Category: Nursing

Child Passenger Safety “What Every New Parent Should Know”

By Kerry S Foligno, RN MSN CPSI

We have all been at the baby shower when the parents-to-be  open the biggest box in the room and the crowd cheers! “Ooooh I love the color”, “Check out the cup holders”—“It matches the stroller perfectly”. In my head I’m saying “I hope they keep the receipt!” The truth is not every car seat fits every car. And not all parents’ needs fit all car seat.

Here are the facts. Seventy-three percent of car seats are not used or installed correctly (Safe Kids Worldwide).  Unfortunately as our new parents are walking out the door of the hospital while embracing one of the most stressful times of their life they realize that car seat installation is not a joke. As nurses, educators and parents we agree that learning happens most effectively when done in a calm, comfortable environment. Our program appropriately titled CPS Safety at Memorial Hospital West started with staff members recognizing a lack of research-based information available for parents and families about child passenger safety. We were very aware, though, of the overwhelming amount of information on convenience features and style and color choices for car seats. To begin we enlisted the help and support of our administrative team. With their involvement we were able to get approval for our first nurse to attend a certification class to become a certified car seat technician. We were able to start community seat inspection stations as additional nurses in our family birthplace department became certified. Our technicians now include registered nurses, social workers, community liaisons and patient care assistants from multiple departments of the hospital.

I am fortunate to work for Memorial Healthcare System that recognizes the importance of education for our community. We incorporate child passenger safety education in many settings. Within my hospital, which is a 384 bed delivering hospital, we have safety classes for families in the community, daily education classes for our inpatients and a car seat inspection station that all incorporate the importance of child passenger safety.

About Child Passenger Safety Education

The child passenger safety education includes classroom information and hands on instruction on car seat installation, how to properly put a child into the car seat and review of other safety concerns. We provide parents and families with information on how to choose the right car seat for their child and the  location where the car seat should be installed within their vehicle. We use teaching equipment that simulates a seat in a car and demonstrate how to properly install a child car seat. We empower our families to educate themselves utilizing the instruction manuals from the car seats and the owner’s manuals from their cars.

The goal is to provide families with multiple opportunities to be educated on decisions about restraining their new baby or older sibling. If they have the opportunity to participate in any of these programs, they are better prepared for that day of discharge from the hospital and their first car ride home. We are also aware that the opportunity for education at the bedside makes for easier transition to correct installation at curbside by the parents.

Community Feedback

The feedback from our community is overwhelmingly one success story after another and a multitude of appreciative emotions. Parents-to-be, grandparents with visiting grandchildren, fellow staff and patients have all benefitted from our hospital-based community program. Grandparents have told us how “impressed” their own children were with the seat installation and correct education that they received. New parents have overwhelmingly expressed their gratitude with sighs of relief that their newborn is traveling home safely.

I am hoping this has inspired all of you to pursue child passenger safety education in your workplace and community. A great place to start is to make research-based information about car seat installation available to your colleagues and to parents and families.

To find out more information on how to become a certified technician, visit http://cert.safekids.org

Great resources include:

Kerry S Foligno MSN RN CLC
Kerry is a Registered Nurse with 30 years of experience including, Adult Surgical ICU/Trauma and Mother Baby. Currently she is at Memorial Hospital West Family Birthplace in Pembroke Pines, Florida working as a Perinatal Educator. Her passion is teaching. Her focus is moms to be, new moms and nursing students. She is a Certified Child Passenger Safety Instructor and coordinates the Car Seat program At Memorial West.

Human Milk is Magical- What Donor Mothers Should Know About Milk Banks

There is no doubt that human milk provides species specific nutrition for the optimal growth and development of all infants, including the vulnerable hospitalized preterm infant. 1,2 Since time began, mothers have supported mothers in providing this optimal source of nutrition but evidence is strong that human milk contains much more than nutrition for the infant’s well-being.3 Despite global efforts to provide infants worldwide with this basic human right resource, no country on earth meets the minimum support for breastfeeding.4  In 2004, Labbock et al., cited a key issue limiting the global acceptance of human milk- social and commercial pressures- that still holds true today and is relevant to current donor milk donation and utilization.5

When a mother is unable to provide enough milk for her own infant’s needs, then donor milk is the next best option. There are basically two business models for human donor milk bank operations; not-for-profit and for-profit. Both models provide safe, processed donor milk for infant consumption. One of the differences lies in the human species-specific properties retained post-processing procedures. The Human Milk Banking Association of North America (HMBANA) is a professional association that supports non profit milk banks by  providing its members with standardized guidelines to screen donors, and process and distribute human milk.6 The for-profit milk banks utilize different, but safe, milk processing procedures, yet the end milk product produced by each contains significantly different human bioactive milk immune and metabolic components. HMBANA milk banks utilize holder pasteurization (milk is heated to 62.5°C for 30 minutes then rapidly cooled to 4°C) whereas for-profit milk banks utilize high vat pasteurization (milk is heated to 63°C ≥ 30 minutes), and  sterilization (milk is heated to 121°C for 5 minutes at 15 pounds per square inch). This sterilization process renders significantly less human species concentrations of protein, fat, immune components, and oligosaccharides.7 Donor mothers will benefit from knowing  this information to make informed decisions about where to donate their milk.

