(COM leen eg tg ar: urs’ Bier Ao ir ee elu 4 } * is Sh. aa > p r e's , * ss _ y ie =e Pero rt raat BER gu ug Ce ee Coen Symptom Management Peon nie crac) Reducing Inpatient Falls‘By Maureen Shawn Kennedy, MA, RIN, FAAN, AIN Editor-in-Chief Email shawn.kennedya@wolterskiuwercom A Year of Migration and Heartbreak Conflict, crime, and economic insecurity are driving global migration. ing scene that has become all too familiar ‘ver this past year—that of refugees be- ‘ng blocked by border guards as they try to make their way from Arica and the Middle East to Eu- rope. Particularly distressing i the image of the 1wo Ose ‘eying children—one can only imagine what night- ‘mares will haunt them and the millions of other chil- séren caught in what many are calling the largest migration of people on record. (See On the Cover.) ‘The number of people displaced by conflicts hhas grown over the last decade and has escalated sharply in the last few years. “This was in addition to the nearly 40,000 families sho tried to-cross the border. [Nurses everywhere will be touched by these mass ‘movements of desperate people. In Europe, nurses have stepped in when governments failed to respond fast enough. In Austria, when the government was slow to organize relief, arses and ether volunteers helped set up a cnicto aid refugees at Vienna's main train station. And according to Franz Wagner, chiet ‘executive officer of the German nurses association, “Nurses all over Germany are volunteering to assist with the flood of refugees.” He added thatthe asso ‘According to the Office of the United Nations High Commis- sioner for Refugees (UNHCR), ‘in 2011 there were 10.5 million refugees, mosily from Afghani- stan, Iraq,and Somalia. By the end of 2014, that number had nearly doubled to 19.5 milion, There are now 59.5 million displaced people worldwide— surpassing forthe first time the 50 million people displaced after World War IL. The majority of refu- gees are now from Syria, and the UNHCR estimates that they constiate one-fourth of the world’s refu- gees, More than half are under the age of 18. While some nations have opened their borders and others say they will increase the numbers of peo- ple alowed to entes the November terrorist attacks in Paris and Mali have ed some governments and citizenry to fear that terrorists may be among the flood of refugees enering their country. Despite President Obama's commitment to take in at least 10,000 refugees over the next yeas, many US. gover- nors say they will not accept Syrian refugees in their states. And the U.S. Hoase of Representatives re- cently passed HR 4038, aso known as the Ameri can SAFE Act of 2015, requiring strict background checks before refugees from Syria or Iraq ean enter the country. ‘While it remains to be sen how many Syrian refugees will make it tothe United States, there's another refugee crisis closer to home —the info of undocumented immigrants from Latin America. According to a report by the Department of Home Tand Security's U.S. Customs and Border Protection, almost 40,000 unaccompanied children under the age of 17 were apprehended atthe border in 2015. sete lation has created two publ service posters condcraning ior AR ourses: tence and supporting open bor oer + Fee inthe United Stes th in the United States the Rowchedl By | cae of Calfona is lowe inal these mass | lowing health care coverage for ce - es etry Brown WE RROP eS | sigied legislation 9 provide coverage for ther children, 50 California nurses will be seeing more immigrants in health care settings. Elsewhere, most undocu- ‘mented immigrants will continue o rely on receiv- ing care in EDs or safery net hospitals. Tasked judith Oulton, chairperson of AJN’sin- ternational advisory board and the former executive director of the International Council of Nurses, ‘what nurses can do to help the refugees. She sad “Nase can advocate for te safety of refugees 25 ‘well as meeting their basic nceds. A year ago, the ‘govemiment in Canad introduced changes... .t0 end supplemental health care benefirs and coverage for ilinesses not deemed a ‘public safety risk’ for ‘nongovernment-asssted refugees, and nurses and doctors protested.” She also suggested that nurses “volunteer at clin- ics and camps providing care; manage narse-led ref- tagee health programs such a those in New South ‘Wales, Australia; help ensure that the policies in hhcath care facilities that support refugees are not discriminatory; and support community effonts to relocate ref Tn the midst of the ongoing U.S. politcal debate on immigration and what to do with the various groups of “them,” it might be wise for us to remember where ‘many of our families came from. At some point in our history, we were “them” W “ANN any 206 ¥ Vb 116 NO. 7AIN ~*~ American Journal of Nursing The Leading Voice of Nursing Since 1900 | Original Research: Examining the U.S. Latino RN Workforce [a Hypoglycemia in Older Adults with Diabetes Essential Oils in Nursing Practice | Addressing Nurse BullyingBy Maureen Shawn Kennedy, MA, RN, FAN, AJN Editor-in-Chief E mall: shawn kennedy@wolterskluwer.com un Violence as a Public Health Problem When will our outrage lead to action? fore last Decemiber, many people probably hnadnt heard of San Bemardino, California, “That changed when a couple opened fre in Sunt facili for adults with disabilies, killing