Author: The Association of Women’s Health, Obstetrics & Neonatal Nurses (AWHONN)

Los Angeles Nurse Pledges to Fill Semitruck with Diapers to Help Families in Need

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by, Jade K. Miles, BA, BSN, RN

rosemarie-cervantes-headshotAWHONN Member on the Move

Rosemarie Cervantes, MSN/Ed., RN has been an OB nurse for 25 years and the Los Angeles AWHONN chapter co-chair for the past three years, collaborating closely with Orange County (OC) chapter leaders. However, her AWHONN story began years earlier.

In 2009, Rosemarie was living in Nevada when she traveled to her first AWHONN national convention in San Diego. After attending informative sessions and interacting with more than 2,500 of her nurse colleagues, she returned home inspired by her experience and motivated to help build the Nevada AWHONN section.

Rosemarie’s energetic personality and reputation as a leader preceded her. Upon relocating to California in 2013, Rosemarie joined LA AWHONN and was instrumental in bringing new life to the chapter. In fact, her first event had nearly 80 attendees! She works closely between the LA and OC chapters since there is so much overlap between nurses that both work and/or live within both Orange and LA counties.

trifold-brochureDiapers by the Dozen—and More!

By the time AWHONN announced its Healthy Mom&BabyDiaper Drive in 2015, Rosemarie was incredibly active with her fellow members in California and already making a difference in her community. But the advent of the Healthy Mom&Baby Diaper Drive brought to light an issue plaguing families that she was previously unaware of.

“The diaper drive was my first introduction to learning about the prevalence of diaper need,” says Rosemarie. “After talking to my fellow members, I realized I wasn’t the only one unaware of how much of an effect diaper need has on families.”

To help create awareness and start the conversation about diaper need, Rosemarie used resources from the Healthy Mom&Baby Diaper Drive toolkit to create a trifold with facts about diaper need to be on display for an LA/OC chapter meeting. This powerful visual aid served as a talking point and incited discussion among the nurses.

Rosemarie overheard positive feedback from members as well as an overwhelming desire to help families in need. This gave rise to a chapter diaper drive in which members were asked to bring a package of diapers to their next meeting. Rosemarie had no expectations since this was a pilot and was delighted by the generosity of her chapter members, who collected 1,765 diapers and 900 wipes.  When asked if they would do it again, the members said yes because they love giving back to their local community.

Plans to Wipe Out Diaper Need in 2016

While Rosemarie was excited to see the turnout of their first chapter drive in 2015, she set her sights on much bigger goals for 2016. Specifically, she is determined to meet or exceed the Healthy Mom&Baby Diaper Drive challenge for 2016—that’s 250,000 diapers!—by filling up a semitruck with diapers at their Fill-a-Truck Extravaganza event set for October 14 at Miller Children’s & Women’s Hospital Long Beach. Reaching that goal won’t be easy, but it will be worth it. Rosemarie has carefully crafted a plan for success that includes a powerful support system.

la-oc-chapters“First, you need to have a team that is passionate about this issue,” she explains. “Everyone has been extremely dedicated to reaching our goal. Secondly, you need a group of individuals with several skill sets to help. I have people who are excellent at acquiring donations, some with strong organizational skills, and others that can get the message out to the community. Lastly, you need to partner with the local community in order to have a successful diaper drive.”

With Diaper Need Awareness Week in mind—September 26–October for the 2016 year, when people bring awareness to diaper need in America—Rosemarie decided to aim for a fall drive for maximum impact and involvement. To get started, she met with a Long Beach City, CA council member and informed her about diaper need in the Long Beach area. She told them about plans to do a diaper drive and asked if they’d be willing to help. Long Beach said yes but that they did not have the logistics or ability to store diapers. Rosemarie took this momentary setback in stride and persevered.

“When you’re trying to work with a corporation or a large group, you have to know the right people to go to,” says Rosemarie. “Often this takes time and can be frustrating, but you just have to keep going until you get what you need.” Rosemarie contacted Baby2Baby, an LA-area diaper bank (and National Diaper Bank Network member) that helps distribute diapers to local families in need. Additionally, a local yoga studio is providing a drop-off location for diapers.

“Baby2Baby, Huggies and AWHONN have been great partners, providing necessary support to make this upcoming event a success,” Rosemarie says. “In addition to much-needed resources, manpower, marketing and other donations from Huggies we are so appreciative of local businesses and community members who have come forward to help in this event.”

Rosemarie also believes in getting the future generations involved in community service, which is why she is working with local Girl Scout troops as well as nursing students from UCLA and Long Beach City College. This is truly a group effort in which nurses are able to come together with the LA/OC communities to promote the health of women and newborns.

Confidence and Compassion: A Winning Combination

In addition to increasing the chapter’s reach and diaper donation totals, Rosemarie wanted to shed light on diaper need and the plight of low-income families. “I felt that this would be a great nurse-led community awareness campaign in our local area,” she says. “Many individuals I have spoken to are taken by surprise [when they learn] about this issue. As nurses, we need to advocate for mothers and infants by educating the medical and local community on the diaper need epidemic in our working class.”

A strong background in fundraising combined with natural instincts to care for others with which all nurses can identify have contributed to Rosemarie’s success in helping the 1 in 3 families affected by diaper need. She found her niche networking with people and not being afraid to ask for things—and that confidence is a certain asset when undertaking projects of this caliber. “I don’t give up,” she says firmly. “If the window closes, I go around and find another way to get to my goal.”

 

The Cornucopia of Contraception

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by, Susan A Peck, RNC, MSN-APN

In 2000, as a new Women’s Health Nurse Practitioner, the provision of contraception to my patients was actually pretty simple.  Most every woman who wanted hormonal contraception used the pill, and there were only a handful of brand name oral contraceptives that we all knew and regularly used.

Shortly thereafter, in 2001, the contraceptive patch and the contraceptive vaginal ring were approved by the FDA.  These other two options quickly became competitors to the oral contraceptive market and gave patients and clinicians more choice, and ways to avoid the sometimes daunting responsibility of daily pill intake.

In the background was the IUD – only ParaGard and Mirena were available at that time.  Still holding on to the worries of the unsafe IUDs of the 1970s and 1980s, most women and clinicians were not supportive of these devices at that time – fortunately that has dramatically changed!  In 2013, the Skyla IUD became available and the Liletta IUD followed in 2015.  And let’s not forget about the contraceptive implant, Implanon (now Nexplanon) that was approved in 2006.

