Tag: nursing

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

  1. Advisory Board Company. Engaging the Nurse Workforce: Best Practices for Promoting for Promoting Exceptional Staff Performance. Washington, DC: Advisory Board Company; 2007.

 

  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.

 

  1. Baldrige Performance Excellence Program. (8 March 2012). Retrieved 4 March 2013 from http://www.nist.gov/baldrige/about/baldrige_faqs.cfm

 

  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).

 

  1. Lawrence, L. (2011) Work engagement, moral distress, education level, and critical reflective practice in intensive care nurse. Nursing Forum. 2011, October-December; 46(4): 256-268

 

  1. Magnet Recognition Program Overview. (2013) American Nurses Credentialing Center; Retrieved 10 March 2013 from http://www.nursecredentialing.org/Magnet/ProgramOverview

 

  1. Malmin, M. (2012, April) Changing police subculture. FBI Enforcement Bulletin. Retrieved 9 March 2013 from http://www.fbi.gov/stats-services/publications/law-enforcement-bulletin/april-2012/changing-police-subculture

 

  1. Morals vs ethics: the problem with trolleys. (13 December 2010). The Philosopher’s Beard. Retrieved 3 March 2013 from http://www.philosophersbeard.org/2010/10/morality-vs-ethics.html

 

  1. Nathaniel, AK.(2006) Moral reckoning in nursing. Western Journal of Nursing Research. 28: 419-38

 

  1. Pauly, B., Varcoe, C., Storch, J. & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethic. 2009; 16(5)

 

  1. Rivera, R., Fitzpatrick, J., & Boyle, S. (2011, June). Closing the RN engagement gap. The Journal of Nursing Administration. 2011; 41(6):265-272

 

  1. Schaufeli, W. B., Salanova, M., Gonzales-Roma, V., & Bakker, A.B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3, 71-92.

 

  1. Simpson, M. (2008 July 8). Predictors of work engagement among medical-surgical registered nurses. The Journal of Nursing Research. 2009 February; 31(1):44-65

 

  1. Wilkinson, J.W. (1987/1988). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16-29.

 

  1. Zuzelo, P. (2007). Exploring the moral distress of registered nurses. Nursing Ethic. 2007; 14 (3) retrieved from: http://www.lasalle.edu/schools/snhs/content/pdf/moraldistresss.pdf

 

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.

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.

Human Trafficking in the US Is Real! Here’s How Nurses Can Help

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by Leith Merrow Mullaly, RN, MSN, IBCLC

Sex trafficking is a form of modern slavery that exists in our own backyard. Traffickers resort to violence, threats, lies and other forms of intimidation to force both adults and children to take part in sexual acts against their will. Sex trafficking can occur anywhere, even in your very own community.

In 2016, the National Center for Missing & Exploited Children estimated that 1 in 6 endangered runaways reported to their Center were likely sex trafficking victims.  The Urban Institute estimated that the underground sex economy ranged from $39.9 million in Denver, Colorado, to $290 million in Atlanta, Georgia.  Prostitutes are victims of these crimes.

Yet, sadly, since 2007 the National Human Trafficking Resource Center Hotline has received only 145,764 calls*  (1-888-373-7888).  Why is this? Many of the victims of sex trafficking have no knowledge that such a resource even exists.  To make a phone call to get help is not possible for most victims as communication is strictly controlled and monitored by the pimp who has all the power.  Perhaps, we nurses should have this phone number posted in areas where women in your care can see it.  Nurses should also be aware of the warning signs associated with trafficking, and  when we suspect our patient/client may be such a victim, we should hand them a phone!

Commercially exploited children in our country have almost universally been sexually abused and enter prostitution with a history of complex trauma.  Their families have been absent or dysfunctional.  Several young women with whom I work were identified by teachers as abused (eg, a 7 year old who wouldn’t change gym clothes because of bruises all over her body).  There  were mixed reaction from teachers.  Some did follow up with local child protective services.  Some called parents.  One young woman told me “My teacher was concerned but my mother denied any sexual abuse but then said ‘well, she is so suggestive around my husband’; I was 6 years old!”  Many girls tried to tell an adult but many were afraid.  Some shared “I have told people and nobody believed me”.  Some were placed in foster homes, and believe it or not, they were molested and recruited by their pimps from the foster care system.