people. Nor had many of us heard of Newtown, necicut, before December 14, 2012, when ang gunman entered Sandy Hook Elementary pool and killed 26 people—20 of them children. Jaws have changed litle, mainly because of the in- fluence bought by gun nights proponencs. This fac~ tion dais that tighter controls on legal gun purchases ‘won't affect criminal behavior because criminals ob- ‘ain their guns illegally. Ye a recent investigation by ‘the New York Times revealed that most ofthe guns {used in recent mass killings were bough legal. I ‘coms obvious that longer watt times and more exten- oa ofthese rows have joined the list of sive background checks could preven some potential vers we've come to recognize: Liicon, Colorado shooters from buying guns. feof the 1999 Columbine ‘ut the Notional Rifle Asso- gh School shootings Au ciation (NRA) has blocked re- ra, Colorado (site of the ‘We must ‘scarch on gun violence for years, 112 Century 16 movie the support ‘making it hard to determine cx shootings); and Blacks- \areabures: that mighe wodke to ede fire rg, Virginia (site of the 2007 dm deaths e's disheartening, ootings at Virginia tofund though unsurprising, that some lest Casuis tg research on | Preidenil candidate and ree sites roaled 57 deaths public figures continue $ wounded. And last year? gun violence. | go further the NRAS message. pimplce data arent in a5 1 For example, days ater the ores, ur according vo the Washington Posts San Bemardino killings, Senator Ted Cruz (R-TX) Taakblog by Ocrober I, there had already been told a crowd, "You don't sop bad guy by ting Or smn, shootings.” which it defined as four or away Our guns you stop bad guys by using Our ans” ore peopl killed oF wounded by gunfire. Gre wonders how many more unintensonal shoot Trae cbconngs are horicand prom much Ou ings wil omur as more people arm therseves. Ang age bur theyre respovibe for only aomallper- gi manufacturers are mein th ines demand entage of US. firearm deaths, An FBI report on 60 “active shooter” events between 2000 and 2013 ted that just 64 involved the killing of three or nore people. During the same time span, o the Centers for Disease Control and Prevention CDO) firearms accounted foc 417,583 deaths— 153,638 suicides and 163,945 homicides. [Research indicates chat U.S. fircarm faalites far sustip those in other countries, which points fo our paling inepeness ac adressng gun violence. Astady comparing US. firearm death rates in 2003 with those in 22 her counties found that che overall US. rate was more than seven times higher. The U.S. firearm homicide rate was 19 times higher, wile firearm ti- Gee and uintersicnal death rates were each over five times higher Fully 80% of all iearmn deaths in che 23 couneries thar year occurred her. ‘Maay peopl found the Sandy Hook shootings pecially heartbreaking, and hoped chs miehe spur hangs in US. gun contra laws. While a few sates cased laws prohibiting the sale of some assault ‘Recording to the Bureau of Alcahol, Tabacco, Fire- arms and Explosives, in 2010, there were 5.5 milion fiecarms manufactured in the United States another 2.8 million were imported. By 2013 chose numbers trad neatly doubled, 0 10.9 milion and 5.5 millon, respectively. “After the Sandy Hook shoosings the NRA missed 3 ‘huge opportunity to lead the developmen of reason able reforms. Ic could have followed the example set by the automobile industry, which, when rescarch showed tha seat bls and air bags caved ves, mod fied its vehicles to decrease fatalities, The NRA could have, but ie dda’. And despite polls showing that mone Americans favor stricter gun controll, many public's health, we must support measures (0 rees~ tablish funding for research on gun violence and its prevention, Another Sandy Hook must not be al- ae eer(oOMotset ry Tae neste Ce VA ~Re ) a se a ce End-of-Life Care Behind Bars: a ted ES Original Research: The Benefits Ce eo Su RRC eee eat ately‘By Maureen Shawn Kennedy, MA, RN, FAAN, AIN Editor-in-Chief E-mail: shawn.keninedy@wolterskluwer.com sking More Questions The importance of case finding. ~ arlicr his yeas the media buzzed with news 4. sbour the lead-contaminated water supply of ot Flnc, Michigan. City officals had switched the water supplier in April 2014 ro an unporable rr, and then denied and mismanaged the ensuing plems. Many reports focused on the city’s appall- lack of accouncabilty. A mother’s refusal to top 1g questions stands at the heart of this story. Daring the sumer of 2014, Fine residene Lee 3 Walters noticed that her young son developed a ‘been happening?” It makes a huge difference when nurses apply critical thinking skills to assessment. AJN has covered many such stories. Tm thinking ae te hyn aoe who ized a pattern of symptoms in stu- dents that the onset of the 2009 HINT in- fluenza pandemic in this counery (ace Inthe News, June 2008). Tm also thinking of Carole Bower, an ‘occupational health murse wino, in 2006 and 2007, recognized similarities in the complaints of workers ring skin rash ater bathing ‘ae Minnesoxa sugheerhouse Re pencs a coe bealth care the ged th rash a scabies oF casefinding | ("YN apont Oceber rct derma Bat Wales atthe 2008), Her case fing leo er doubes, and afer sv- reat the discovery of 2 new lines, es 3p rt abo thepurview | ropes inna as er tested, When the lead cof all nurses. | an autoimmune