Barrier methods have also always been accessible to women, such as condoms (male and female) and various spermicidal formulations, as well as the diaphragm – did you know the “old” diaphragm is no longer available, but that there is a new one, Caya?

So, when we consider all of these options, and factor in the complexity of some women’s medical conditions or social practices, how can women’s health clinicians consider not only which method might be most acceptable to a woman, but also which method is the safest??  There certainly is a lot to keep track of with all of today’s contraceptive choices.  And if a woman does not use her method correctly, what can a clinician advise?

Fortunately, the CDC has recently published two documents, the 2016 US Medical Eligibility Criteria for Contraceptive Use (MEC) and the 2016 Selected Practice Recommendations for Contraceptive Use (SPR).  The references are invaluable for any clinician who is providing contraception to women.  I have a copy of both at my desk in my office and even after 16 years of practice, I regularly rely on their guidance to make the best, safest recommendations about contraceptive choices for my patients.

I’d like to tell you about two recent patients, for which both references helped guide my decision making. 

First, Jennifer, a 32 year old woman living with multiple sclerosis, has used oral contraceptives successfully for five years.  She enjoys the regular, very light periods she has with the pill, and is a very responsible pill taker – never misses one!  But, this year, when I see her for her annual exam, I learn that her MS has unfortunately taken a turn for the worse.  She is currently in a wheelchair more the 50% of the time and her mobility is greatly limited.  She is very hopeful that this period of immobility will be short lived – there is a new MS drug she is starting next month.  So, I begin to wonder whether an oral contraceptive is the best, safest method for Jennifer.  I use my 2016 MEC App on my phone and determine that due to her immobility related to MS (increased chance of hypercoagulable state) it may be time to change methods.  She and I discuss all options and she decides on the Mirena IUD.  Not only is she pleased with a long term method, she feels more comfortable knowing she is safe – it is one less thing she has to worry about.

My next patient is Mary, a 20 year old healthy college student who tells me that she wants to use the contraceptive implant, Nexplanon.  She is going back to school out of state in two days, and would really like to have the implant inserted today.  In the past, some clinicians have traditionally preferred to insert LARC methods during a woman’s menstrual period to “make sure she is not pregnant”.  However, this is often cumbersome for scheduling and delays an opportunity to provide effective contraception.  So, I use my 2016 SPR and review the section ‘how to be reasonably certain a woman is not pregnant’.  I determine that since Mary has consistently and correctly used condoms since her last period, it is safe to assume she is not pregnant. After receiving her informed consent, I safely place the Nexplanon and she is able to return to college with a highly effective long term method of contraception.

It is important to remember that in nearly all situations the use of a birth control method is safer than an unintended pregnancy. These CDC resources are invaluable guides for clinicians so we can be confident our contraceptive recommendations are based on the latest evidence.  Both the MEC and the SPR are available free – of- charge with the option of downloading an APP for your device.

Tell your colleagues and have these references close at hand!

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Susan A. Peck, RNC, MSN, APN is a practicing Women’s Health Nurse Practitioner. For 20 years, Ms. Peck’s career has focused on women’s health care, first as a labor and delivery staff nurse and for the last 16 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.

Ms. Peck’s areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.

 

 

 

Like Mother, Like Daughter: Working to Wipe Out Diaper Need

by, Jade Miles

Michelle and Corinne

Michelle Delp and daughter Corinne

Helping mothers and babies comes naturally to mother-daughter team Michelle and Corinne Delp. This dynamic duo has made a big impact on families experiencing diaper need in their hometown of Rome, PA.

Michelle Delp, RN, has been a nurse for 30 years, and for the last 7.5 years she has worked as a maternal-child home visiting nurse for Nurse Family Partnership (NFP) of Bradford, Sullivan, and Tioga counties in Pennsylvania. She works with first-time low-income moms beginning in the second trimester of pregnancy through their child’s second birthday. NFP nurses offer the support these women need to deliver healthy babies, become confident parents, and achieve their life goals. Michelle is certified as a childbirth educator, birth and bereavement doula, and lactation counselor.

It’s no wonder that the apple doesn’t fall far from the tree; Michelle’s daughter Corinne starts nursing school at Arnot Ogden Medical Center this fall. Corinne has had many opportunities to learn from her mother. She shadowed her mother when Michelle was a camp nurse, and they have even found themselves helping out side by side at the scene of several accidents. Corinne’s natural caring instincts and up-close-and-personal experiences with her mom have put her on the path to becoming a nurse.

Before graduating from North Rome Christian School this past spring, Corinne needed to complete a senior year service project. Driven by her love for babies and children, Corrine—who also works as a nanny—chose to organize a diaper drive for the Endless Mountain Pregnancy Care Center (EMPCC) in Towanda, PA. She called it “Bottoms Up for EMPCC.”

delp photo 1Corinne first learned of EMPCC when they came to speak at her church and became increasingly familiar with the organization by serving at their yearly fundraising banquets. Knowing that EMPCC is frequently in short supply of diapers and moms can’t use food stamps to pay for them, Corinne felt certain that a diaper drive would be perfect for her project and would also serve a great need in the community. She fulfilled her 30-hour requirement while working tirelessly to market and organize the drive, as well as collect, transport, and stock diaper donations at EMPCC.

They advertised the diaper drive on Facebook for just under a month, and word soon spread about the event. The volume of donations exceeded Corinne’s expectations: The grand total came to 6,212 diapers; they had also had several people donate wipes. Michelle credits their success to the true sense of community in her small town.

Another clever idea? Add a little incentive to encourage folks to donate. Michelle and Corinne took advantage of a Target promotion and created a Target registry with diapers in a variety of sizes and also some wipes to help people reach the free shipping total. The promotion the first week was to purchase three packs of diapers and receive a $20 gift card; the second week, it as a $30 gift card with a purchase of two bulk packs or a $10 gift card with the purchase of two giant packs.

delp photo 3All items were delivered to Michelle and Corinne’s home, and they personally delivered everything to EMPCC. Both ladies said that hearing the UPS truck come by was always exciting because it signaled the arrival of more donations. In fact, North Rome Christian School administrator and EMPCC board member Lee Ann Carmichael decided to request that more shelves be built to accommodate the influx of diapers at EMPCC. At the end of the drive, Corinne’s senior class of 10 students filled those shelves to the brim, all as a result of the kindness and generosity of their friends, neighbors, and colleagues.

