such as finishing a run and then taking a yoga class. Other ideas to consider for passive rest include: reading, walking, listening to music, meditating, practicing mindfulness awareness, taking a shower or bath, or spending time with a loved one. Active rest can
be defined as a “reduction in work load” and is basically a planned slowing-down of normal daily activity (at work or during leisure time) (Brandon, 2014). Athletes might be familiar with active rest by means of designating significantly less intense workout day’s in-between high intensity work out days (Brandon, 2014). This same principle applies to everyone: engaging in active rest allows an opportunity for the body to re-energize and relax on planned “less busy” days so that health can be maintained amidst the more stressful, hectic days.
Ultimately, individuals need to find what works best for engaging in healthy self-care practices to achieve a state of contentment and relaxation. Though individuals tend to view rest as a “waste of time” and may associate rest with feelings of guilt, rest is as essential to the body as food; life cannot be sustained without rest (Atkinson, 2010). True relaxation is not a state of laziness; rather it is being proactive to continue to achieve a state of wellness and health in your body, mind, and spirit (Hogan, 2016).
Developing healthy rest habits is just as important as maintaining healthy sleep routines. Rest and sleep go hand in hand; it is important to any healthy lifestyle to develop healthy self-care practices within all the domains that Healthy Nurse Healthy Nation addresses (ANA, 2017). Together, as a community, nurses can continue to encourage and support one another as they join this movement to promote health through rest practices. Perhaps then nurses can reserve the nursing diagnosis of “self-care deficit” for their patients and become role models for “self-care adequacy.”
ReferencesAmerican Nurses Association (ANA) (2017). Rest. Retrieved
from https://engage.healthynursehealthynation.org/restAtkinson, L. (September, 2010). Why rest is as good as
sleep as long as you don’t just slob out in front of the TV. Retrieved from http://www.dailymail.co.uk/health/article-1313812/Why-rest-good-sleep-long-dont-just-slob-TV.html
Blasche, G., Pasalic, S., Bauböck, V., Haluza, D., & Schoberberger, R. (2017). Effects of rest-break intention on rest-break frequency and work-related fatigue. Human Factors, 59(2), 289-298. doi:10.1177/0018720816671605
Brandon, L. (November, 2014). Dr. Quiet’s three types of rest. Retrieved from https://chekinstitute.com/blog/dr-quiets-three-types-of-rest/
Brooks, M. (March, 2017). Nurses love what they do but battle fatigue, survey shows. Retrieved from http://www.medscape.com/viewarticle/879761
Christensen, D. (2016). Balance perfectionism and compassion with a meditation exercise. Retrieved from https://voice.ons.org/news-and-views/balance-perfectionism-and-self-compassion-with-a-meditation-exercise?utm_campa ign=Hea lthy%20Nurse,%20Healthy%20Nation&utm_content=52467135&utm_medium=social&utm_source=facebook
Hogan, K. (December, 2016). The different types of rest you need and how to get them. Retrieved from https://www.mindbodygreen.com/0-28061/the-different-types-of-rest-you-need-how-to-get-them.html
Page 8 • DNA Reporter November, December 2017, January 2018
Are you are a Delaware RN and have a friend or colleague worthy of recognition? Please take a moment to vote and tell your fellow RNs to vote!
VOTING IS OPEN TO DELAWARE RNs Now through February 5, 2018
VISIT: WWW.DENURSES.ORGand look under PROGRAMS for Delaware Today Top Nurses!
VOTING IS NOWOPEN!
Please join us we celebrate the honorees:Delaware Today’s Excellence in Nursing May 17, 2018 • Bella Vita at Cavalier’s Country Club in NewarkFor tickets and information, visit DelawareToday.com.
November, December 2017, January 2018 DNA Reporter • Page 9
Safety is a concern for all nurses; however, home and community health nurses have unique vulnerabilities and concerns. More than 500 Christiana Care Visiting Nurse Association (CCVNA) nurses, therapists, home health aides and medical social workers provide healthcare in patients’ residences throughout the state of Delaware. CCVNA staff provided more than 300,000 visits in 2016.
