On the Cover
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JN This Month
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JN
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June 2013
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Vol. 113, No. 6
ajnonline.com
On the Web
AJN
’s Web site, www.ajnonline.com, offers access to current and past issues (from 1900 on), podcasts, article collections, news alerts—and much more. Bookmark our blog, Off the Charts (http://ajnoffthecharts.com), to read frequent updates and share your thoughts on what you see in your nursing world. Join us on Facebook (www.facebook.com/AJNfans), fol-low us on Twitter (http://twitter.com/AmJNurs), and be sure to download the new AJN app on your iPad.
WHAT WE’RE BLOGGING ABOUT
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“Good Medicine,” by Marcy Phipps, RN, describes how music was the best medicine for one patient recovering from a traumatic brain injury (http://wp.me/prthD-3Oo).
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In “The Hands of Strangers,”
AJN
clinical managing editor Karen Roush reflects on the Boston Marathon bombing (http://wp.me/prthD-3Ob).
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When should crucial conversations about death be had with critically ill patients? Oncology nurse Julianna Paradisi dis-cusses her ideas on end-of-life education in “Birdcages: An Oncology Nurse on Crucial Information Patients Need About Dying” (http://wp.me/prthD-3NB).
WHAT READERS ARE SAYING ON TWITTER, FACEBOOK, AND OUR BLOG
“My hospital has just created an order set called ‘Integrative Therapy.’ It includes choices like aromatherapy, massage, and Reiki. I am amazed!”
“I can only imagine what it might be like, confined to an ICU bed, unable to control the sounds assault-ing your ears.”
“I have seen much death and dying over my 30 plus years as a nurse and personally as a health care proxy. There is no tidy solution and I have yet to see a scenario that played out as I would have imagined.”
“I still think quality care goes back to being able to have reasonable debates across disciplines instead of shooting orders and lists at each other.”
JUNE PODCASTS
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Monthly highlights:
Listen to
AJN
editors discuss the contents of the June issue.
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Behind the article:
Editor-in-chief Shawn Kennedy speaks with
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the authors of “Assessing Sleep in Adolescents Through a Better Understanding of Sleep Physiology.”
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the authors of “Fracking, the Environment, and Health.”
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n our cover this month is a photograph of Washington County, Pennsylvania, resident Jenny Smitzer. The jar of contaminated tap water she holds turned that color af-ter drilling for natural gas began in 2005 above her farm. Smitzer still showers in that water, but it is undrinkable, so she must drink bottled water. This photograph is one of more than four dozen on the subject of hydraulic fracturing, or frack-ing, by photographer Les Stone that appear on the Web site Pho-todocumentary by Les Stone (http://lesstonepublishorperish.blogspot.com), where he also writes about the harmful effects that extraction of natural gas from deep rock formations has had on rural Pennsylvania. Eleven U.S. states currently engage in fracking, and eight more are either considering or preparing for this method of gas drilling. The gas-rich area called the Marcellus shale, which is located beneath parts of Pennsylvania, Ohio, New York, and West Virginia, is being targeted by energy companies for drilling. In June 2012, the American Nurses Association passed a resolution calling for a moratorium on new drilling permits for fracking because of concern over the technique’s poten-tially harmful impact on human health and the environ-ment. This resolution, titled “Nurses’ Role in Recognizing, Educating and Advocating for Healthy Energy Choices,” also called on nurses to become engaged in energy policy. For more on the potential health hazards caused by fracking, see “Fracking, the Environment, and Health” in this issue.—
Michael Fergenson, senior editorial coordinator
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ENVIRONMENTS & HEALTH
ajn@wolterskluwer.com
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June 2013
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Vol. 113, No. 6
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Fracking, the Environment, and Health
New energy practices may threaten public health.
M
elissa Owen became concerned when her 10-year-old son developed such severe nose-bleeds that she used tampons to stop the bleeding. Soon after, a blistering rash appeared on his skin, and his sister began having similar nose-bleeds. The Colorado family’s physician attributed these symptoms to air pollution caused by the use of hydraulic fracturing—“fracking”—to extract natu-ral gas in their community. He recommended they move.In northeastern Pennsylvania, the Micelles family thought signing a lease to allow fracking operations on their farm would relieve some of their financial burden. But within the first week of drilling, Elizabeth Micelles noticed a sweet odor and a metallic taste in her mouth; by the second week, she and her husband and three children were experiencing fatigue, dizzi-ness, vomiting, headaches, and nosebleeds. A visit to their NP and laboratory tests revealed that each had measurable levels of benzene, a known human car-cinogen, in their blood.These acute health problems are common among people living in communities in which “unconven-tional” oil and natural gas extraction, such as frack-ing, occurs. (These examples are composites based on the experiences of families affected by fracking as compiled by the Damascus Citizens for Sustainabil-ity.
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) Common symptoms or complications among people living near fracking sites include
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fatigue.
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burning eyes.
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dermatologic irritation.
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headache.
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upper respiratory (difficulty breathing), gastroin-testinal (severe abdominal pain), musculoskeletal (backache), neurologic (confusion, delirium), immunologic, sensory (smell and hearing), vas-cular, bone marrow (nosebleeds), endocrine, and urologic problems.
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the risk of endocrine disruption.
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changes in quality of life and sense of well-being. Longitudinal reports from long-term exposure to con-taminated air and water from gas extraction don’t exist, but anecdotal reports make clear that the re-moval of fossil fuels from the earth directly affects human health. It’s well known, for instance, that the combustion of fossil fuels emits greenhouse gases that contribute to climate change,
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and increased rates of asthma, cardiovascular disease, and lung cancer are all associated with our reliance on and use of fossil fuel energy, including coal, oil, and natural gas.
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Children are at higher risk than adults for develop-ing asthma and suffering complications from asthma owing to poor air quality, which can be caused by the burning of fossil fuels.
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As the population ages, older adults become more vulnerable to climate-related extremes in temperature and ambient air pollution from fossil fuels because of comorbidities and age-related changes, such as decreased respira-tory reserve and the slowing of cardiac compensa-tory mechanisms.
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Moreover, there are numerous occupational hazards for the fossil fuel extraction workforce, ranging from noise concerns
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to ma-jor injuries
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and respiratory irritants that result in chronic disease.
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Despite these health concerns and efforts to insti-tute a moratorium on fracking until its environmen-tal and health effects are better understood, the United States continues to rely heavily on fossil fuel energy. Currently, 36% of annual U.S. energy consumption is derived from petroleum, 26% from natural gas, 20% from coal, and 8% from nuclear sources, with only 9% supplied by renewable energy, such as wind and solar power.
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President Obama’s administra-tion has repeatedly emphasized its plan to continue development of all energy sources—including a sig-nificant expansion of drilling and fracking operations for natural gas and oil. Although the extraction of these nonrenewable sources of energy help the United States to meet its current energy demands and secu-rity needs, it’s critical that the human and ecologic health threats associated with fracking be better un-derstood and addressed.
FRACKING
Extracting natural resources trapped within the pore spaces of low-permeable rock, such as shale, typi-callyrequires drilling deep—up to 8,000 feet.
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Using a process called high-volume hydraulic fracturing, or fracking, areas of weakness and small fractures
By Ruth McDermott-Levy, PhD, RN, Nina Kaktins, MSN, RN, and Barbara Sattler, DrPH, RN
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