Another social and commercial pressure is the monetary compensation for donating milk . Donor mothers should know the differences in processing fees between non-profit and for-profit milk banks. A mission of HMBANA milk banks is to contain processing costs so that donor milk can be equitably distributed. One mechanism to contain costs is to not offer monetary compensation for milk donations.  For-profit milk banks offer monetary compensation which is then passed on to the consumer resulting in higher prices for donor milk. Guiding principles to determine whether or not a donor of a biological product can be offered compensation is outlined in an international statement developed by the convention of the Council of Europe   ; only those products created using patents can be distributed for commercial profit.8 This guidance protects for-profit milk banking companies. Donor mothers have the right to know how their milk will be processed and sold.

Lastly, for-profit milk banking companies have abundant resources to promote their product using sophisticated, provocative ad campaigns. Donor mothers have the right to receive informed healthcare data regarding the value of donor milk that retains 50-90% of human milk properties post-processing-the milk provided by non-profit human milk banks- which benefits  optimal infant growth and development.

HMBANA mentors those who are developing milk banks in areas where improvement in breastfeeding support is needed. To learn more about how to become a HMBANA- developing milk bank  visit www.hmbana.org . The Mothers’ Milk Bank of Louisiana, a developing milk bank member of HMBANA, would like to express sincere gratitude for the guidance of our mentor bank, the Mothers’ Milk Bank at Austin under the leadership of Kim Updegrove, Executive Director, as well as HMBANA guidance documents. August is National Breastfeeding Month. Let’s join together to honor all donor mothers for their lifesaving donation of miracle milk and pledge to inform and enlighten them of the invaluable impact of their milk donation decisions.

References

1.            American Academy of Pediatrics Committee on Nutrition SoB, Committee on Fetus and Newborn. Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics. 2017;139(1):e20163440.

2.            Medicine AoB. ABM Position on Breastfeeding – Revised 2015. Breastfeeding Medicine. 2015;10(9):407-411.

3.            Agarwal S, Karmaus, W., Davis, S., & Gangur, V. Immune markers in breast milk and fetal and maternal body fluids: A systematic review of perinatal concentrations. Journal of Human Lactation. 2011;27(2):171-186.

4.            UNICEF. #breatfeeding- Breastfeeding A Smart Investment. 2017; https://www.unicef.org/breastfeeding/. Accessed August 5, 2017, 2017.

5.            Labbock ML, Clark, D. & Goldman, A. Breastfeeding: maintaning and irreplaceable immunological resource. Nature Reviews Immunology. 2004;4(7):565-572.

6.            Human Milk Banking Association of North America. Guidelines for the establishment and operation of a donor milk bank. Forth Worth, Texas: Human Milk Banking Association of North America; 2016.

7.            Meredith-Dennis L, Xu, G., Goonatilleke, E., Lebrilla, C., Underwood, M. . Composition and variation of macronutrients, immune proteins, and human milk oligosaccharides in human milk from nonprofit and commercial milk banks. Journal of Human Lactation. 2017.

8.            Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. Treaty No.164. 1997; http://conventions.coe.int/Treaty/en/Treaties/html/164.htm. Accessed July 27th, 2017.

 

 

Shelley Thibeau, PhD, RNC, is the Director of the developing Mothers’ Milk Bank of Louisiana. As a NICU nurse for 38 years, her interest in breastmilk has expanded to exploring breastmilk immunology associated with preterm infant health.

Providing Care for Survivors of Sexual Abuse During Childbirth

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“Humiliating and Traumatic,” these are the words from a survivor of sexual abuse when asked to describe her labor and delivery. All too often, women who have been sexually abused carry their wounds into the delivery room. And, all too often, these unresolved traumas rear their ugly heads and cause complications, from labor dystocias, to full blown anxiety attacks that result in a woman completely shutting down. These are some of the more challenging labors to manage.

According to the U.S. Department of Health, one in four girls and one in five boys will be sexually abused before they turn 18. One in five women and one in 71 men will be raped at some point in their lives. This is in many ways a silent epidemic. Sometimes victims don’t disclose their abuse to their care providers. The reasons vary, and can range from  ongoing suffering of the traumatic effects of the abuse and  avoiding  reliving it, to a continuing sense of shame that victims  may have never come to grips with.

What are some possible signs of sexual abuse?

According to When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, having a constellation of these symptoms can indicate a history of abuse. Having one or more of the following should trigger a red flag and considerations for a woman’s  care during childbirth:

  • Not able to feel fetal movement. Some women have “numbed” that part of the body
  • Hyperemesis gravidarum
  • Chronic pelvic pain
  • Missed prenatal appointments
  • Panic with vaginal exams
  • Extreme anxiety with IV starts
  • Disassociation that manifests as if she’s going into a trance

Many of these symptoms can understandably occur in women who don’t have a history of sexual abuse, but when a woman has two or more, it’s reasonable to suspect that such a history is possible. These symptoms can stem from PTSD, which is triggered by a woman’s perception of loss-of-control, as well as the physical sensations that occur during pelvic exams, labor, and birth. By rushing through procedures, and not allowing the woman time to process (if possible), understand, and consent to what is happening to her body, we can inadvertently trigger a posttraumatic reaction.