Knowledge of strategies for personal safety is important as well as understanding how an employee’s attitude about safety influences their risk for injury. Per the U.S. Bureau of Labor Statistics, in 2015 the recordable injury incident rate for education and health services was 4.0; the rate represents the number of injuries and illnesses per 100 full time workers. Half of these workplace injuries resulted in days away from work or transfer to another position. Workplace injury can result in pain, potential loss of income and inability to participate in work and family activities, and workplace injuries are costly to the employer. There are direct costs associated with the medical treatment of injuries, and indirect costs including loss of productivity, manager investigation time, and office resources as illustrated in Table 1. Staff members who experience a physical injury can have emotional repercussions, including traumatic stress disorder, anxiety, fear of future violence, and depression (McPhaul, Lipscomb, & Johnson, 2010). Staff who cannot reconcile these feelings may change jobs, further impacting agency cost.
Table 1: According to the Occupational Safety & Health Administration [OSHA] (2015), the average costs associated per injury type are listed below:
The Pet Threat Even the friendliest pets can become aggressive to a healthcare worker laying
hands on their owner. CCVNA has had success in reducing injuries caused by animals from seven to one in three years, using a multi-pronged plan. A pet securement policy was drafted and shared with staff and patients. It states, “Pets must be secured during VNA staff visits,” regardless of the temperament of the animal. Central Intake staff began asking if there were pets in the home during pre-admission calls and communicating that the expectation is for pets to be secured during staff visits. Employees were provided with information regarding the number of dog bites to increase awareness. In all instances, increased knowledge of potential dangers leads to heightened safety awareness.
Personal Ownership of Safety Awareness and ownership of personal safety are at the forefront of safety
awareness training in the industrial setting. The literature illustrated that employees’ safety awareness is one of the most important pillars of any successful safety system (Ismail, Doostdar, & Harunl, 2012). Without healthy employees, the work does not get done and customer needs are not met. Putting staff safety first is a challenge for both manager and employee, but is imperative.
It has become the standard at CCVNA to inform employees when there is an employee incident by any cause. Post injury “huddles” are completed to discuss the events leading up to and during the incident with the purpose to look for lessons learned. An email format entitled “VNA Learning” is used to share these lessons with effort to be engaging while still informative and maintaining
Healthcare Worker Safety in Home and Community Health
Beth Redfield is a Quality Specialist at Christiana Care Visiting Nurse Association and has been an occupational therapist for 28 years. Beth’s responsibilities include employee safety and performance improvement. She is currently working with Christiana Care’s Operational Excellence Department on a project to reduce employee injuries. Beth is an alumnus of the University of New Hampshire. Beth can be reached at [email protected] or at her desk 302-327-5272.
Gale Moore Bucher is the Director of Quality and Risk Management at Christiana Care Visiting Nurse Association. Gale is an alumnus of the University of Delaware where she also serves as adjunct faculty. Gale can be reached at [email protected] or at her desk 302-327-5341.
Beth Redfield, OTR/L Gale Moore Bucher, MSN, RN, CPHQ, COS-C, FABC
Gale Moore Bucher
Injury Type Direct Cost Indirect Cost Total Cost
Contusion $ 27,511 $ 30,262 $ 57,773
Mental Stress $ 30,947 $ 34,041 $ 64,988
Strain $ 33,140 $ 36,454 $ 69,594
employee anonymity. Since beginning the process to increase employee awareness of risks and colleagues’ injuries, the time between injury occurrences has doubled.
Community ViolenceHome healthcare workers may be exposed to potentially serious or even
life-threatening events in the community. Traditional safety measures used in institutional settings cannot be implemented in patients’ homes. In 2016, CCVNA convened a town hall meeting for employees to share their concerns about safety communities they serve. Concerns included:
• Parking time limits
• Street violence
• Substance abuse within the home
The Delaware Association of Home and Community Care (DAHCC) reached out with agencies to city police departments and mayors to discuss ways to reduce risk while providing care in the community. As a result, hangtags for the rearview mirror were developed with the DAHCC logo (a large red heart) and provided to employees working in the city areas. Jennifer Rittereiser, MPH, Branch Director, shared, “City police know to look for vehicle hang tags and will provide additional surveillance in neighborhoods at high risk for violence” (May 23, 2017). Police will also be more lenient with parking time restrictions, understanding that a start of care assessment may take more than two hours.