The experience left a lasting impression on this mother-daughter pair, and they were both touched to see people coming together to make a difference. “People are generous, even when they don’t have enough for themselves,” said Michelle, referring to several of her clients from NFP who wanted to donate leftover diapers from their children as they had changed sizes (Note: Most banks will accept loose diapers or open packs; just call ahead to ask).

“I learned that being able to reach out and communicate with others outside of my normal social circle is an excellent skill to develop,” said Corinne. “I live in a community that is very supportive of others’ endeavors. It’s beautiful to see a large number of people rally behind a cause.”

 Corinne and Michelle’s diaper donations are just one example of what nurses are doing to end diaper need—and their efforts will count toward our 2016 Healthy Mom&Baby Diaper Drive goal of 250,000 diapers donated. We want to hear your story, too! Go online to AWHONN.org/diaperdrive to let us know what you’re doing to help the 1 in 3 families who experience diaper need.

For more information on how you can start a diaper drive in your community, contact Healthy Mom&Baby Diaper Drive consultants Jade Miles ([email protected]) and Heather Quaile ([email protected]).

Jade HeadshotJade K. Miles, BA, BSN, RN, is a nurse consultant for the Healthy Mom&Baby Diaper Drive and lives in Raleigh, NC. 

 

 

 

Informal Milk Sharing in the United States

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by, Diane L. Spatz, PhD, RN-BC, FAAN

Susan is a nurse in a Neonatal Intensive Care Unit (NICU) with a strong human milk culture.  Every day she provides evidence-based lactation care and support to mothers who have critically ill infants. She understands fully that human milk can be a lifesaving medical intervention and received two days of on the job education regarding the critical importance of human milk and breastfeeding.  Seeped in this culture, Susan also believes that nurses and health professionals have an obligation to help families make an informed decision and while it would be ideal if all infants were exclusively breastfed by their own mothers, this is not always feasible or possible.

Susan is also challenged personally Having experienced infertility for 10 years, she has decided to adopt a newborn. She has read the literature and met with a lactation expert .  Susan is aware that even with great effort and time investment, she may never achieve a full milk supply.  She is very concerned about giving her infant formula and asked the lactation expert about accessing Pasteurized Donor Human Milk (PDHM).

The Human Milk Banking Association of North America (HMBANA) is the organization that oversees non-profit milk banks in the United States.  Even though the number of HMBANA milk banks is increasing in the United States and the amount of PDHM has also increased substantially in recent years, PDHM is still prioritized to preterm or vulnerable infants in the hospital setting.  HMBANA milk banks do sometimes dispense PDHM to the community setting.  However, in these instances, it is for infants with special medical needs and usually requires a prescription from a health care provider.

So for Susan who is planning to adopt a healthy full-term infant, she will likely be unable to access PDHM.  Susan is considering informal milk sharing in order to supplement what milk she is able to produce through inducing lactation.  It is important for nurses and other health professionals to be aware that informal milk sharing does exist and also to help families make an informed decision.

There are many reasons why women or families choose to pursue informal milk sharing in addition to the reasons in Susan’s story, including:

  • Women who have glandular hypoplasia or breast surgery and are unable to develop a full milk supply
  • Men and women who adopt children and may be unable to induce lactation
  • Women who have had bilateral mastectomy prior to childbearing
  • When a woman dies in childbirth and her family members wish to honor her plans to breastfeed
  • A short term need for supplemental human milk due to early breastfeeding challenges or a delay in Lactogenesis II

Although very beneficial in all of the above cases, informal milk sharing is not without any risk because just as antibodies, white blood cells, and other immune components are transferred in human milk, viruses can also be transferred.  In addition, some medications transfer into human milk (most in very small amounts, but some in larger).

Mothers who are considering informal milk sharing should consider the following steps:

  1. Get a complete health history from the donor mother. It is essential to understand  the donor mother’s past and current medical history as well as lifestyle choices is essential.  It is also acceptable for the mother to ask the donor mother for a copy of her serologic testing from pregnancy.
  2. Find out how the milk will be expressed, labeled, stored, and transported. The donor mother, first and foremost, should have an excess supply of milk that she does not need for her infant. When mothers express milk, care should be taken to ensure the safety of the milk.  At our institution, we have mothers wash their pump equipment with hot, soapy water and rinse well after every use and have them sterilize the equipment daily.
  3. What types of containers will be used for storage (the recipient mother could supply these to the donor mother) and how will the milk be stored (fresh or frozen) and transported from the donor mother to the recipient. Conversations between recipient mother and donor mother should be on-going to ensure safety of the milk. In this area the research literature has also evaluated  the use of home heat treatment to “pasteurize” the milk. Research has shown that heat treatment of the milk on a stovetop is not the same as Holder pasteurization, this technique has the ability to destroy viruses.  It is important to note that heat treatment also destroys some of the beneficial components of human milk.

Recently, the American Academy of Nursing published a position statement regarding the use of informally shared milk. This, along with resources shared below can be a starting point to have these conversations with families who are interested in the topic.

As health professionals, is also important to understand that there is a difference between milk sharing –  mothers may share  altruistically and be commerce free or there may be  an exchange of money or mothers who are paid for the milk.  When financial exchange enters the equation, mothers seeking to get paid for their milk may be motivated to dilute or alter their milk.  We should advise parents to be alert and aware of this.

Until PDHM becomes universally available, if a family does not wish to feed their infant formula, the only other option available is informally shared milk.  Having transparent and honest conversations with families to help the understand this practice is essential.


Resources for Informal Milk Sharing

The American Academy of Nursing (2016). Position statement regarding use of informally shared human milk.  Nursing Outlook, 64, 98-102.

Martino, K., & Spatz, D. L. (2014). Informal milk sharing: What nurses need to know. The American Journal of Maternal/ Child Nursing, 39(6), 369-374. doi:10.1097/NMC.0000000000000077

Spatz,  D.L. (2016.) Informal Milk Sharing. American Journal of Maternal Child Nursing;41(2):125. doi: 10.1097/NMC.0000000000000225. PubMed PMID: 26909729.

Wolfe-Roubatis, E. & Spatz, D. L. (2015). Transgender Men & Lactation: What nurses need to know. The American Journal of Maternal Child Nursing,40(1): 32-38. doi: 10.1097/NMC.0000000000000097.

Israel-Ballard, K., Donovan, R., Chantry, C., Coutsoudis, A., Sheppard, H., Sibeko, L., & Abrams, B. (2007). Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. Journal of Acquired Immune Deficiency Syndromes, 45(3), 318-323.