reacionto pig, came back seven times bersinpreeine aeroulied dure per than the accepeable max- ingen processing his = sn, she had her son tested His serum kad level in- ted lead poisoning. Yet during that summer and more than a year afterward, cry, state, and federal cals persisced in saying the city’s water was safe. cunt he fall of 2015, after independent environ nal researchers verified that Flint’s water had highly ated iad levels and a local pediatrician reported 2 showing a sharp increase in the numberof chil n with elevated blood lead levels, did officials ad- there was 2 problem. Icanthelp but wonder what se 18 ronths of lad expasure will ukimately mean the long-term health of Flint residents, especially se most vulnerable. (See our two-part series “Lead zards for Pregnare Women and Children,” October | November 2008.) nthe Fine water criss, it was a masher who recog: eda partern of signs and sympeoms, raised ques- refed tobe lasted by logis newer and edly pursued an appropriate response. Would her and countess others, have escaped leod poisoning roviders had asked about recent environmental ges during their assessments, or had themselves de the connection? Nurses atthe point of care are ally the frst o take stock of a patients problems. how often do we doit by habit, following a check- without dhe mindfulness thar might lead us to ake TE ttl. sue, we're publishing a report by Sara Barron, a nurse inraral Washington who, in 2012, realized tha the birth of dee infants with anencephaly within weeks ff each other at one hospital was unusual. She con- ‘acted colleagues in nearby facies and, upon lear. ‘ng of other cases, called the tate health deparament. ‘An investigation revealed thatthe rate of anenceph- alic births in south central Washington was more tha four times the nasional average, and it has con- tinued to climb. No cause has yet been determined. “Today we have abundant research impbeating en- vironmeneal factors in disease ourbreaks and birth de- tion ro infants born with microcephaly is probable, iis not yer proven and may take years o do so. It will ake painstaking research and analysis of mult- ple factors to-make thar determination—very rmuch like what the investigators are ding in Washingion. Case finding isn't only the responsibly of public Ihcalh investigatons it fall within the purview ofall ‘nurses. Nursing asiessments must inchide questions about patients’ homes and neighbochoods and jobs ‘and pets and miliary servic. All of us, wherever we ‘Sea ale tik ices Ge shia See eink Maen,A Year of Migration and Heartbreak Conflict, crime, and economic insecurity are driving global migration. 1 our cover this month is a heartbreak- ‘ng scene that has become al oo familiar ‘over thie past year—that of refugees be- ing blocked by border guards as they try to make theie way from Affica and the Middle Bast to Eu- crying children—one can only imagine what night- mares will ant them and the milions of exer chit ‘dren caught in what many are calling the largest migration of people on record. (See On the Cover.) “The number of people displaced by conflicts thas grown over the lat decade and has escalated sioner for Refugees (UNHCR), in 2011 there were 10.5 mili refugees, mostly from Afghani- san, Iraq, and Somalia. By the end of 2014, that number had nearly doubled to 19.5 million. “There are now 59.5 million isplaced people worldwide— forthe frst time the SO million people ‘displaced after World War Il. The majority of refu- that they constinute one-fourth of the world’s refa- ‘gees. More than half are under the age of 18. ‘While some nations have opened their borders and others say they wil increase the numbers of peo- pile allowed to enter, the November terorist attacks in Paris and Mali have led some governments and ‘Gitizenry to fear that terrorists may be among the flood of refagees entering their country. Despite President Obama's commitment to take in a least 10,000 refugees over the next yeas, many U.S. gover ors say they will not accepe Syrian refugees in their sates, And the US. House of Representatives re- ‘cently passed FIR 4038, also known as the Ameri- can SAFE Act of 2015, requiring strict background checks before refugees from Syria or Iraq can enter the country, ‘While it remains to be seen how many Syrian will make it to che United States, there's ‘nother refugee crisis closer to home—the influx Of undocumented immigrants from Latin America land Security’ almost 40,000 unaccompanied children under the age of 17 were apprehended at the border in 201. spectral “This was in addition vo the nearly 40,000 families ‘ho tried to eross the border. ‘Nurses everywhere will be touched by these mass movements of desperate people. In Europe, nurses hhave stepped in wen governments failed to respond fast enough. In Austria, when the government was slow to organize reli, nurses and other volunteers helped set up acini aid refages ar Vierna’s main train station. And according to Franz. Wages chief ‘exccutve officer of the German nurses association, "Nurses all over Germany are volunteering to asist with the flood of refugees.” He added that the asso- ciation has created two public ‘service posters condemning vio- lence and prot pe bor Here inthe United States, the _sxate of California is alone in l- California nurses wal be seing more immigrants