In addition, staff was made aware of the following safety measures:
• Exit the home if you feel threatened, fearful or unsafe.
• Wear uniforms and identification badges.
• If you are being verbally abused, ask the abuser to stop. If the abuse doesn’t stop, leave the home and notify your manager.
• Change visit schedule to a safer time of day.
• Weapons and pets must be secured during the visit.
• Keep your cell phone and car keys in your pocket.
• Be aware of exits and bathrooms. If unable to exit the home, staff may lock themselves in a bathroom while they call 911.
McPhaul et al. (2010) pointed out that the Home Visit Risk Scale can be used to assess risk for violence in home healthcare. The HVRS was developed based on three dimensions to predict risk: Decision latitude, psychological demands or workload, and social support. In this context, a healthcare worker’s ability to make safety decisions, such as leaving or not entering a home reduces the risk of being a victim. Safety meetings to discuss hazards and prevention provide social support that further reduces risk and associated stress.
Approaching Safety Culture Key components of a safety culture are management commitment and worker
participation. A robust safety program should include:
• Employee surveys to identify areas of risk and obtain feedback on current practices
• Prioritization of hazards
• Policies and procedures, reporting and tracking of injuries and near misses
• Safety training
• Social support such as a safety committee
• Functional communication devices
• Analysis of injuries to mitigate harm and identify prevention strategies
• Annual program evaluation (OSHA, 2016)
ConclusionBased on literature reviewed and the agency’s experiences, leadership
commitment to safety programming is critical to reduce injury risk and incidence. Injury rates fall when employees place personal value on safety habits and care for one’s self and others. We encourage you to consider your own habits and attitudes regarding safety culture at your workplace. We hope these ideas will help you achieve a healthier safety culture.
ReferencesBureau of Labor Statistics. (2016). Incidence rates of nonfatal occupational injuries and
illnesses by major private industry sector and selected case types 2013-15. Retrieved from https://www.bls.gov/news.release/osh.t07.htm
Ismail, Z., Doostdar, S., & Harun, Z. (2012). Factors influencing the implementation of safety management system for construction sites. Safety Science, 50 (3), 418-423.
McPhaul, K., Lipscomb, J., & Johnson, J. (2010, May). Assessing risk for violence on home health visits. Home Healthcare Nurse: 28 (5), 278-289.
Occupational Safety and Health Administration [OSHA]. (2015). Guidelines for preventing workplace violence for health care and social service workers. Retrieved from https://www.osha.gov/Publications/osha3148.pdf
Beth Redfield
Page 10 • DNA Reporter November, December 2017, January 2018
Reprinted with permission of The American Nurse
Retaining newly hired, competent nurses — whether new graduates or experienced RNs — is good for everyone: employers, staff, patients and the new employees, themselves. What is vital to their tenure, however, may be how they are transitioned into the workplace and whether the organization is committed to a culture of safety.
“Orientation is the first step in retaining nurses,” said Dennis Sherrod, EdD, RN, professor and Forsyth Medical Center Endowed Chair of Recruitment and Retention at Winston-Salem State University and a member and past-president of the North Carolina Nurses Association. “Although it’s difficult when working with a large group of new employees, it’s important that the orientation be nurse-centered, meaning individualized as much as possible to their needs, that there is a mentorship piece in place and that newly hired nurses are introduced to the culture of the workplace early on.”
Nurse turnover is an ongoing issue — with some health care facilities faring better than others. According to the 2016 National Healthcare Retention & RN Staffing Report by Nursing Solutions, Inc., (NSI) the turnover rate for bedside RNs rose to 17.2 percent in 2015, an increase from 16.4 percent in 2014.
According to a 2014 article in Policy, Politics, & Nursing Practice, New York University College of Nursing Professor and researcher Christine T. Kovner, PhD, RN, FAAN, and colleagues reported that about 17.5 percent of new nurses leave their initial job within the first year.