Diane SpatzDiane L. Spatz, PhD, RN-BC, FAAN is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a nurse researcher and director of the lactation program at the Children’s Hospital of Philadelphia (CHOP). Dr. Spatz is also the director of CHOP’s Mothers’ Milk Bank.  Dr. Spatz is an active researcher, clinician, and educator who is internationally recognized for her work surrounding the use of human milk and breastfeeding particularly in vulnerable populations. Dr. Spatz has been PI or co-investigator on over 30 research grants, included several from the NIH.  She has authored and co-authored over 80 peer reviewed publications.  Dr. Spatz has authored or co-authored position statements for the International Lactation Consultant Association, the Association of Women’s Health Obstetric & Neonatal Nursing and the National Association of Neonatal Nurses.

In 2004, Dr. Spatz develop her 10 step model for human milk and breastfeeding in vulnerable infants.  This model has been implemented in NICUs throughout the United States and other countries worldwide. Dr. Spatz has been named a prestigious “Edge Runner” for the American Academy of Nursing related to the development and outcomes of her model.  Her nurse driven models of care are critical in improving human milk & breastfeeding outcomes and thus the health of women and children globally.

Dr. Spatz is also the recipient of numerous awards including: Research Utilization Award from Sigma Theta Tau International and from the University of Pennsylvania:  the Dean’s Award for Exemplary Professional Practice, the Expert Alumni Award and the Family and Community Department’s Academic Practice Award   She is also the recipient of the Lindback Award for Distinguished Teaching. Dr. Spatz received the Distinguished Lang Award for her impact on scholarship, policy & practice.

In the university portion of her job, she teaches an entire semester course on breastfeeding and human lactation to undergraduate nursing students and in the hospital portion of her job, she developed the Breastfeeding Resource Nurse program.  Dr. Spatz is also Chair of the American Academy of Nursing’s Expert Panel on Breastfeeding and their representative to the United States Breastfeeding Committee.  Dr. Spatz is also a member of the International Society for Researchers in Human Milk & Lactation

 

Water Exercise for Pregnant Women

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by, Lizzy Bullock, WSI

Exercise goes a long way to promote to a healthy pregnancy.  Exercise has many benefits for mom and baby but in the summer months, it can be difficult to find an activity that doesn’t cause you to overheat. In fact, the American College of Obstetricians and Gynecologists advises pregnant women not to exercise outside when it’s extremely hot or humid and to drink plenty of water before, during and after exercise to avoid dehydration.

Benefits of Swimming During Pregnancy

Many land-based exercises become difficult to participate in as you continue to gain weight, and if your legs begin to swell. This is especially true of exercises like running and cycling that require more effort to carry your increasing weight. The resulting discomfort and fatigue often deter women from continuing their exercise routines during the third trimester, according to a study published in Medical Science & Sports Exercise. However, a study published in the Journal of Nurse Midwifery found that pregnant women who swam for exercise were able to maintain their routine’s intensity and saw no decline in performance, even late into gestation. This continued exercise allows for a lowered risk of gestational diabetes and a shorter, easier labor, according to a study by the International Journal of Obstetrics and Gynecology.

And, thanks to water’s naturally cooling effect, it’s difficult to overheat in a pool as long as the water is not excessively warm. The Australian Physiotherapy Association reports that swimming and water aerobics are safe for a pregnant woman’s body and will not cause fetal hyperthermia when the pool is heated to 33 degrees Celsius or less (91.4 degrees Fahrenheit).  Do remember to drink fluids before and after swimming as you may not notice sweating as much when in the water.

A few other precautions: wear non-slip footwear when poolside to avoid slipping and avoid crowded pools because your risk of accidentally being kicked in the abdomen increases the more swimmers are in the pool. Wear sunscreen if swimming outside to protect your skin and prevent development of the mask of pregnancy (darker areas of skin which can develop on the face during pregnancy and be made worse by sun exposure).  Don’t swim so vigorously your heart rate exceeds 140 beats per minute. Finally, don’t dive or jump feet first from any height into a pool when pregnant.

Tried-and-True

Success stories from pregnant women worldwide are an inspiration to get in the pool. Kristi Lee, 36, competed in the United States Masters Swimming Nationals while pregnant in 2011. She noted a decrease in her lung capacity but still managed to take home a silver medal in her age group. She gave birth to a healthy baby girl and was back in the water three weeks postpartum.

Another successful pregnant swimmer, Natasha Bertschi, competed in a triathlon in her 34th week of pregnancy. She elected to stick with water exercise because she found that it relieved first-trimester nausea, helped her to give birth naturally (rather than by Cesarean) and kept her weight to a healthy level.

But, you don’t have to be an elite athlete to benefit from the effects of being in the water during your pregnancy. As a pregnant swimming instructor, I spend at least 30 minutes in the pool every day. Sometimes just walking back and forth; sometimes swimming gentle laps alongside a student. The result is significant. My body feels cooler even after I get out. I’ve also managed to avoid varicose veins) and foot and ankle swelling (caused by sluggish circulation in the lower legs during pregnancy). In fact, the Mayo Clinic specifically recommends walking in the pool to keep swelling at bay. On days that I don’t teach lessons, I feel a marked difference in my body: increased abdominal tightness, lower back pain, and a general heaviness that’s tough to bear.

Things to Consider Before Getting in the Pool

Can I Exercise?

With so many considerations, it’s hard to know what’s safe for you and your baby. If you’re unsure about exercising during pregnancy, know that the American Pregnancy Association recommends moderate exercise for nearly every pregnant woman. Research by the Mayo Clinic indicates that, when carried out safely, exercise during pregnancy results in many attractive benefits such as preventing excess weight gain, increasing stamina, allowing for easier sleep and easing back pain. Additionally, doctors at California State University found that regular exercise during pregnancy led to the formation of more hardy, resilient vascular muscles in the child. There are certain circumstances, such as when a woman has preeclampsia, placental complications, or cervical insufficiency, when your midwife or doctor may advise you to avoid exercise and take it easy.  It’s always a good idea to discuss exercise with your provider at your first prenatal visit.