in health care sertings. Elsewhere, most undocu- mented i ‘will continue to rely on receiv- ing care in EDs or safery net hospitals. Tasked Judith Oulton, chairperson of APN’sin- ‘ternational advisory board and the former executive direcor ofthe International Council of Nurses, ‘what narses can do to help the refugees. She said, “Nurses can advocate for the safety of refugees as swell as meeting ther basic needs. A year ago, the goverment in Canada introduced changes «. «10 end health care benefits and coverage for ilneses not deemed a ‘public safety risk’ for noagorernment-asisted refugees, and nurses and doctors protested.” ‘She also suggested that nurses “volunteer at clin- ies and camps providing care; manage nurse-led ref waze health such as those in New South ‘Wales, Australia; help ensure thatthe policies in health care facilites that support refugees are not discriminatory; and sapport community Moo 2018 * VoL 18, No.4 By Maureen Shawn Kennedy, MA, RN, FAAN, AJN Editor-in-Chief E-mail: shawn kennedyewolterskluwer.comVhat Nurses Do Quiet thoughtfulness can ‘at the bedside of an obviously very ill patent, given the monitoring equipment, ventilator, Jinamber oft lines. On the surface, it doesnt ap- ar as ifthe nurse is doing much, This what fam- ‘members might think if they enter the room. It might be what crosses colleagues’ minds as they pe cover shows a critical care nurse be a powerful intervention. tasks, procedures, and protocols on top of unsafe {nurse-1o-patien} ratios and are not supported by upper management. Their frustration builds as their voices aren heard and leads to high tumove.” "While the disconnect between New nurses’ expee- tations of practice and the reality of hospital narsing isn't newt seems to have taken on a new level of mr Ee perhaps wishing they to had ime to “jast tension, as emphasis on quar improvement imple a there.” ‘menting care bundles, manag- Burin that quiet stillness, ing new computerize systems, any things may be happening. Isanurse’s ‘and data reporting has created yernarse may be reading the ‘vigilance ‘an additional burden on muses onicors for heart rate and atthe point of care. How can thm, mean arterial pressure, ‘becoming a nurses be vigilant watchers if 1d oxygen saturation levels. there so lite time to just be ‘quick look would tell him thing of the there, really looking at and J patient's urine outpue, and past? evaluating their patents? Yet, quick touch would reveal ‘most hospitals stil fail to invest ether the patients skin is sel and clammy or dry and warm, He could also be king for facia grimacing orbiting on the endo acheal tube—clues that sedation might he inade- cate. Or he could just be taking a quiet moment to elect on all that has happened during his shift and shat he will eportto the next shift during handover. ‘Warchfulness is one of nurses’ most valuable skill ni important responsibliies. Yes, medications must ¢ administered and interventions implemented and managed, but our critical assessment and evaluation a patient’ responses might arguably be even more mportant. Indeed, patents are in our charge because fey require our careful vigilance. Bue s this crucial nursing function becoming a thing ofthe past? In AJN's February editorial and blog post ps/vpane/p75y OFS), Twrote about how expe- enced nurses seem to be fleeing bedside nursing po- tions in favor of other roles and arcaining; degrees, leaving nev, inexperienced nurses to stat acute and critical care unis. We rexcived @ comments and letters on the topic. Most respondents that nurses seemed ro be leaving the bedside and blamed the difficult hospital work environment and the fac that nurses’ time i spent rushing from on patient and task to another, without, as one person terote, “the time or resource to perform the job as its intended to be [performed].” Another person noted, Nurses are no longer able to provide comprehensive quality care because there's just no time for it.” And from another, “Nurses are swamped with numerous iitintimneen in staff a5 a means of casuring quality and safety. ‘Data on how nursing makes a diference in patient ‘outcomes have been gathered for neasly 200 years— from Florence Nightingale in the Crimean War Linda Aiken in the present day. This hit home when 1 azended this years anrasal meeting of the National As sociation of Clinical Nurse Specialists, wherein session ‘afer sesion T heard about nurses improving care and lowering costs. I abo recently heard a presentation by Region Gc ‘a nurse and the chief exeeutive cof the Hospital of the University of Peansyl- ‘van (se Profiles in this issue, in which she cited sew- tral projects led by nurses that improved outcomes, {increased patient satisfaction, and lowered cores. And ‘arses’ ability to create innovative solutions 10 in~ ‘crease access to care and quality was also evident st the American Nurses Associaton’: Quality and Inno- ‘vation Conference in March. es frustrating that despite all the evidence, nursing is sil straggling to prove is value. From observation th assessment to managing care—nuures possess the intimate knowledge of what works for each patient. For Nurses Week, instad of giving nurses trinkets orice cream, perhaps hospitals could highligh murs- ing’ vital contribucions o patients, families, and ‘even boards of trustees by showeasing nurse-led