Beyond the upheaval on units, nurse turnover is costly. The NSI Nursing Solutions, Inc., (NSI) report noted “the average cost of a turnover for a bedside nurse ranges from $37,700 to $58,400, resulting in the average hospital losing $6.6 million. (Some reports place turnover costs even higher.)
Offering smoother and safer transitionsAn overarching goal of Southeastern Health’s
orientation program is promoting a culture of safety in newly hired employees – both new grads and experienced nurses, according to Cynthia McArthur-Kearney, DHA, MSN, RN, NE-BC, manager of Education Services at the North Carolina hospital system and NCNA member. This is accomplished, in part, by using concepts outlined in TeamSTEPPS.
TeamSTEPPS is a system aimed at assisting health care professionals to provide higher quality, safer patient care by strengthening their skills around teamwork, communication, conflict resolution and eliminating barriers to ensuring the best clinical outcomes for patients.
All RNs going through the nursing services orientation are exposed to the program’s concepts, and all preceptors receive specialized TeamSTEPPS training so they can reinforce important concepts specifically to new grads during orientation and in their residency program.
“We don’t need to train new grads on how to insert catheters or change dressings,” McArthur-Kearney said. “Although the tasks are important, we want to teach them critical thinking. And the focus needs to be on safety. We need to make sure new grads – and all our nurses – understand what a culture of safety looks like and why it’s important.”
For example, preceptors working with new grads emphasize the importance of teamwork to achieving positive patient outcomes, understanding the roles of each team member, and how to communicate effectively with team members, including patients and their families. Role playing is often employed, such as learning how to have an effective conversation with a team member who may want to do a clinical task in an outdated way, explained McArthur-Kearney.
“To have a culture of safety, nurses also need to be aware of their environment, what’s going on around them,” McArthur-Kearney said. “So we emphasize that if a nurse sees a team member who is not filling a role during a code or who appears overloaded with an influx of patients, for example, that nurse must step up to ensure the best patient outcomes.” They also are taught how to identify
ANA NEWS
when a situation may be getting out of control, as well as de-escalation strategies.
Another important component of on-boarding at Southeastern Health is orienting all newly hired staff on concepts outlined in the hospital’s strategic pillars. These concepts focus on embracing a language of caring, being fully present when interacting with colleagues, patients and family members, and showing kindness, including through non-verbal cues.
Added McArthur-Kearney, these strategies not only help to create and maintain a culture of safety, but also help with staff retention.
Another approach to quality and safetyThe University of Alabama at Birmingham
Medical Center changed the way it conducted its orientation and residency programs for new hires about four years ago, according to David James, DNP, RN, CCRN, CCNS, who previously served as the advanced practice nurse coordinator for Clinical Nursing Excellence at UABMC and is an Alabama State Nurses Association member.
“Orientation used to be more of an inservice-type model with a lot of content and a ‘parade of stars,’ where staff from various departments were given a few minutes to discuss their roles,” James said. “Now we’ve moved to a different model, taking the Quality & Safety Education for Nurses competencies used at the UAB School of Nursing and using them for our orientation schema.”
Developed by nurse leaders involved in the QSEN initiative, the competencies address quality and safety education around patient-centered care; teamwork and collaboration; evidence-based practice; quality improvement; safety; and informatics. (Please see the QSEN Institute website at www.qsen.org.)
Each day of the UABMC orientation is linked to one of those core competencies, James said. And although having everyone understand that patient safety is essential, it’s extremely important that nurses know what systems are in place to support patient safety – whether it’s evidence-based practice or the use of technology.
In terms of structure, all newly licensed RNs attend the five-day orientation, which also addresses UABMC workplace culture, and then participate in a yearlong residency program to help ease their transition into practice and hardwire key competencies, according to Connie White-Williams, PhD, RN, NE-BC, FAAN, the director of UABMC’s Center for Nursing Excellence and an American Nurses Association member.