Accommodating Your Changing Body

Every day you’re baby is growing and your body is changing – making traditional exercise less manageable and, let’s face it, less appealing. Research by Thomas W. Wang, M.D. published in the American Family Physician Journal points out the many bodily changes that affect a pregnant woman’s ability to work out. As your uterus and fetus develop, your center of gravity shifts, resulting in less stable balance. A larger midsection leads to lumbar lordosis (swayback) which can be painful, and hormone production is thought to soften joints, increasing the risk of sprains and strains. Wang also notes that pregnant women who perform weight-bearing exercise may report pain and discomfort in the pelvis and abdomen, likely due to tension on the round ligaments that have stretched immensely to provide space for your growing child.

Thankfully, when you swim water provides a resistive force without the demands of  load-bearing exercise. And, because water provides a low-gravity workout environment, women who are expecting can exercise without worrying about risks like falling, joint stress or abdominal trauma. What’s more, water’s weightlessness removes the sense of heaviness in the back, legs, and feet – providing you with much-needed relief.

When beginning any exercise, it’s always best to first check with your midwife or doctor before undertaking any workout activity. Once the go-ahead is given, get in the pool and enjoy.

Lizzy1-HeadshotLizzy Bullock is a swimmer, Red Cross certified swimming instructor (WSI) and swimming coach with over a decade of experience working with infants, children, and adults. Lizzy currently works as a swimming instructor and staff writer for AquaGear, a swim school and online swim shop.

 

What You Need to Know About Hepatitis B

by, Leslie Hsu Oh

You’ll be fine. Don’t be selfish. This was Mā Ma’s last words to me. Even though she hadn’t been able to eat anything for days and liver cancer caused by hepatitis B had coated the insides of her abdominal cavity, I still didn’t believe it was possible that I could lose her. A year earlier, she had been diagnosed with liver cancer a week after my eighteen-year-old brother died of the same disease.

Dropping my college textbooks, I grabbed her hand and said, “I won’t be fine. Today is your wedding anniversary. In a few weeks, I turn twenty-one. There’s no way that God would take both you and Jon-Jon.”

No matter what I said, her eyes remained closed against the crisp white hospital pillow. Desperate, I said the most hurtful thing I thought I could say, “If you die, I won’t get married. I won’t have kids without you.”

Her eyes fluttered. I knew the words upset her because she once told me that becoming a mother was the best thing that ever happened in her life. An hour later, a chocolate brown bubble escaped from her mouth and she was gone.

For years, I thought that Oath was meant to punish Mā Ma for leaving me. But when I finally realized it was because I was afraid hepatitis B would claim another person I loved, I understood that I was only hurting myself.

My two daughters (11 and 3) are as feisty as my mother and my son (8) dotes upon me the way I thought only my brother could. They are free of hepatitis B because nurses like those of you who belong to AWHONN worked with me to ensure that all my kids were given the hepatitis B vaccine at birth, even though I am not chronically infected with hepatitis B. This is something that parents need to request.  I’ve spent the last 19 years since founding The Hepatitis B Initiative educating parents about how they can protect their children from hepatitis B.

Today, The Hepatitis B Initiative operates in several states preventing liver diseases caused by hepatitis B and C among Asian Americans and Pacific Islanders, African Americans and other high-risk groups. We have served Chinese, Vietnamese, Korean, Cambodian, Laotian, Thai, Filipino, Nigerian, Ethiopian, Cameroon, Sierra Leone, Indian, Pakistani, Egyptians, Sudan, Syrian, Afghanistan, Bangladesh, Indonesian, Ghanaian, Moroccan, Saudi Arabian, Brazilian, Nepalese, Burmese, Salvadorian, Guatemalan, Ecuadorian, Sri Lankan, Mexican, El Salvadorian, and Honduran communities who are not accessing health care due to a lack of affordable treatment options, employment in industries which expose workers to hepatitis (such as nail salons, health care work, etc.), language barriers, and a lack of culturally competent care.

Because we bring services directly to places where the community gathers (51 events held in 2015) like mosques, schools, churches, temples, health fairs, ESL classes, clients are willing to share the reasons why they have never heard about or been screened or vaccinated for hepatitis B.

Hepatitis B is an easily preventable disease and yet it kills 2 people every minute. In the United States, 1 in 10 Asian Americans is chronically infected with hepatitis B. It is one of the greatest health disparities.

First, most who are infected feel perfectly healthy. As many as 75% of the Americans living with hepatitis B or C do not know they are infected.

Second, even though like my family’s situation, most Asian Americans contract hepatitis B from mother to child during birth, there is a stigma that it is a sexually transmitted disease and therefore most people living with hepatitis B choose to remain silent about their condition.

  • They are worried that they will lose their jobs or ruin their chance of finding a partner.
  • Immigrants believe they will be deported since hepatitis B is a reportable disease.
  • Many believe that it’s better not to know whether they have hepatitis B or liver cancer or cirrhosis.
  • Or worse no one ever told them that hepatitis B was a serious disease.

Third, many cultures enforce silence. I’ve been told all my life not to talk about the bad stuff. Pretend everything is fine. Save face.

My mother was a photographer, journalist, and painter. She taught me that art could say the things that we are afraid to say, how it could heal long after the life of its creator. With the weight of a camera around our necks, my mother would ask as we waded through white waters or leaped onto the back of a horse: “What story are you trying to tell?” In nearly fifty national parks, my aesthetic developed in the natural world, places woven with indigenous knowledge, bled in streambeds, trapped in rock layers, eroded in the earth.

While The Hepatitis B Initiative has had a life-saving impact, I realized that the transformative power of art does more. People tell me that my story saves lives. That’s why I’m working on a memoir which I hope will inspire others to find their voice. That perhaps together we can end the silence and stigma cloaking hepatitis B and other diseases.

On October 15, 2016, the Hepatitis B Initiative will be throwing a Gala at the Willard Hotel in Washington, D.C. to celebrate 10 years as a nonprofit. For more information, please visit hbi-dc.org or contact [email protected].

Losing her mother and brother to hepatitis B at the age of twenty-one inspired her to found the Hepatitis B Initiative in 1997, which she later expanded to the Maryland, Virginia, and Washington, D.C. area with Thomas Oh. Today, this award-winning nonprofit continues to operate in several states mobilizing communities to prevent liver diseases caused by hepatitis B and C among Asian Americans and Pacific Islanders, African Americans and other high-risk groups.

Leslie Hsu Oh
[email protected]
www.lesliehsuoh.com

Babies Have Back-to-School Needs, Too

by, Summer Hunt

This time of year from late July into August, many moms are preoccupied with back-to-school shopping for all the basics: pencils, paper, glue and the like, as well as products like paper towels, hand soap and facial tissue. Just as these items are important for school-age kids, babies and toddlers have “back-to-childcare (and preschool)” needs, too—and diapers top that list.