improvements in quality and safety. Having experi- ‘ced, knowledgeable nurses atthe bedside is as crit- ‘eal as having a qualified anesthetis. for surgery: good ‘outcomes aren't possible without ether. ¥ -AIN¥ Way 2018 ¥ VoL 18, N.S By Maureen Shawn Kennedy, MA, RN, FAAN, AJN Editor-in-Chief Email: shawn kennedy@wolterskiuwe.comAjJN ~~ Ameting fumalst Murdag The Srating Hamer od Rrorveng Ginn | RoNurses Wanted—Almost Everywhere It seems the nursing shortage has arrived. ach year, Lattend one of my favorite meet ings—the annual conference of the National Student Nurses’ Association (NSNA). This year, 3,000 enthusiastic attendees, mostly junior land senior nursing students, gathered ia Nashville “Tennessee, andthe atmosphere was charged and up sign-on bonus for RNs and LPNs. Other organiea~ tions are developing partnerships with schools and creating programs fo expose potential nurses to cin ‘al stings, with hopes that many will tay on. In Col- orado, the legisianure enabled commanity colleges to offer hachelor of science in nursing degrees and LPN ‘beat—more so than in years past. schools are expanding or reopening. ‘Most ofthe senior students I met already had Ina repor rekased last July the National Center ‘hospital jobs lined up; several ‘Workforce Analysis, had the luxury of being choosy ‘using 2014 asa baseline, pro- about where they would begin The dass jected both shoreages and sur their carcers, with hospitals with 2018: pluses of RNs by region. It nurse residency programs a key aeons ‘noted tat in 2030, sever states factor in their decision making. ‘entering a ‘will be affected by shortages, Tasked Diane J. Mancino, ex- with those in California, Texas, ‘cutive director of the NSNA, Job seeker's ‘New Jersey, and South Carolina if what I was hearing was wide- market. the most severe. spread, and she confirmed, nor Ts hard to know if these pro- ing that the NSNA “has been tracking new graduate workforce data since 2008 and we are defintely seeing a higher employment rate for new graduates.” “This is markedly different from prior years, when most senior students were still secking positions in late April some coukln't even secure an interview, a5 ‘most hospitals sought “experienced RNs only.” How things have changed: Hospitals are now secing many ‘nurses retire og after amassing clinical experience, eave for opportunities outside the acute care setting (see AJNS February editorial. Recent media headlines and reports from around the country cite an abundance of unfilled nursing Po- sitions and warn of worsening shortages inthe near future. Karren Kowalski, president and chief exceu- tive officer of the Colorado Center for Nursing EX ‘ellence, an organization focused on developing the ‘tare’ nursing and health care workforce, said that in Colorado there are “enormous shorzages” of experi- ‘enced nurses in critical care, EDs, operating rooms, fand labor and delivery as well as the neonatal ICU, ‘She noted, “We graduate approximately 2,000 new rnurses each year. Most are able to get jobs, although tsi i new? nurses per yea.” ‘Some hospitals have resorted to offcring sign-on ‘bonuses to fill positions, specially in specialty areas. Florida hospitals are offering five-figure sign-on bo- inuses as wel as funding for relocation and tuitions tone Pennsylvania nursing home is offering 3 $5,000 ronotertine co jections will become reality, but given the growth of the aging population and the in~ Creased need for long-term and community care, cou pled with the retirement and rapid turnover of acute ‘Care RNS, it likely that all bealth care sectings will ‘need marses. The Burcau of Labor Statistics projects thar more than million RINs wil bended by 2024, ‘and preciis RN job growth through 2026 at 15% — faster than any other ocuption. 'A survey of 233 chief nursing officers conducted last July by national staffing company AMN Health- care found that 72% said their shortages were mod tte to vers and most expected shortages fo worsen ‘over the next five years, They also acknowledged that the shortage was having.a negative effect on patient ‘care, patient satisfaction, and staff morale. “The class of 2018, i ems, is entering a job seek- er market. that ned sifnow—or smart workplaces that wish to get aha in the future—are jn competition to recruit new staff. Organizations thatcan invest in new nurses with programs that pro= vide sapport and training will have a leg up in re- cruitment. But retaining these new recruits needs to bbe a group cffoce involving ll nurses ian organiza~ tion. We know from studies such as the RIN Work Project thatthe frst year of a nurse's first job is a catical one, with almost 18% of new nurses kaving their ist employer after one year. We need to wel- come our new colleagues, be patient and supportive, ‘and remember that once we were new and inexperi- ‘enced t00. ¥ AIN® he 2018 ¥ YL 118 NOS By Maureen Shawn Kennedy, MA, RN, FAN, AIN Editor‘in-Chief E mall: shawn kennedyawotterskiuwercomPL meet ele mite T ede ed aL To a‘By Maureen Shawn Kennedy, MA, RN, FAAN, AJ Editor-in-Chief E-mail: shawn.kennedy@woltersh Seeing—and Nursing—Our Power By standing up for patients, we stand up for ourselves. and has a “Don’t worry, I've got this” arti- tude makes patients and families fel sae. ‘That was the message of Dana Woods, chief execa- tive officer of the American