What can nurses do?  This may seem so much bigger than what we can do as individuals. But we can develop a more acute awareness about the realities of human sex trafficking right in our own environment.   When you hear or suspect human sex trafficking may be occurring to the patient sitting before you, believe them!  They very frequently display a fearful, distrusting affect because many times they have tried to tell and NOT been believed.  Offer them your belief.   Former President Jimmy Carter wrote an editorial in the Washington Post (May 31, 2016) entitled: “Curb prostitution, punish those who buy sex rather than those who sell it”.  I recommend reading this. Carter describes the “Nordic Model” which is a system that treats purchasing and profiting from sex as major serious crimes.  That might be something for which nurses in small or large groups, such as an AWHONN  Chapter or Section, can advocate for at their own local or state level.  Just imagine the impact it could have if the men in your community who are purchasing sex were prosecuted and exposed in public as the criminals they actually are.  We have heard “but he is a pastor” and “but he is on city council” and “ their reputations would be destroyed”.  Women and children who are sold for sex face more than ruined reputations, they face ruined lives!

As health care providers and patient advocates we must begin to work vigorously with our own elected officials to change the unacceptable and shocking status quo.  Did you know that trafficked children are treated as criminals in many jurisdictions even though under Federal law those under 18 years old are classified as victims?

My state, the Commonwealth of Virginia, was the last state in the country to pass a stand-alone human sex trafficking law (2015).  Now, anyone assisting, or working to traffic, sell or purchase prostitution can be arrested and charged.  This law came about because of the incredible tenacity and diligent work of a very few advocates working with their local legislators.  They provided both Representatives and their constituents with education on this issue.

Health education has always been a strong focus for nurses.  The public looks to us to educate them and the public trusts nurses to provide solid, honest information.  My “own public” sat in disbelief when we first started talking about sex trafficking right here where we live and work.  I heard comments like “No way, this is a lovely community.  Not here!”  As they learned the realities they were initially horrified, but now are very energized to help in any number of ways.  We also can’t  forget to educate parents.  They need to know that when young teens, girls and boys, meet other “youth” on the internet they are often opening themselves to traffickers.  When middle and high school kids sext and post photos they can and do become easy prey to predators.

If your community doubts the very idea of sex trafficking in your town, send them to a website called “Backpage”.  It is a trafficking website that lists ads for prostitution.  In my small size city there are more than 20 ads a day!  “Plenty of Fish” is another site that purports to be a dating site. We have had some of our trafficked victims “hooked up” on this site with “clients” purchasing sex.  If a nearly naked woman is advertising to come to a hotel room to provide a “massage”, read between the lines.  If the face is blurred, it most likely means the girl is a young minor.  If you look…unfortunately you will find human sex trafficking right in your own backyard.

Overwhelmingly the young women with whom I work had dreams of growing up to be moms or lawyers or teachers or doctors or nurses.  One girl had seriously and sincerely wanted to be an astronaut.  No one ever dreamed of growing up to be a prostitute!  They were brought into the “life style” as young minors.    They did not choose the life and do NOT benefit financially (a common misconception).  Once used, these victims are humiliated, shamed, embarrassed and trapped in a system they despise but have no idea how to escape.  Many seem to know of a girl who tried to escape who either “disappeared” or who was re-captured with her photo posted on line with her head shaved and tattooed by  her pimp.

NURSES CAN MAKE A HUGE DIFFERENCE if we just start working together to: 

  • Learn the facts about Human Sex Trafficking in our own communities
  • Work more closely with local and state law enforcement
  • Provide vitally-needed education to our peers, friends, organizations and parent groups
  • Advocate with legislators to enforce the law and explore alternatives such as the “Nordic Model” which is now used in Canada, France and Sweden
  • Believe a patient who trusts you enough to share their situation
  • Post the National Human Trafficking Resource Center Hotline – 1-888-373-7888—in a visible location in your setting
  • Be hyper-alert to telltale signs such as :
    • Tattoos or branding
    • Very unclear past history and no stable address
    • STD’s, especially repeated episodes
    • Wearing scanty clothes – often 2 sizes too small
    • Presence of cotton or debris in vagina and/ or rectum
    • Problems with jaw or neck
    • Inability to keep appointments
    • No identification
    • Accompanied by a person who does not allow the patient to speak or does not want to leave them alone during interview and/or care
    • Inconsistent stories (conflicting stories or misinformation)
    • Lack of documentation of age- appropriate immunizations and health care encounters

There are 3 million nurses in our country.  I believe that together we have the power to change hearts and minds so that our local communities and our nation understand the realities of human sex trafficking.  I serve on the Foundation Board of a home for victims. Our motto is: “Changing one life at a time and changing the world for future generations”.  I have seen the first goal come true with individual young women.  Won’t you join me in meeting both goals?