Did you know that babies and toddlers can’t attend childcare without an adequate supply of extra diapers? It may not seem like much, but for the 1 in 3 families who don’t have enough diapers to keep their babies clean, dry and healthy, buying extras typically breaks the bank. Without enough diapers, parents are forced to choose between work—and a paycheck—and taking care of baby.

The Harsh Realities of Poverty
Diapers cost $70-$80 per month, per baby, and parents can’t use food stamps for diapers—in fact, there is zero direct government assistance for diapers. Low-income families can’t afford to buy diapers in bulk, and many do not have access to big-box discount stores or online shopping. This means families hurting the most financially are hit hardest when it comes to buying essential care items like diapers. In fact, the poorest 20% of Americans spend nearly 14% of their income (after taxes) on diapers, according to the National Diaper Bank Network (citing 2014 government data)—that’s $1 out of every $7 of their average $11,253 income spent on diapers, or $1,575 a year on average.

Parents just want to do right by their children. We spoke with four moms last year who talked about their experiences with diaper need. These families are doing their best to keep their babies happy and healthy, even if that means going without or making tough decisions about paying other bills. And with 5.3 million babies in America living in low-income families, these moms are not alone in their struggles.

Nurses on the Front Lines
AWHONN is proud of all the work our nurses to do to take care of moms and babies, especially those in the most vulnerable populations. Our Healthy Mom&Baby Diaper Drive gives nurses the recognition they deserve when they go beyond patient care and collect items like diapers, wipes, clothes, car seats for their tiniest patients.

Across the country, at section and chapter meetings, through community baby showers and diaper drives, when donating diapers to diaper banks and women’s shelters, and in their own hospitals and clinics, nurses are on the front lines every day combatting diaper need for their patients.

Let Us Share Your Efforts!
What are YOU doing in your area to make sure that babies are clean, dry and healthy? Are you:

  • Giving out diapers at community and education events?
  • Participating in a diaper drive event with your local faith community or civic group?
  • Sharing diapers with families in need in any other way?

Tell us your stories at AWHONN.org/diaperdrive, or contact our Diaper Drive consultants Jade Miles and Heather Quaile. Our consultants can also help you increase your efforts or start something new and make sure that your current successes are counted in our final totals. You can also visit DiaperDrive.org to make a dollar donation that will be used to purchase diapers at wholesale for diaper banks across the country. Are you an advocate for cloth diapering? There are several diaper banks that accept cloth diapers, and you could even initiate a cloth diaper drive in your community!

As families everywhere get ready to head back to school, why not toss an extra pack of diapers into your cart to donate to your local bank? Or, head over to DiaperDrive.org while surfing the Internet for prime deals on books and binders and donate $20 dollars to diaper a baby for two weeks. You’ll ensure a brighter future and a better bottom line for babies everywhere—and that’s a guaranteed A-plus in our books.

Nurses Make Change Possible for Babies_1

Summer HuntSummer Hunt
Summer Hunt is the editorial coordinator for publications at AWHONN

Ladies on a Mission

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Guatemala

by, Lori Boggan, RN

When we enter the medical profession, we make a lifetime commitment to the service of others.  As nurses, we serve our patients, our community, our friends, and our family.  No other profession has such a deep connection to and is so trusted by society.  We are the ones at the bedside day and night.  We are the ones that our patients trust with their privacy, their secrets, and their lives.

Volunteer nursing is no foreign concept for American nurses.  In fact, the earliest “nurses” were nuns, or family members of those active in the Civil War.  They were in the trenches before any formal nursing education or organization existed.

For most, nursing is a calling.  Nurses are innate caregivers.  What is it about a nurse that is willing to use her own money, travel to an unfamiliar place sometimes lacking basic accommodations, and work long hours without pay?  It is the drive to care for those in need.

The following interview is with one of AWHONN’s own that goes above and beyond.  Nancy Stephani Zicker, a labor and delivery nurse from Central Florida has journeyed to Guatemala yearly since 2014 to help less fortunate women in need of gynecological surgery.  She journeys with her friend and obstetrician, Dr. Cecille Tapia-Santiago, of Volusia ObGyn Daytona Beach.  In addition to gynecological surgeries each year, Dr. Tapia sees patients in the mission’s clinic and educates Guatemalan midwives.  I interviewed both ladies in hope to inspire others to join mission work.

How long have you been going on missions?

Nancy:  I have been going on yearly medical mission trips every March since 2014.

Cecille:  I have been doing 1-3 mission trips a year since 2000.


Where has your mission work taken you?

Both: Guatemala


Why Guatemala?  Is there any particular need there with regard to women and infant’s health?

Cecille:  Absolutely. When we go there we provide contraceptive care, well woman care, and manage surgical conditions (uterine fibroids, large ovarian cysts, and pelvic prolapse being the most common).


Describe a typical day in the life of a volunteer nurse.

Nancy:  Each year that I have gone, I have been assigned to work as a circulating nurse (and sometimes scrub in to tech or assist) in the OR. There are clinic nurses, OR nurses, PACU nurses and ward (floor) nurses.

FullSizeRender-100We go in to a completely bare room and make it a functioning OR.

As an OR nurse, we first have to unpack and sort all of our supplies, as well as set up the operating rooms. We arrive on a Saturday late afternoon and get right to work. Sometimes we set up in community centers and sometimes we set up in an actual hospital. This usually takes Saturday evening and all day Sunday to accomplish.

Monday morning, the surgeries begin. Depending on the number of cases scheduled, we usually are in the OR from 8am-5pm. Once all surgeries are done at the end of the week, we have to break down the ORs to leave the space as we found it and inventory all supplies so we can order more for next year.  We all have had to improvise and be creative with available equipment and supplies. It’s quite the challenge, but the entire team comes together and we make it work.z


20140306_102410Cecille, describe your work educating midwives in Guatemala

It’s THE BEST PART. Midwives in Guatemala are mostly lay (no formal training at all). Guatemala has one of the highest infant mortality rates in the world. We do 1-2 day seminars and teach basic infant resuscitation as well as basic management of labor, delivery and postpartum complications. The midwives have to deal with a lot of prejudice from the physician community and often won’t get paid for their service if the patient has to be transferred to a hospital.  So anything they can do to show their critics that they are furthering their education and are doing right by a patient is helpful.