Admittedly, the discussion of sexual abuse is a tough topic for those on either end of the conversation. We often just touch on the subject while reviewing women’s admission histories, and then move on. Fortunately, we don’t need the admission of abuse to employ strategies developed for survivors. It’s actually much more common for caregivers to pick up on non-verbal cues and then tailor their care. A real tragedy is the guilt and shame survivors can feel after giving birth. So, like we would do for any woman,  it’s best to acknowledge the struggle of labor and birth, the strength a woman demonstrated, and the effort and precious reward she  achieved.

What are interventions that nurses and other caregivers can provide?

  • Explain as much as you can in advance, for example “If we run into an emergent situation there might be unfamiliar nurses coming in to help. I know this can cause anxiety, but I want to prepare you ahead of time in case it happens.”
  • Always start with asking permission. From starting an IV to turning on the overhead lights, make sure to obtain permission before doing any procedures or making changes to the environment
  • Go slowly with everything you do–this can be helpful in relation to a woman’s  fear of losing control. Fast movements can be triggers. This is especially important when uncovering a woman or assisting her with positioning.
  • Limit vaginal exams. These are especially traumatic and should be minimized. If a woman is having difficulty in relaxing enough to complete an exam, try making an agreement about when and why you can perform one. If a woman understands that the exams are being performed only when necessary, and with her consent, her anxiety is often more controllable during exams.
  • Minimize people in her room. She might have issues with nursing students or residents, especially if they are male. Obtain her permission before any new staff come into the room, unless there’s an emergent situation.

What are things not to say?

  • Intrusive interest-prying for details or descriptions of the abuse
  • Minimizing the abuse: “Well, that’s over now.”
  • Exaggerated concern
  • Shock or disgust
  • Pity

What are good things to say?

  • “I can imagine that was very hard to share that with me. It takes a lot of courage to talk about and I respect you for doing that.”
  • “Sometimes talking about these episodes can trigger strong feelings. How are you feeling right now?”
  • And, it’s always essential to assess the woman’s current well-being “Do you feel unsafe in any aspect of your life?”

Not all survivors of sexual abuse have difficulty with pregnancy or childbirth, for some it can be empowering. For those who do struggle, recognize that we have a powerful opportunity to help them. We can communicate therapeutically to help  change the woman’s focus from feeling out-of-control.  We can employ care practices to avoid the woman feeling re-traumatizatized.  And we can set the stage to promote healing and bonding with the newborn. In many instances it’s our tacit recognition and respectful and supportive care that facilitates healing, more than any words we could utter or medicines we could administer.

Where can I learn more?

What are resources for my patients?

  • National Sexual Abuse Hotline: 1800-656-HOPE
  • RAINN: Rape, Abuse, Incest National Network, www.rainn.org

Tasha-poslaniecTasha Poslaniec has been a registered nurse for 17 years. She has been working in obstetrics for over a decade and is currently a Perinatal Quality Review Nurse and Childbirth Educator.

She also writes about nursing and childbirth and has been published in the Huffington Post and the American Journal of Nursing. Pain control in childbirth has long been a topic of study and research for her.

5 Ways to Be More Baby-Friendly (Without Becoming a ‘Baby-Friendly Hospital’)

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By Deirdre Wilson

There are many great reasons why hospitals choose to work toward and achieve Baby-Friendly hospital status. There are also plenty of ways to encourage breastfeeding in line with the World Health Organization’s (WHO) guidelines without having that official Baby-Friendly Hospital designation. In fact, research has shown that implementing Baby Friendly practices such as early breastfeeding after birth, skin-to-skin care , and rooming-in,  in hospitals that do not have this designation, resulted in higher rates of breastfeeding initiation and duration.

Whether or not you’re pursuing Baby-Friendly status, your hospital can effectively support and promote breastfeeding among staff, mothers, and their families. Here are just 5 of many ways to go about it:

1. Start educating women about breastfeeding early.

Setting expectations and goals early in the care process that a mother will achieve desired health objectives. This is true of breastfeeding, as well.

  • Educating mothers about the benefits of breastfeeding is most successful when it starts during pregnancy. Indeed, Step 3 of WHO’s 10 Steps to Successful Breastfeeding—the key criteria for formal Baby-Friendly hospital status—requires that hospitals “inform all pregnant women about the benefits and management of breastfeeding.”
  • Educating parents proactively, rather than waiting for them to request information, ensures they have the education they need when they need it.
  • Educating parents electronically means the information can be shared in small, consistent pieces that don’t feel overwhelming. It’s also a time savings for staff and providers who would otherwise need to use medical appointments for breastfeeding education.

2. Incorporate breastfeeding education into your ongoing staff training.

Keeping your staff updated on supportive breastfeeding practices doesn’t have to be time-consuming or require organized training classes. Consider providing electronic breastfeeding education for staff to access anywhere and at their own convenience. Choose a solution that lets you track their progress, so you know when they’ve read the required information.

3. Stay in touch with women and their families about breastfeeding support opportunities, even after they’ve returned home.

In the U.S., 74% of babies have breastfed at least once, but only 23% are still breastfeeding by 1 year of age, according to the CDC’s Breastfeeding Report Card. Once new mothers are discharged, a strong connection with your hospital can encourage them to take advantage of available support, overcome challenges and stick with breastfeeding.