“Our onboarding process for experienced nurses beyond the orientation is unit-based and individualized to their needs,” she said. For example, a nurse who has 15 years in cardiac care and is hired onto a neuro unit should not be expected to take a full workload as quickly as someone who was hired onto a unit they have vast experience in.
Further, White-Williams added that about a month after their employment, she and Chief Nursing Officer Terri Poe, DNP, RN, NE-BC, meet with these experienced nurse hires to get their input about what went well, where improvements can be made and whether they feel welcomed. And experienced nurses, like new grads, are assigned preceptors who serve as an ongoing resource.
But to ensure a culture of safety and to retain staff takes more.
“We have probably 900 new nurses this year who we are trying to successfully orient and onboard,” White-Williams said. “We’re no different than anyone else in terms of trying to retain folks. It really does take a village to do this successfully, and it takes a lot of resources.”
A journey toward safety“We say let’s hire for attitude and train for skill,”
said Clyde A. Bristow III, MSN, RN, CENP, chief nursing officer at Wake Forest Baptist Health Lexington Medical Center and director of Clinical Education. “We can teach nurses how to insert an IV, but what we’re looking for are things like how does the nurse engage and communicate with patients, do they make them feel safe.”
Safety is an ongoing theme at WFBH. All newly hired staff must attend a four-hour program called Safety Starts Here within their first 90 days of employment, according to Bristow.
“We start early by weaving in culture of safety principles – those based on high reliability and best practices – throughout our [orientation and new grad residency] programs, and all newly hired nurses must integrate them into their care,” Bristow said. Those principles range from engaging in daily safety huddles to maintaining patient privacy to working collaboratively with all disciplines, and they are constantly reinforced.
All new hires also must commit to WFBH’s “patient and family promise,” according to Phyllis Knight-Brown, MSN, RN, WFBH clinical education manager and a member of the Association of Nursing Professional Development, an organizational affiliate of the American Nurses Association. That promise speaks to staff pledging to patients that they will keep them safe, care for them, involve them and their families in care, and respect them and their time.
“We also try to empower all our nurses to feel they can say, ‘I have a concern’ or ‘I need help,’ especially new nurses so they are not struggling alone,” she said.
Looking specifically at newly hired, newly licensed RNs, WFBH provides them with a yearlong, residency-type program called Journeys. It consists of a general and a unit-based orientation; a structured preceptorship; quarterly workshops, which include simulated practice and didactic sessions; and the opportunity to network and gain support from their co-hort. Workshop content is specific to new nurses’ units, however, the eight-hour sessions also cover issues such as stress management and self care, cultural competence and diversity, safety terminology and resources, patient instability, and shared governance.
“We have some flexibility in the program so we can tailor it more to the needs of our new nurses,” Bristow said. “We don’t want to find out on the 89th day that they don’t get along with their preceptor or haven’t learned how to do x, y or z. So preceptors and nurse managers meet often to determine where someone might need training. Then that nurse is placed in a situation where he or she can learn, which really benefits them as new nurses.”
WFBH also has a network of resource nurses, including preceptors, who can continue to provide guidance and information after the orientation and residency is complete.
Final commentsThere is no secret recipe to creating a good
orientation and onboarding program to retain competent and safety-focused nurses, according to Sherrod. However, it needs to be competency-based, nurse managers and staff need to celebrate and welcome new hires, and everyone should have a mentor.
Beyond orientation and residencies, retention also is dependent on factors such as workload, effective collaboration, strong professional practice roles and a healthy work environment.
“Having this retention culture is a way to help prevent a revolving door of new hires and strengthen an organization’s culture of safety and retention by providing nurse-centered orientations and work policies,” Sherrod said. “And retention is everyone’s responsibility.”
– Susan Trossman is a writer-editor for the American Nurses Association.
Stepping Into a Culture of SafetyOnboarding programs help retain nurses, strengthen patient care
November, December 2017, January 2018 DNA Reporter • Page 11
ANA NEWS
The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.
“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”
Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition
CMS testified on Tuesday, May 23rd before the U.S. House Committee on Ways & Means Subcommittee on Social Security and U.S. House Committee on Oversight & Government Reform Subcommittee on Information Technology, addressing CMS’s comprehensive plan for the removal of Social Security numbers and transition to MBIs.