Is there any one particular patient story that you can share that stands out in your mind where you felt you really made a difference in that patient’s life? 

Cecille:  One of the midwives came back to a refresher course and told us that she gave CPR to a baby with apnea. Initially the family was resistant and thought the baby was dead. The midwife pulled out her certificate from the seminar and showed the family. She told the family to let her try and do CPR. She successfully performed mouth to mouth and chest compressions and the baby was fine!  We also had a young lady with an enormous pelvic mass that was compressing her entire abdomen and pelvis. She had been turned down by everyone and when we saw her, she was cachectic and probably a few weeks away from dying. We removed an enormous yet benign ovarian cyst. It was over 50cm in diameter and weighed 25 pounds.

How has mission work changed your practice?

Nancy:  It has made me a better nurse. Seeing and working with the patients I see on my mission trips has renewed my love of nursing and my compassion for people in general. The patients I see on these trips are so profoundly grateful for the care they receive.  It helps to renew one’s zest for nursing.

Cecille:  It hasn’t really changed how I practice at home, but you have to be a particular type of person to do well on these trips. In order to do this type of work you have to be patient, flexible, meticulous, and creative. You can’t go to these trips if you’re going to expect U.S. standards of equipment, timeliness and availability of things you have every day at home (for example blood, cautery, suction, light).  I have seen time and time again physicians, nurses and staff struggle because they have unrealistic expectations of what it’s like to operate in third world conditions. And by the same token seen plenty (like Nancy) that just sail, adapt and just sail.

How has mission work changed you as an individual?

Nancy:  Personally it has made me realize that as humans we all want the same things- we want our children healthy, we want access to quality healthcare, we want to be able to be happy in our daily lives, and we want a peaceful existence.

Cecille:  It refreshes my choice and faith in my profession. Medicine has changed so much. The physician/patient relationship many times is not what it used to be. We live in a defensive medicine environment that often plays in to how we practice here. Over there, patients and families trust and believe that, just like at home, I do my very best to provide the very best care my skill set allows, and that I will never go above that skill set and take unnecessary risks. That trust factor makes any responsibility tolerable.

Guatemala

What advice would you give a nurse contemplating mission work?

Nancy:  It’s important to choose the right organization to join, one that interests you. Each one has a different application process and requirements, as well as when and where they go on their trips. They all differ with their missions and what they offer. I have gone on 3 trips so far, and have applied for my 4th with the same group. It’s called Cascade Medical Team, whose parent organization is Helps International. I have friends that have used various other organizations. It’s important to choose one that fits your interests and your budget, as well as the dates you’re available to go. Also, for me on my first trip, it really helped that I went with someone I knew and who had experience with volunteering for medical mission trips. Not only was she able to give me a heads up on what to expect, but it is just amazing to be able to share the experience with someone you know- someone who understands why you would want to, or should want to, volunteer for such a trip
.

How can a nurse prepare for his/her first mission?

Nancy:  Be open-minded. Prepare to go out of your comfort zone and learn new things, both in the nursing/medical field and also culturally.

FullSizeRender-101Where to next?

Nancy:  To date, I have only been to Guatemala. At this point in time, I only volunteer for one mission trip each year and I have found that I really enjoy helping the people there and so have concentrated my trips to Guatemala.

Thanks for sharing, Nancy and Cecille!  And thank you for your service!  For more information on their work with Cascade Medical Team, visit www.cascademedicalteam.org.

Lori Boggan, RN
Lori is a NICU Staff Nurse at Sahlgrenska University Hospital in Gothenburg, Sweden. After becoming a nurse, Lori traveled across the country to work a three-month travel contract in San Francisco, California. Nearly five years later her journey continued to Gothenburg, Sweden, where she now lives and works. She also write her own blog Neonurse at https://neonursetravels.com/ or on Instagram.

Specialty Training for Novice Nurses

by, Heretha Hankins, MSN-Ed, RNC

Twenty-five years ago when I was a young, new nurse there was a lot of talk about the nursing shortage. Every nursing magazine speculated on how patient care would suffer if we didn’t train more nurses. Several years ago I looked around and saw tangible evidence of this looming shortage for the first time in my career. At first limitless overtime was available and then came incentive pay and bonuses as an effort to cover the shortage. Finally, nursing broke the unwritten golden rule. We started accepting new grads into specialty areas.

When I started nursing school I knew I wanted to work in L&D but my instructors explained that I must first work “general nursing” (med-surg) before I could even consider a specialty like OB. Today there is such a low pool of applicants for multiple open positions we are seeing a growing trend of graduate nurses entering specialty areas. After six months they are expected to possess critical thinking skills; one year later they train another new graduate. As we see an increase in the hiring of graduate nurses into critical practice areas such as OB, ICU and ER there needs to be a change to the training approach. The “each one teach one” approach is no longer effective.

OK, so here is where I want to really talk to nurse leaders. How do you know when a nurse is successfully trained? Can you measure the progress? Is the retention rate of your unit impacted by turn over from the nurses with less than two years experience? When I asked myself these questions I was inspired to design and implement the Perinatal Nurse Training Program (PI.N.T).

Developing the Program

The PINT Program is a 16 week program which includes 72 hours of didactic information in the classroom setting with a curriculum and reading assignments. Peer-reviewed books are required purchases (build a practice on research not hearsay). We also incorporate AWHONN’s basic and intermediate fetal monitoring courses into the training to assure the information received is consistent with national standards. Yes, it sounds and looks like going back to school.  Didactic hours are spaced throughout the 16 weeks building on concepts as the nurse builds in practice.

Use of a focus plan and checkpoints makes progress measurable. The checklists are tasked-based because a new learner has concrete thought processes. Consistent feedback in 1:1 sessions helps to promote progress or strategize about practice opportunities. In the last four weeks there are two to three novice nurses assigned to one preceptor. This gives the novice an opportunity to strengthen a solo practice while keeping that preceptor safety net nearby. After the 16 weeks, periodic monitoring is used to assure practice assimilation, answer questions and offer support. By the one year anniversary of practice the novice must pass the National Certification Corporation (NCC) exam for fetal monitoring to be considered successful.

Prior to PINT unit based orientation was largely completed with using preceptor pairing. Small amounts of didactic were used but were generally attached to vendor presentations for products used in the practice. Many things such as fetal monitoring and high risk pregnancy care were covered by use of self-learning modules. It is also worth noting, prior to my arrival the educator position was vacant for approximately five years.