When following up with women who’ve recently had babies invite them to schedule a session with a lactation consultant or attend a  breastfeeding support group at your hospital. These opportunities not only provide additional revenue sources,  but also nurture relationships with women and their families, who will be more likely to return to your hospital in the future—whether for obstetric or other medical care.

4. Ask new moms for feedback about your hospital’s breastfeeding support practices.

Breastfeeding is an emotional topic for new mothers. With patient experience and satisfaction so important to a hospital’s bottom line these days, you want to know where you stand in patients’ minds.

Surveys are a great way to measure patient satisfaction with your breastfeeding education practice and policy. Send a quick survey by email or text message, asking new moms specifically about how your breastfeeding support has helped them and where you can improve.

5. Collect data on how many women who had their babies at your hospital continue breastfeeding.

Healthy People 2020, the population health measures created by the federal Office of Disease Prevention and Health Promotion, set goals for how many infants are breastfed by the year 2020, including 34% of infants breastfeed at 1 year and 26% breastfed exclusively through 6 months.

If you want to work toward or even surpass this goal, you need to measure how your patients are doing after they leave the hospital. Providing patients education in a digital format, i.e. on their mobile device, combined with data collection technology can help you gain insight.

Baby-Friendly status remains the gold standard for many hospitals encouraging breastfeeding. But if your facility has limited resources, these 5 strategies can help your hospital successfully support and encourage breastfeeding.

For additional information on becoming a Baby-Friendly hospital, visit www.babyfriendlyusa.org

AWHONN Resources

Deirdre Wilson, Senior Editor for UbiCare, is an award-winning writer and editor with 30 years’ experience researching and writing on a wide range of health, wellness and education topics for newspapers, magazines and a news wire service.

The Power of Touch & Infant Massage

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Lori Boggan, RN, Certified Infant Massage Instructor

The power of human touch is unmatched and irreplaceable.  It is an innate need of every human being, especially the infant.  I recently sat down and picked the brain of an expert in the field of infant massage.  Peter Walker, a London based physical therapist, who has been working with babies, children, and their parents for over 40 years. He travels the world and has trained nearly twenty thousand or more midwives, nurses, and other health professionals through his Developmental Baby Massage and Movement program. In his words “touch is the newborn’s first language-it is her prime means of communication and plays an essential role in the forming of early parent-child relationships.”  The following are just a few of the many benefits of touch and massage to both the infant and parents.

Skin to Skin

Study after study has shown the unbelievable benefits of placing an infant skin to skin with its parent.  The power of touch is evident from the first moments after birth when the infant is placed skin to skin. Remarkably, the infant’s temperature, heart rate, breathing, and blood sugar stabilize while being comforted on their mother or father’s chest.  Touch begins here.  A bond between parent and infant begins here.

Enhanced Immunity

The simple act of skin to skin with the mother sets forth an intricate orchestration of colonization and antibody formation that is transferred from mother to baby through the breastmilk.  A study done at John Hopkins University found a significant reduction of nosocomial infections in  infants massaged daily with sunflower seed oil however a Cochrane review of this practice published in 2016 found the evidence lacking that emollient therapy would prevent invasive infections and cautioned that more research was needed..

Hormonal Influence

Done regularly, massage may reduce the level of the stress hormone, cortisol circulating in an infant’s bloodstream.  In turn, it may increase the level of endorphins, the body’s natural opiates as well as oxytocin, the love hormone.  Both leave the infant with a sense of well being and further promote attachment between parent and child.

Colic & Gas Relief

The jury is still out on the exact the cause of colic.  Colic starts as early as the few weeks after birth and results in crying for long periods of time-particularly at night.  Massage may relieve a distressed and colicky baby.  Regular tummy time and massage of the stomach may ease gas, constipation, and aid in digestion.  It is best to avoid tummy time and massage directly after a feed.

Joint Flexibility & Increased Muscle Strength

 According to Peter, developmental massage, practiced according to his program “releases ‘physiologic flexion’ imposed by the fetal position from the time the infant spends in utero.  Gentle massage together with soft stretching can allow the infant to relax and coordinate their muscles to improve the circulation to their body’s extremities, open the chest to deepen their breathing volume, relax the tummy to assist digestion and disposition, and strengthen the muscles of the head, neck and back in preparation for (upright postures and movement).”

Develops Trust & Confidence

Infants learn through touch.  The gentle, reassuring hand of a parent teaches the infant early on that his or her needs will be met.  Touch and massage further foster a deep bond between infant and parent.  The infant learns to trust and the parent develops confidence in his or her ability to care for the infant.

Benefits to Parents

A 2011 study in the Journal of Perinatal Education found “participating fathers were helped by increasing their feelings of competence, role acceptance, spousal support, attachment, and health and by decreasing feelings of isolation and depression.”  Other studies have shown that mothers that massage their infants have improved mood and decreased symptoms of depression.

Educating Parents

Nurses and midwives at the bedside have an excellent opportunity to teach the benefits of skin to skin and massage.   Early education should start right at birth by encouraging immediate and regular skin to skin contact.  In addition, parents can be taught simple techniques as seen here.  It is best to use oil for massage so the hands move nicely against the skin. For sick or unstable infants in the Neonatal Intensive Care, teaching parents and family members the importance of touch in the form of a gentle hand is essential.  By simply placing and holding a steady hand over the infant that is confined to an incubator or radiant warmer, we are still able to convey trust and reassurance.  Early massage can begin when the infant is stable and willing.