Association of Critical- Care Nurses (AACN), who spake at the AACN's annual meeting in Boston in May about her experi cence of having a family member seriously il. Te also experienced, as a A= who is attentive, exudes confidence, in very stressful circumstances —think of Utah nurse ‘Alex Wubbels who was arrested for protecting her pa ‘tient’s pal rights (see Ethical Issues, March), or ICU nurse Katic L. George, who challenged her hospital's hierarchy to insist on tests that proved her patient ‘was not brain dead (sce Profiles, October 2016). “These nurses’ actions are magnificent examples of patient advocacy. However, nurses don’ always fel ‘empowered to change the larger family member, that feling of system, We can be reluctant to safety in confident nurse pres speak up, contribute at meet- ‘coce. My first son was born five Hfanyone has | ings, or offer suggestions. ‘weeks early and was showing pees ‘Yet, more than anyone, signs of mild reapiratory distress ‘nurses have the knowledge and Thecame anxious when the pe- stand tall, eee dliatrcresdent inthe delivery q bevter meet pions’ ned and ponwadowtoa: Hews | Mh oo ace create a safer environment. Arci- ‘awkward in his amempcto suc- ccs in ths issue are good exam- ‘tion my son and had trouble ‘connecting the oxygen tubing tothe Amb bag, To my sgeat relief a nurse saw what was happening, quickly approached the resident, and said, "Here let me,” resolving the situation efficiently and effectively. ‘Amy Cuddy, who gave the opening keynote ad- dress at the AACN mecting, expanded on Woods's ‘message about acting with confidence. Cuddy is as0- ‘Gal psychologist and Harvard University lectures, au- thor of Presence: Bringing Your Boldest Self to Your Biggest Challenges, ava ‘ofa 2012 TED Take ‘that has garnered mailions of views. She spoke about her research on the effects of “power posing,” that iy the universal stance that conveys power (ink Wonder ‘Woman or Superman: hands oa hips, les apart). She ‘maintains that practicing expansive postures (shoul- ders back, head up, wider arm movements, making ‘oneself “big”) versus inward postures (shoulders cury~ ing in, head down, constricted movements) creates phiysiclegyal changes that instil confidence, even un- der stress. While some of her critics have raised ques- tions about the rigor ofthe science underlying ber work, Cuddy says rccent research supports her find- ings that these pose-induced feelings of confidence. and power are what enable people to act on behalf of themselves and others. This message certainly resonated with the approx ‘mately 9,000 critical care nurses attending the AACN conference, and I think ie particularly germane to nursing. There have been many incidents in which nurses have felt empowered to advocate for patients srevetritecon pes of chat: Baumgartner and colleagues report on outcomes of a nurse-led protocol for using ketamine to provide beter pain management inburn Ehrhardk and colleagues developed a tool wo identify parents at isk for cifficalt placement, changing policy so patients wouldn't have to endure ‘mukiple v sticks; and three nurse ethicists write about their programs to create unit based thics champions to support aurses when they face ethical challen (Clearly these nurses and innovators were cmpowered by their knowledge, sense of professional dury, and ‘ellingess to put themselves and their ideas out dare. ‘Wha I describe to new nurses the power imbal- ance that existed when we baby boomers began ‘our carecrs—we were expected to stand when phy- sicians entered the room and never question their kuin dey seks pansive postures woul in those days: farses who were considered overconfident or out to ‘change the system were often written up and seea as troublemakers. “Today, though more of us feel empowered to speak up and act with confidence, I still ear from iho feel frustrated, defeated, and power: less because they feel ignored or undervalued by their ‘organizations. Yecthey soldier on, and amid the chaos ‘of a normal day, may have shining moments of suc- ‘cess that remind them of why we all chose nursing. ‘While the jary may stil be out on whether power posing works, I say go fort. anyone has a reason 10 stand tll its a nurse. ¥ AIM i 2018 Vo 118.7AJN De cee ieeie ettes Se | Ll eh hed a bill Cees ay a ee ee eeClosed Borders, Closed Hearts The shameful treatment of immigrants needs our: collective outcry. ‘lear day, I can see the Statue of Liberty in New ‘York Harbor, right there atthe tip of Manhattan. ‘Ac night, is light is visible for miles. These stirring, ‘words, from a poem written by Emma Lazarus, are inscribed on its base: Give me your tired, your [See On ‘younger than age 13); photos of hundreds of cldren JTeeping on mats in pens inside warehouses converted to shelters and the lack of a system to keep track of the Children 9 they can be reanited with their parents— ‘many of whom have already been deported —groups as disparate as rigious and health care She ing aces, 21 sate acme eran ‘many in own ‘condemned poor, party: the action Your huddled masses yeam- Nurses must | and urged him to sop the pol jing to breathe free, +6 ,. Several governors refused “The wretched refuse of your continue ‘wallow cheie national guard coming chore advocate for | moopsto asst atthe border ‘Send these, the homeless, th J 7 and several