Road Blocks

The greatest obstacle identified was seen in the change with preceptor assignments. Traditionally a novice was assigned to one preceptor for all of orientation. In the PINT program the preceptor assignment is fluid but generally stable for two weeks. My philosophy for this approach is based in inherent human error and autonomous practice. No one is perfect and sometimes what works well for one may not work for another. Seeing multiple different practices allows the novice to build his/her own autonomous practice.

Measuring Success

My measurement of success for this program is in the pass rate of the exam and the increase retention of new hires on the unit. With a total of 71 novices trained to date we boast a 98% pass rate by one year of practice on the NCC exam, a two year retention rate of 75% and a one year of near 90%. Program evaluation surveys provide feedback from the participants regarding what they gained and what could be improved. The participants noted the program worked well for them and they appreciated the structure. I am most proud to know that this leads to increased patient safety and healthy moms and babies. As I recall that was what motivated me to want this practice when I was a new graduate nurse.

Advice For Nurses Wanting to Start A Specialty Training:

  • Provide didactic training on the routine patient type starting with normal before sending the novice to the unit or training on complex procedures.
  • Make time for didactic classroom throughout the process so time if given to build on concepts.
  • Start the process with cohorts so that each participant can connect with someone in the group.
  • Encourage journaling because it helps develop critical thinking.

HerethaHeretha Hankins MSN-Ed, RNC is a Professional Development Specialist at Holy Cross Hospital in Silver Spring, MD, affiliate of Trinity Health System. She is the creator/facilitator of the Perinatal Nurse Training (PiNT) Program which she has presented to the Central Virginia Nursing Staff Development Organization, Maryland Patient Safety Perinatal Collaborative and Trinity Health Perinatal Summit. With 20+ years of nursing experience she also freelances as a Nurse Education Consultant. Her professional passion is to train the best nurses to provide the best patient care. She is always willing to discuss this at [email protected] or any other forum.

White House Climate and Nursing Roundtable

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Wednesday, May 25th
by, Kimberly J. Angelini, WHNP-BC, RN

Today was a beautiful sunny day in D.C.

As part of Extreme Heat Week, the White House hosted representatives from leading national nursing organizations to discuss the critical importance of fighting climate change to protect public health.

Nurse leaders from across the country were convened by the Alliance of Nurses for Healthy Environments (ANHE) with hopes of establishing a relationship with decision and policy makers in Washington.

I was personally introduced to effects of environmental toxins on health through Stacy Malkan’s book Not Just a Pretty Face: The Ugly Side of the Beauty Industry. I was shocked to learn that the FDA does not regulate cosmetic products and that many contain chemicals and toxins that have been known to cause cancer and birth defects. In the book she mentions a study in which the cord blood of a newborn was found to have high levels of many of these toxins. Makes you think twice.

With this in mind I found the Skin Deep database by the Environmental Working Group (EWG.org) that lists chemicals in products and rates them as a consumer reference. I got involved and attended several lectures held by the EWG on environmental toxins as well as climate change and the effects on health. This area is critical yet remains out of the minds of the general population. The ANHE and other organizations are playing a fundamental role in bringing these health issues to the forefront and lobbying for policy change.

Nurses are on the front lines caring for America’s health.  In light of the current and predicted health threats from climate change, this historic event focused on how nursing organizations can address this public health threat through educating their members, leading research, incorporating climate change into their nursing practice, and participating at the local, state, and federal levels on climate policies like the Environmental Protection Agency (EPA)’s Clean Power Plan, which sets the first national limits on carbon pollution from power plants.

Nurses are health care professionals accustomed to looking at health holistically (telling someone to eat healthy is more complicated if the only food source in a town is fast food and gas stations.)  It is the nurse who looks at the environmental, social, and cultural aspects of an individual’s life to understand if a treatment plan will work. Nurses, as the most trusted profession, are at an opportune position to educate patients on the effects of climate change on health and anticipate the public health issues that will arise in a changing environment.

Although combustion of fossil fuel, agricultural practices, and forestry, are already causing harm and change can not be expected overnight, the harm will be less if we take prompt action. We need to both decrease the causative agents and increase our adaptations and resiliency.

Major health consequences include:

  • Extreme Heat –
    • As temperatures rise, there will be an increase in heat related deaths and illnesses (particularly for vulnerable populations including pregnant women, children, elderly, and homeless)
  • Air –
    • Increased temperatures decrease air quality
    • Wildfires have been increasing 5-6 fold and contribute to increased ozone and particulate matter resulting in increased cardiovascular and respiratory illnesses and death
    • Higher pollen counts contribute to longer and stronger allergy seasons
  • Increased Precipitation—
    • Combination of rising sea level and increase in extreme precipitation in the form of hurricanes and storm surges can lead to flooding, alter infrastructure and result in negative health consequences before, during, and after the event, such as drowning, trauma and mental health consequences (eg PTSD)
  • Water-related infections—
    • Flooding and increased water temperatures increasing contamination of water and toxic algaea growth (Vibrio vulnificus)
    • Contamination of water or shellfish
    • GI illnesses, sepsis
  • Vectors –
    • Elevated temperatures and increased water breeding sites (lead to longer and larger populations)
    • Ticks and mosquitos will show earlier in season and expand northward geographically
    • Increased exposure to lyme, zika, malaria, west nile, etc.
  • Food –
    • Increased temperature, humidity, and season length
    • Increased salmonella 
  • Mental Health –
    • Traumatic events and natural disasters
    • Distress, grief, PTSD, social impacts, and increased stress

The impact on human health is a nonpartisan consequence of climate change that speaks to everyone globally and cannot be denied by opposition.

The need for nursing participation was clear and members of ANHE encouraged White House staff to consider electing nurses onto their committees. The role of developing committees and initiatives within each specialty nursing professional organization was addressed and the overarching importance of combining resources and efforts across nursing specialty organizations and interdisciplinary to accomplish optimal health for our nation.

Going forward, the EPA is voting on an alliance with ANHE to support continued collaboration and efforts to address this global and pressing issue.

KimAngKimberly J. Angelini, WHNP-BC, RN is a PhD student at Boston College studying women’s health promotion. She is currently a board certified Women’s Health Nurse Practitioner and works at Dowd Medical Center Gynecology. Kim also works as a staff nurse on the in-patient transplantation unit at Massachusetts General Hospital.