Peter sums it up perfectly, “from the very beginning, the mother should remain at the center of any “treatment” offered to her baby.  Most mothers want to hold their babies and establish skin to skin contact before the baby is removed, weighed, measured, bathed, or dressed.  From his mother’s womb into her arms, touch becomes the primal language of the newborn, and it is through holding and caressing that a baby is made to feel welcomed and loved.”

 

AWHONN Resources

Additional Resources

Lori is an American Neonatal Intensive Care nurse that has made her way to Sweden.  Her passion is maternal and infant education.  She incorporates her years of work in maternal and infant health with a passion for wellness through her Prenatal Yoga, Mommy & Me Yoga, and Developmental Infant Massage classes in Gothenburg, Sweden.  Follow her adventures on Instagram or through her nursing blog, Neonurse.

 

Nancy Nurse & Moral Distress

Cheryl J. Bonecutter, RNC, WHNP-BC, MSN, DNP

Nancy Nurse walks into the hospital for her twelve hour shift like she has hundreds of times before in her eight year career as an obstetrical nurse.  Tonight, like so many other nights, she contemplates if she will have an enough nurses to care for the ladies presenting in labor tonight.  She dreads the thought of having another discussion with Dr. Kantwaite about delivering a baby before the 39th week and the evidence that has been presented to him multiple times by the nurses and chief of the department.  The chief is so frustrated and tired of dealing with Dr. Kantwaite that he has stopped answering the calls from the nurses pushing this physician’s blatant noncompliance with safety and best practice through their chain of command.  Nancy documents and reports these occurrences to her nurse manager who throws up her hands, asking what can she do to resolve these problems.  She knows through several candid conversations with her manager that there is approval to hire only a limited number of staff in the budget and she is always pressured regarding the productivity of the unit.  The moment-to-moment operations of the labor and delivery unit is challenging at best.  The needs of one patient turn into needs for two patients or more with the mother through recovery and the baby as they transition into life on their own.

Nancy Nurse has been assigned to care for a woman delivering an anencephalic baby.  The family has requested that all resuscitation measures be used to save their baby despite discussions with the parents on the mortality of anencephalic babies from the neonatologist and obstetrician.  Nancy realizes that Dr. Kantwaite is on call tonight and is already calling to induce a 37.3 week gestation primagravida patient.  Her cervix is closed but he wants the nurse to insert cervadil to ripen her cervix and start Pitocin in the morning.  Nancy has reviewed the prenatal record and finds no medical reason to induce this woman.  Nancy is also in charge tonight and has had one of the nurses for her shift call in ill.  This leaves them one nurse down tonight, giving her patient assignments as well as taking charge nurse responsibilities assisting the other nurses with their deliveries, transitioning babies and checking that the unit is stocked, paperwork is completed, staffing is evaluated for the next shift and all of the charge nurse assigned duties.  Nancy has planned to attend the clinical excellence meeting in the morning to discuss a new medication reconciliation process the hospital wants to implement through the computer system.     Moral distress, ethical dilemmas and ethical distress are all difficulties that nurses face on a daily basis in virtually every healthcare environment.  These quandaries can influence nurse engagement, job satisfaction, turnover, nurse attrition, patient safety and quality of care.9,23  The personal impact of moral distress can result in feelings of frustration, anger, anxiety, guilt, and loss of self-worth, depression, nightmares, resentment, sorrow, helplessness and powerlessness.23 Rather than experience these negative feelings, they may choose to transfer to another position or even leave the nursing profession in order to escape this distress.13(p258),23

Morals and ethics, although frequently used interchangeably, are different in definition.  The simple difference to distinguish morals and ethics is that “morality is about making the correct choices while ethics is about proper reasoning”.16  Healthcare systems across the nation, in some form or fashion, have an ethics committee, yet  morals committees or boards are absent.

Moral distress and how it effects the overall nursing engagement has been understudied and is frequently the “elephant” no one wishes to discuss in the organizational structure of healthcare.  Many factors and situations influence moral distress including staffing, physician practice, nursing practice, ethical climate, violence in the workplace and organizational policies but since moral distress in based on individual values and perceived obligations this varies from nurse to nurse.8   Nursing turnover, job satisfaction, quality of care, nurse attrition, caring attitudes, moral sensitivity and overall nurse engagement can be affected by moral distress.  Moral distress and ethical distress are continuing to be utilized interchangeably in research and education.  Ethics training focuses on ethical dilemmas and principles and may not include the tools needed to minimize the effects of the moral residue.  The American Association of Critical Care Nurses has developed the “4 A’s”.  Ask if you are feeling moral distress, Affirm your feelings, Assess and put the facts together and Act or create a plan and implement it.8  Other strategies that have been utilized include speaking up, be deliberate and accountable, build support systems and focus on changes in your environment at work.  Get educated on moral distress and get everyone involved.  Get down to the roots and develop polices, plan an inservice to train others.8

As we move toward improving our professional satisfaction with our work, improving quality of patient care and expanding our roles in healthcare; we must address the needs to diminish moral distress through effective tools that are easily accessed, supported by our institutions and professional organizations.  We know that how we engage in our work can be crucial to our outcomes.  Breaking down barriers in achieving our greatest work satisfaction, placing our mission first for our patients, developing a professional practice model and implementing tools to assist us with dealing with our moral distress will bring us closer to our purpose of caring.