New Medicare Cards Offer Greater Protection to More Than 57.7 Million AmericansNew cards will no longer contain Social Security
numbers, to combat fraud and illegal use
Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.
Work on this important initiative began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.
CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.
For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html
SILVER SPRING, MD – After more than eight years of dedicated and visionary leadership, ANA Enterprise Chief Executive Officer Marla J. Weston, PhD, RN, FAAN, has announced her resignation, effective January 1, 2018.
“We are indebted to Marla for her many years of stellar leadership, helping ANA gain the visibility and impact needed to be the premier organization for registered nurses, leading change and improving health for all,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “She has tirelessly led the Enterprise through bold transformative changes and guided us into new strategic directions.”
Since becoming CEO in 2009, in partnership with the ANA Board of Directors, Dr. Weston had led the integration of three entities, the American Nurses Association, American Nurses Credentialing Center and American Nurses Foundation, into an enterprise; strengthened the membership recruitment and retention infrastructure resulting in high growth; enabled greater coordination and impact in ANA’s advocacy work; and sharpened ANA’s focus on the programs and services it offers to nurses. These changes have built a stronger ANA Enterprise through increased strategic alignment and operational efficiency.
“It has been an honor and a pleasure to serve as the ANA Enterprise CEO,” said Dr. Weston. “I am
ANA Enterprise CEO Weston Announces Resignation
proud of how far the Enterprise has progressed and believe the time is right for me to step down. I remain deeply committed to and passionate about my profession and ANA. ”
Dr. Weston will continue in her full-time role until the end of the year, and is committed to supporting a successful transition for the new CEO. The ANA Board of Directors will engage in a search process to select the next CEO.
# # # The ANA Enterprise is the organizing platform
of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the American Nurses Foundation. The ANA Enterprise leverages the combined strength of each to drive excellence in practice and ensure nurses’ voice and vision are recognized by policy leaders, industry influencers and employers. From professional development and advocacy, credentialing and grants, and products and services through its Nursing Knowledge Center division, the ANA Enterprise is the leading resource for nurses to arm themselves with the tools, information, and network they need to excel in their individual practices. In helping individual nurses succeed—across all practices and specialties, and at each stage of their careers—the ANA Enterprise is lighting the way for the entire profession to succeed.
SILVER SPRING, MD – The American Nurses Association (ANA) is outraged that a registered nurse was handcuffed and arrested by a police officer for following her hospital’s policy and the law, and is calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.
The incident occurred July 26 at University Hospital in Salt Lake City, Utah and video footage of the incident was recently released. Registered nurse Alex Wubbels was arrested after refusing to draw blood from an unconscious patient who had been injured in a collision and was a patient on the burn unit.
According to the video, Nurse Wubbels shared details about the hospital’s policy with the police officers and consulted her supervisors in responding to the detective’s request. Wubbels cited the hospital’s policy, stating that blood could not be taken from an unconscious patient unless the patient is under arrest, a warrant had been issued for the blood draw, or the patient consents. The police officers stated that they had implied consent to get the blood sample and they believed that the hospital’s policy contravened their duty to enforce the law. However, “implied consent” has not been Utah law for more than a decade. Additionally, the U.S. Supreme Court ruled in 2016 that warrantless blood tests go against privacy interests and public safety and therefore are not allowed.
“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN, NEA-BC, FAAN.
According to the Code of Ethics for Nurses with Interpretive Statements, “the nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”
Unfortunately, nurses often are victims of violence on the job. In 2015, ANA adopted a policy of “zero tolerance” for workplace violence and called on nurses and their employers to work together to prevent and reduce the incidence of workplace violence.
“Nurses and police officers work collaboratively in many communities,” said Cipriano. “What occurred is simply outrageous and unacceptable. Nurse Wubbels did everything right. It is imperative that law enforcement and nursing professionals respect each other and resolve conflicts through dialogue and due process.”
American Nurses Association Calls for Action in Wake of Police Abuse of Registered Nurse
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