airlines said they Hemy limp beside ec Llift my lamp the port the children. ‘golden door! Sao "Although there was partisan finger-pointing as to who had ‘Now the statucis no longer a beacon of hope and promise; it a reminder of days gone by, Recent ‘events and report have left me feeling that we as a tation, asa society of people who are purportedly ‘guided by moral and ethical values, are hurling for. ard without brakes, We find ourselves in a surreal {world in which we have become the abusers, the bad {guys the callous bullies who tur our hacks on those Jess fortunate. ‘Ta May, a report published in the Annals of Inter- nal Medicine ‘burnout and stress among cl nnicians who provide“ hemodialysis” to undocumented immigrants with end-stage renal failure, Undocumented immigrants are not cigble for ‘Medicare or Medicaid, and only a few states cover hemodialysis as an cmergcacy condition. instead of receiving dialysis several times ‘weekly, which isthe standard of care, most undoew- Joented immigrants can only receive dialysis when ‘hey present to the ED in ifethreatening real fail fare That our systcra causes life-thresting conditions ‘and postpones treatment based on a person’ citizen ‘ship seaus i inhurnanc. “had whe would have ever thought the United ‘Scares would precipitate a humanitarian crisis within “gsbonders? When the White Howse initiated the pol- oy to separate families apprehended crossing the Mexico-Texas border it was met by an unprect- -deoned backlash of outrage. Fucled by media reports ‘of young children being forcibly removed from theit parents (according to Kaiser Health News, 20% are etter cn the power to change the situation, the president re- leated and signed an executive order on June 20 t0 end the policy and allow families tbe detained to- gether As we went to pres, a federal jude ordered {he reunification of families and a halt to most fam- ily separations at the border. However, its still ot lenown how the more than 2,000 chiklren who were ned from their parents will be reunited with them. These children have now joined the estimated 10,000 others who have crossed the border as un- ‘accompanied minors and are living in detention cen- fers around the country—and they will likely remain there for months as their cases are sorted Out. Teremains unclear how these children’s health needs are being met or whether anything is or will be done to try to mitigate the stress and anguish and ‘cmorional trauma thats being inflicted on them. “That the leaders of our government thought this was 4 reasonable thing to do reflects a callousness and dlzachment co the suffering of others that’ unprese- dented and traly unconscionable. "AIN has long history of documenting nursing ical profession. Oar pages are san chert and dinfanchbed. NOW, ‘more than ever, we need to embrace that legacy. ‘AgNey Aagus 2078 ¥ VoL, NaSEDITORIAL By Maureen Shawn Kennedy, MA, RN, FAN, AJN Editor-in-Chief E-mail: shawn-kennedy@wolterskluwer.com ing Our Lives Away Exercise may not mitigate the ill effects of prolonged sitting. ‘used to be very physically active. I walked all the time when I worked in 2 hospital. Up and down the long corridors, and then a few blocks to the ‘When my children were young, I pushed a ‘around the block. When they started school T worked parttime, I still managed to carve out 0 be active, playing tennis three to four times @ We need to revisit the way Asa result, the ANA declared 2017 the Year ofthe Healthy Nurse, with the aim of helping nurses incor- porate healthy habits into their lifestyles. That has continued in 2018 wih the “Healthy Nuse Healthy Nation Grand Challenge” (see vw ‘on.072). This initiative aims to engage nurse in improvingtherr health ane serving a role models by focusing on pysical acivity, sep, natrion, quality of life, and ser. | we think about wayside, especially during che ‘early darkness of winter. Most weekdays, I get into ‘my car for an bourlong drive to Manhattan, where 1 spend most ofthe day sitting a a desk or in meetings. “Then | repeat the hour-long drive home and sit for an hour or so during dinner and while watching televi- sion ia the evening. [sit for 12 to 13 of my waking hours. Tm more active on weekends, hitting the tread ‘milla bit. But even those days are marked by signif- cant periods of siting, because I often use the weekend “eatch upon work. ~Weall know that exercise, eating healthfully and "getting cnough sleep are important to staying fit and preventing disease. But nurses, like many of our pa- “tients, are working in high stress jobs and often have -responsibiites than can be realistically man Bed ins worksay end thea we go beac to ‘are for our families and maybe even attend school ‘Our lives are laden with obligations thar prevent us from speading time on our own needs, and we are likely to put our needs last regardless. ‘The outcome of this lifestyle can be seen in the ‘of a “health risk appraisal” the American Association (ANA) conducted from 2013 to activity. the effects of an otherwise sedentary lifestyle. In an in- egrative literature review in this issue (sce “Too Macs Sitting: A Newly Recognized Health Risk”), author Linda Eanes looks ar stodies that examined the beat effects of prolonged uninterrupted sitting sitting for 30 minutes or more) and high-volume sitting sitting for sever hours or more each