Dr. Cheryl Bonecutter has been a registered nurse for over thirty years, and a Nurse Practitioner for over twenty years, specializing in Women’s Health, NICU, and Pediatrics.  She received her ADN degree from North Central Technical College (nka North Central State College) in Mansfield, Ohio, and thereafter, achieved her certification as a Women’s Health Nurse Practitioner from the University of Wisconsin-Milwaukee.  After completion of her BSN, Cheryl attained her MSN from Drexel University in Philadelphia, and followed that with a Doctor of Nursing Practice (also from Drexel University), graduating Summa Cum Laude as to both advanced degrees.

Cheryl has been active with numerous agencies and organizations, including the March of Dimes, AWHONN, and Sigma Theta Tau.  In support of women’s and children’s health policy, she has provided testimony to various committees of the Ohio, South Carolina and Texas legislatures, and has served on several local and state advisory boards.

Through her career, Cheryl has worked the entire vertical spectrum of Women’s Health, from bedside to provider to administration, and is currently working as a Nursing Administration consultant with Healthtrust in the Houston, Texas area.

References

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  1. Bakibinga, P., Vinje, H., & Mittelmark, M. (2012, February 20) Factors contributing to job engagement in Ugandan nurses and midwives. 2012 March 29. International Scholarly Research Network Volume 2012.

 

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  1. Bjarnadottir, A. (2011). Work engagement among nurses in relationally demanding jobs in the hospital sector. Nursing Science (Vard/Norden). 2011, March; Publ. No. 101, Vol. 31, No. 3: 30-34

 

  1. Corley, M.C., Elswick, R.K., Gorman, M., & Clor, T. (2001, January). Development and evaluation of a moral distress scale. Journal of advanced nursing, 3(2), 250-257.

 

  1. Corley, M. & Selig, P. (1992). Nurse moral reasoning using the nursing dilemma test. Western Journal of Nursing Research. 1992; 14(3): 380-388

 

  1. Elpern, EH., covert, B., Kleinpell, R. (2005) Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care; 14(6): 523-30.

 

  1. Epstein, E.G., Delgado, S.(2010, Sept 30) Understanding and addressing moral distress. OJIN: The Online Journal of Issues in Nursing. Vol. 15, No. 3, Manuscript 1. Retrieved 3 March 2013 from http:www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Understanding-Moral-Distress.html

 

  1. Ganz, F. & Berdovitz, K. (2011). Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of Advanced Nursing. 2011, October 22; pp. 1516-1525

 

  1. Hamric, A., Borchers, T., & Epstein, E. (2011 April 14) Moral distress and ethical climate in nurses and physicians in intensive care unit (ICU) settings. Retrieved 8 February 2013 from http://www.virginia.edu/inauguration/posters/2.81.Biosciences.Hamric.Borchers.pdf

 

  1. Jameton, A. (1984) Nursing Practice: The Ethical Issues. Prentice Hall, Englewood Cliffs.

 

  1. Jones, C.B. & Gates, M. (2007) The costs and benefits of nurse turnover: A business case for nurse retention. OJIN: The Online Journal of Issues in Nursing. 12(3).

 

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Where are the contraceptive options for males? It’s Not Just a ‘Women’s Issue’

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By Kate McNair, RN, BSN, SANE

The sexual revolution began in 1960 with the emergence of a novel birth control for women in the form of a pill. Despite the increase in contraceptive options for women over the past 55 years (including many new long acting and reversible options), options for males have remained stagnant and have not progressed beyond the condom.

Although there have been attempts to create hormonal birth control for males, barriers persist. A recent study tested an inject-able male hormonal contraceptive (testosterone and progestin) with 266 male participants across 10 sites (Behre et al., 2016). These injections attempt to interrupt the normal hormonal cycle and decrease sperm count, rendering the male reversibly infertile (Ashbrook, 2016). The efficacy was 96%, a rate higher than OCPs(Oral Contraceptive Pills) for women (Ashbrook, 2016; Behre et al., 2016). Unfortunately, although the results were encouraging, the trial was abruptly halted last November due to reported side effects. Males reported acne, mood swings, and pain at injection site (Behre et al., 2016). Males also reported increased libido (Behre et al., 2016). Rationale for the discontinuation of the study has not been reported by the review board at the World Health Organization.

The reported side effects experienced by the males in the Behre et al. (2016) study mirror contraceptive side effects experienced by females. This further supports persisting patterns of cultural patriarchy in today’s science and reinforces cultural messages to the public that family planning and contraception is fundamentally a responsibility and burden placed solely on the female. While science may never occur without cultural bias, as personal beliefs and viewpoints tend to permeate our work (consciously or not), women’s health nurses can lend their support and voice to promote efforts to eradicate the androcentric bias in today’s contraceptive research.
As I become a nurse scientist, I am emboldened and hopeful, not deterred. I see opportunity for change in science, influenced by leaders in the nursing field. We must make a point to understand underlying biases in science and encourage nurses to have their voices heard. Only then can nurses advocate fully for the women they serve. Contraception is not just a women’s responsibility or burden, and we can change this paradigm starting now.