AWHONN believes Nurses are ideally positioned to screen, identify, care for, provide referral services for, and support victims of human trafficking. Therefore, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) supports improved education and awareness for nurses regarding human trafficking. Learn more about AWHONN’s position on this critical topic.

Resources:

References

*Number of calls reported to the Human Trafficking Hotline as of December 2016 for more information visit https://humantraffickinghotline.org/

Estimating the Size and Structure of the Underground Commercial Sex Economy in Eight Major US Cities

National Center for Missing & Exploited Children

Urban Institute

leithLeith Merrow Mullaly, RN, MSN, IBCLC
Leith Mullaly is a past president of AWHONN and has served at all levels of the organization. Leith has a passion for both nursing and the specialty of Women’s Health and Newborn care. Her focus within AWHONN has always been to mentor future leaders and encourage nurses’ participation in their professional association. She has experience as a Staff Nurse, Staff Educator, MCH Director, Clinical Faculty Member, Certified Lactation Consultant and Author. She is a nationally ranked speaker on topics such as Postpartum Depression, Breastfeeding, the Image of Nursing, Service Excellence, Perinatal Loss and Bereavement, Mature Primiparas. Her interest in care for Victims of Human Sex Trafficking has been a major focus for the past several years.

Navigating a Labor Experience: As a Student

By Amy Smith, Student Nurse at MGH Institute of Health Professions, Boston

I could feel the excitement in the room as I entered. The couple was receptive to my questions and suggestions; and the woman was more than happy to involve me in her care.  I tried to build rapport even though I was nervous in my role as a nursing student. This was the first time I had assisted a woman in labor and, after her membranes were artificially ruptured, her contractions started to come about two minutes apart.  At one point, I had my hand on her back and her husband smiled at me across the room and signaled for to me to remove my hand!  It was a great moment in which the support person and I connected!  I remained quiet during her contractions and I asked her if she wanted me to breathe with her but she said she had it under control. I kept thinking back to my own labors and what I felt I wanted from support people so I asked her if she would like lower back counter pressure but she refused.  The family had not done a childbirth preparation course so I assumed that their interest or skills with working through labor was limited.  I thought that they would need my help more yet her prenatal yoga practice seemed to have given her the tools she needed to get through her labor. The tools I offered her personally were meditative.  I told her to focus on her favorite place, to discuss her needs and frustrations with us in between contractions and reassured her that I was there for her to breathe with her and regulate her breathing as needed.

Reflecting on the Nursing Care Women and Babies Deserve virtues I used during this experience, I believe they were humility and engagement. Humility in that I had to understand I did not know what was best for this family. I assumed they would want and need what I needed during childbirth or skills I learned from the comfort measures video I used to prepare for this clinical experience. The woman decided what she needed and I was there to support her. In respecting their wishes I could engage with the family. Before I left them for the day they commented, “We felt like we had our own doula”.  It was easy and a pleasure to engage with this couple and follow their commands and offer suggestions. I told them I had never wanted to stay at clinical so much as I did with them. I will always remember this family.

 

Additional Resources

AWHONN’s Nursing Care and Women Babies Deserve Poster –  AWHONN’s statement on ethical nursing practice, Nursing Care Women and Babies Deserve, is rooted in the American Nurses Association’s Code of Ethics for Nurses, and provides nurses with core elements of ethical nursing practice for our specialty and corresponding examples of the virtues of ethical practice in action.