day). Se writes thatthe studies, including several systematic reviews and meta- analyses, come to the same conclusion: “Simply put, ‘00 much sitting, with its characteristic reduced energy ee re health even inthe presence of regular txerose She points cut, howeney tha ea rience ‘shows that interrupting sitting with shore periods of physical activity may mitigate the ill effects. Tes easy to come up with any number of reasons ‘not to exercise—T'm foo busy, too tired, to0 over- vwhelmed with family ities, o have too ‘much todo. But we can make small changes to break up the amount of time we sit each day. Walk down the hall fora drink of water every 30 minutes (drink ing more water is aso a good thing) stand and pace while on a call walk around the block before entering, ‘the building or after leaving, and, yes, use a ereacimil ‘or stationary bike, or walk in place, while watching television. These small changes can add up. Thave a new determination to change my sedentary ways. [set the alarm on my computer at 30-minute intervals, so [stand and walk about. Lalso bought a rowing machine and put it in front of the television at ome. ts worth ay. ¥ -AIN > September 2019 * Wot. '18, No.9i} AN © eee a teats t it | i Re ee See eed iat pli eal = Peete > = oe meSomething for Every Nurse Articles on workplace violence, nursing and the media, and other noteworthy topics. 1, we aim to have content for every nurse in every issue. That means providing articles ‘on a wide variety of topics; its the reason we don't do themed isues. But among the varied content in this months issue are two article that focus on the same copic—and it’ a topic that unites all nurses: che in- Caeatetce Epes ‘creasing presence of violence in the workplace. ‘Asnew nurses, we quickly became aware ofthe routine hazards of our profession: the back and neck injuries; the physical strain of lifting pa- tents, bending over bed, and ‘Pushing and pulling equipment; the emoconal stress ofa high-pressure job, wire mis- tales in jadgment can cause real harm. But few of us began our careers expecting physical violence ro be a ‘common occurrence, In recent yeas, however things have changed. Violent behavior secms to be a cor- ‘mooplace and inereasingly frequent oocurrence in hos- pitals and nursing cae facilities. More and more, such Violence i the result of intentional harm. Researchers from the National institute for Qccu- pational Safety and Health found that the incidence ate of injuries from violence increased by 23% cach year between 2012 and 2015. In 2016, the Bureau of Labor Statistics reported 6,190 cases of non fatal injuries from violence in hospitals, of which 3,490 ‘rere intcrtionally inited by another person. Nars- ing and residential care facilites reported a total of 8,240 nonfara injuries, with 5,160 classified as inten tional. ‘An American Nurses Association survey of 3,765 [RNsand nursing students conducted in 2014 revealed that 43% of respondents had beea verbally andor ‘physically threatened by a patient ora patient's family member; 24% reported they had been physically as- sulted, Clearly this isa major problem that need to be addressed. In their article in this issuc, “Workplace Violence “Training Using Simulation,” Brown and colleagues describe a program developed at thir instiation that ‘uses simulation training on a mock imi. The pol isto train staffhow bestto react when faced with 3 threat= ning or overtly violent incident. Through participation eet in stage scenarios involving an active shooter and de- briefings, staff learn what to say and do to increase the odds of surviving an assault and to protect pa~ tients, (To sce a video clip of a simulation that ac- companies the article, go to htrplinks hww.coml AJNAI25.) Another article on this topic, Workplace Violence,” appears inthis months Legal Claticcol- uma, Nurse and arromey Edie ployers, and nurses educating themselves on policies and programs that support safery. Her takeaway message isan important one: “Nurses should never accept workplace violence as jst pare of the job... Violence is perpetuated when it isnormalize ‘Also in this issue, we're very pleased to publish re- search by Mason and colleagues that was conducted aan adjunct to their recent replication of the 1997 ‘Woodhull Saady on Nursing and the Media (the repli- cation study is being reported elsewhere), In this qusli- tative stdy, the researchers examined why reporters don't seck cut nurses’ views wien reporting on health ‘care—an important issue, because they are perpetu- ating nursing’ invisibility and negating nursing’ m= portance in health care by ignoring nurses’ opinions. The authors also offer recommendations on whet to do to increase journalists’ use of nurses as sources. “Then there are our two CE articles: one on a rel- atively now intervention for hemorrhagic shock — resuscitative endovascular balloon occlusion of the ‘ort —and the ether from the Hospice and Palliative ‘Nurses Association about managing pain in people with opioid use disorder, another issue nurses are in- creasingly confronting. And ofcourse there’ coverage ‘of major health news, commentaries, and more. Alin all, we've got something for every ourse. Readon. ¥ [AIN-¥ 0:tob¢r 2018 Vol. 118 No. 10 By Maureen Shawn Kennedy, MA, RN, FAN, AJN Editor-in-Chief E-mail: shawn-kennedy@wolterskluwercom