References
Ashbrook, T. (2016, November 4). Fresh controversy in male birth control. On Point.
Podcast retrieved from http://www.wbur.org/onpoint/2016/11/04/male-birth-control
Behre, H., Zitzmann, M., Anderson, R., Handelsman, D., Lestari, S., McLachlan, R. &
Colvard, D. (2016). Efficacy and safety of an injectable combination hormonal
contraceptive for men. Journal of Clinical Endocrinology and Metabolism.
Retrieved from http://press.endocrine.org/doi/pdf/10.1210/jc.2016-2141

IMG_4306Kate McNair is a women’s health nurse practitioner & PhD student at Boston College. She also maintains clinical practice as an OB/GYN RN at a community health center in Roxbury, MA. Follow her on Twitter @fem_nurse.

Pediatric Clinical Experience – Incorporating Core Values into Care

By Michael Burke

As nursing students in the pediatric clinical setting, the character and values we display are crucial to not only our own growth, but also to the well-being of our patients. We all understand that the “student” label is often correlated with inexperience, and can lead to feelings of uncertainty and apprehension from patients. In the pediatric setting, hearing “student nurse” can add an extra level of anxiety for parents whose vulnerable, sick children are at risk. While parents may be wary of having students as caregivers for their children, there are several ways to help put them at ease and give confidence to both parties. In the pediatric setting parents are often exponentially more nervous than the patients themselves, but through positive practice values and confidence, the student nurse has the ability to truly make a difference when it comes to providing the best family and patient centered care possible.

According to Ruhl, Golub, Santa-Donato, Cockey, and Bingham (2016), nurses who give care integrate six core values into their practice including compassion, engagement, integrity, courage, humility, and wisdom. During our time as students in the pediatric clinical, I found that of these six core values, integrity served me the best and helped me grow the most when it came to family centered care. Integrity is something that is valued in all facets of life, but is expected in the nursing field. It is something that nurses pride themselves on not only because of the types of people who pursue nursing, but also because it can have a very positive influence on patients and families. Integrity is shown through honesty, respect, and judgment-free care and the nurse with integrity will stand up for the patient and family even while risking criticism and/or distain (Ruhl et al., 2016).

On the final clinical day of our pediatric rotation, I was assigned to a 42-day-old male patient who had presented one day earlier in respiratory distress, which was later determined to be a symptom of positive metapneumovirus. When I first entered the room with my clinical instructor, the introductions revealed that the patient’s mother was also a nurse, but had no experience with pediatrics and was understandably very concerned about her son. As a student in this situation, I could tell that the mother was instantly uncomfortable with my presence, but the clinical instructor did a great job of integrating me into the conversation and into the patient’s care. Weighing only 3.18kg with a respiratory infection, the patient was rather unstable throughout the shift, often fluctuating from low 90’s O2 Sat down to the low 80’s at some points even with supplemental 0.2L/min O2 by nasal cannula. The patient was prescribed PRN nebulizers, corticosteroids, and suctioning for these situations and with busy nurses and a busy clinical instructor; it was my responsibility to be on top of the patient’s status. Over the course of the shift it was often me alone with the patient and the mother, and from her perspective, I can imagine her hesitant feelings about this, especially considering her profession. However, through use of the core values, most notably integrity, I was able to gain her trust over the course of the shift. If there was something that she was more comfortable having the primary nurse do instead of me, I showed understanding and alerted the nurse. If she had a question and I did not know the answer, I would find the primary nurse or my instructor in order to find out. If I did know the answer I would simply and confidently respond. I could tell that her comfort level increased over time and by the end of the shift, she trusted my judgment enough to leave her son in my care while she took a dinner break. As a student, the important thing was not to know everything; the important thing was that I had the judgment and honesty to know my limits and ask for help when needed.

Reference

Ruhl C., Gulab Z., Santa-Donato A., Cockey D. C., Bingham D. (April/May, 2016).  Providing nursing care women and babies deserve. Nursing for Women’s Health Journal, 20(2), 129-133

Mike_BurkeMichael Burke was born in Boston and raised in Carlisle, MA by his parents Kate and Jim. He attended Concord-Carlisle High School and went on to earn a BA in Anthropology and a minor in Journalism from The George Washington University in Washington DC, where he also served as captain of the division 1 men’s soccer team. Currently a student nurse in his final semester at MGH Institute of Health Professions, Mike hopes to continue to progress as a student and future nurse by providing the best care possible to his patients.

A Special Thank You to Our Preceptors

Elizabeth Rochin, PhD, RN, NE-BC
Vice President of Nursing, AWHONN

After long days or nights, and years into a career, we as nurses may forget what initially brought us into nursing. If you want to remember, simply ask a student. In fact, I had the opportunity to ask fourteen nursing students just today why they chose nursing as a career path.

Here is a sampling of what they said:

  • “I wanted to make a difference in someone’s life.”
  • “There is nothing more pure than helping someone in need.”
  • “I knew since I was three years old that I wanted to be a nurse. I think I inherited it, my mom and grandmother are nurses.”
  • “This is my second degree. I discovered in myself a very strong need to help others, and went back to school. This was the right decision.”
  • “I was originally in sales and marketing, and realized that I loved making connections and promoting relationships. This was the perfect way to do both.”
  • “The first time a patient said, ‘You’ll make a great nurse,’ I knew I made the right decision.”
  • “I can’t imagine doing anything else. This is the perfect way to give back.”
  • “To use my hands to help heal a patient, or help to bring a new life into the world, I can’t think of anything better.”

Most of us will remember thinking about one or more of the quotes above, and will bring us back to our own days as a student nurse, and renew the passion in our work.

For the next several weeks, colleges and universities throughout the nation will graduate the newest members of women’s health, obstetric and neonatal nurses. We congratulate and welcome you to your new lives and careers. Nursing offers such diversity in career paths, and the opportunities for expert bedside care, advanced practice and nursing leadership roles have never been greater. There has never been a more exciting time to be a nurse!

But it is also important that we understand and remember that at one time or another, we were all new. None of us came into nursing knowing everything. We all needed a hand to hold us steady, and a guide to offer direction and counsel in how to move from a new graduate to a team member who could safely and effectively care for patients and their families.

Occasionally we forget what it felt like to be new. And we must be willing to remember. The greatest gifts we can bestow upon our newest nurses are understanding, time and expertise. We must commit to assisting our new graduates to grow and develop, and assist them to make the difference they want to and know they can make.

I would like to take this moment to thank all of our outstanding preceptors who strive to give our new graduates (and all new nurses, for that matter!) the best possible experiences and learning opportunities. Preceptors are those nursing team members who work with a new nurse for 12-20 weeks, and sometimes much  longer, to ensure appropriate training and competence. Preceptors are the “life blood” of nursing, and your effort and dedication to your orientees and organizations does not go unnoticed. Thank you for taking on this vital role and for shaping the next generation of women’s, obstetrics, and neonatal nurses.

Five Staff Portraits for Reston HospitalLiz  has over 25 years of Women’s and Children’s experience and  has devoted her professional career to the care of women and children with roles as a staff nurse, nursing educator and most recently executive leadership. She has presented nationally on patient experience and mentoring new nursing leaders. In 2008, Liz was named to the Great 100 Nurses of North Carolina, and is a member of Sigma Theta Tau. In addition to her clinical work and expertise, Liz has taught at the baccalaureate and graduate levels at East Carolina University College of Nursing. She is board certified as a Nurse Executive by the American Nurses Credentialing Center.

My Top Five Exercising Tips to Improve Your Mind, Body, and Spirit

Lynn Erdman, MN, RN, FAAN,

For Nurses Week, we are promoting the “year of the healthy nurse.” We are encouraging nurses, like you, to focus on having a healthy mind, body, and spirit, to support your overall wellbeing. For me, I love exercise and have become more committed to it than ever. I find that the simple activity of exercising helps to clear my head and prepares me for my day. If your body and the mind are healthy, the care you can give your patients will be improved.

Exercising has so many benefits for the body: weight management, endorphins that elevate your mood and the energy it delivers to you. Here are my personal five tips for exercising that I believe will help improve your mind, body and spirit.

  1. Establish routine. As nurses, our schedules can be pretty hectic and unpredictable, which is why it’s important to establish a regular exercise routine. This is key because when you neglect to establish a routine, it’s easier to make excuses or find reasons not to workout. For me, I go to the gym at 5 AM because that works for me. Take a step back and see what time works best for you. Exercise has to be established as a priority and built into your schedule for a day or for the week.
  2. Stand up regularly at work. As nurses, we stand up most of the day which is a wonderful way to stay active during the day. I find that getting up every once in a while is important to do at work because it keeps the blood flowing. It’s as simple as taking a brisk walk around the block, the facility or the grounds that can make all the difference. If you have the opportunity to have a standing desk, use it. I love mine. It makes it easier to walk around the office, and simple tasks that require you to go to a different part of the office are no longer hard to do.
  3. Use a medicine ball as your chair. If I am going to sit at work, I always sit on my medicine ball chair. This keeps my body still exercising even when I am sitting because it keeps my leg muscles moving and works out my core.
  4. Switch it up. When it comes to exercise, many of us are creatures of habit. We tend to gravitate towards doing the same routine on the elliptical, treadmill, or muscle work out. Regular workout is great but to maximize the time spent at the gym it’s important to include variety in your exercises to keep your muscles challenged. This helps overcome a weight loss plateau, builds new muscles, and prevents boredom from doing the same routine.
  5. Meditate for five minutes a day. Spend five minutes a day doing either spiritual meditation or just focus your mind in a direction of positive thinking. As nurses, we have stressful days. Meditation helps relieve some of the stress you face in your day-to-day life.

I have found that when I take care of my body and my mind my overall spirit is better. Nurses have hard days and multiple stress points at work. Whether its meditation, yoga, or exercise, all of these methods help improve the work-life balance we all reach to achieve.

Lynn Erdman, MN, RN, FAAN,
Chief Executive Officer, AWHONN

Lynn joined AWHONN in 2014 with more than 30 years of experience in the healthcare and nonprofit sectors.  She is a highly skilled national leader in the field of nursing and previously held key national leadership positions with three global health organizations: the American Cancer Society, the American College of Surgeons, and the Susan G. Komen Global Headquarters.  Lynn has also served in top leadership positions with several hospitals and healthcare systems.