Read a commentary about Nursing Care Women and Babies Deserve in AWHONN’s journal Nursing for Women’s Health. Consider submitting your own story of how you or your colleagues practice nursing care that women and babies deserve at https://www.awhonn.org/?NursingCare

nursepicamyAmy is an ABSN student at MGH Institute of Health Professions, Boston.  She was a stay at home mother for 12 years,  a community coordinator for a non profit kids running program and a volunteer at Dana Farber Cancer Institute in Boston before deciding to enter the nursing field.  With extensive volunteer experience from a camp for blind & visually impaired adults and children, to co-president of an elementary school PTO, she enjoys working with diverse groups of all ages.  Amy aims to work in labor and delivery after graduation in August 2017 but is also interested in global health and epidemiology.  She has intentions to keep making a difference in the lives of those she may never meet again.

We May Have Different Religions

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By Evgeniya Larionova

“We may have different religions, different languages, different colored skin, but we all belong to one human race”. –Kofi Annan (Ghanian Diplomat, 7th UN Secretary-General, 2001 Nobel Peace Prize winner)

What is exactly childbirth? Some people compare it to a miracle, a heroic act, or a surge of love accompanied by strenuous and intense hours of labor. It’s absolutely one the most unique experiences that can happen to a woman’s body. The time when she is particularly vulnerable and in need of much support and care.

For me, a nurse practitioner student on labor and delivery floor at Massachusetts General Hospital, witnessing childbirth was something that I would never forget. Thrown into the action on a first clinical day, I had mixed feelings of joy, excitement and a slight nervousness. I felt extremely privileged and grateful to witness a natural delivery and I was hoping to help a future-to-be mom during the process.

From the morning report I found out that the woman I was assigned to follow was a recent immigrant from Guatemala who belongs to the indigenous Mayan population. Mayan was the patient’s native language but she was also able to understand Spanish. Her husband had been residing in the United States for 5 years. She moved here a year ago and the family has finally reunited.

My patient was accompanied by a traditional nurse midwife known as comadrona. Comadronas are trusted women leaders in their communities who accepted a spiritual calling. They usually don’t receive any formal training but have years of experience delivering babies. Comadronas regard birth as a natural process and rely heavily on God and prayers. The nurses established a plan of care recognizing my patient’s spirituality and personal support system. The Mayan midwife was present during labor and helped with comfort measures. The nurses also invited a qualified interpreter.

When I entered the room, a nurse and a midwife, along with the comadrona, surrounded the tiny woman. One of the nurses was checking her vital signs and the nurse-midwife was encouraging the woman to take slow deep breaths and relax. The comadrona, wearing a traditional colorful embroidered dress, was gently massaging her back. The room was dimly lit and the scent of fresh lavender floated in the air. My patient’s contractions were increasing steadily and were becoming more regular. This was active labor –she was ready to give birth.

The whole atmosphere struck me. There was no other language present in the room but the language of trust, respect and compassion between these women. I immediately wanted to become connected with what was happening- just by holding this woman’s hand and talking to her.

Reflecting back on this experience, I understood that nurses not only created the environment that made this woman feel comfortable and that was respectful of her spirituality but that the environment also had a significant impact on the labor and birth process. Although childbirth is unique and at the same time a unifying biological event for any woman; providing therapeutic communication, physical, emotional, spiritual care and comfort during the labor process is crucial.

The comadrona shared her knowledge and experience with the American nurses. It was important for my patient to have a traditional midwife near the bedside who comforted and prayed with her. There was interplay between modern and traditional medicine that contributed to the positive outcome. Nurses in this particular case were not only culturally sensitive and able to understand cultural values, beliefs and attitudes of clinicians and patients, but also culturally competent and had knowledge, capacity and skills to provide high-quality care (Jernigan et al, 2016).

It’s essential for any nurse in such a unique, heterogeneous country like the United States to be cognizant and open-minded of cultural diversity and the patient’s cultural perspectives. I will take this amazing experience to my future nursing practice and strive to always treat my patients with dignity, respect and compassion. I also hope to continue to integrate a holistic model and culturally sensitive care into our modern childbirth practices.

This woman gave birth to a beautiful baby daughter whom she named after a nurse taking care of her during her labor and birth.

Additional Resources & References
http://prontointernational.org/
https://he-he.org/en/
http://www.mayamidwifery.org/
http://midwivesformidwives.org/guatemala/
http://www.birth-institute.com/study-abroad-guatemala/
http://www.acog.org/
Jernigan, V. B. B., Hearod, J. B., Tran, K., Norris, K. C., & Buchwald, D. (2016). An Examination of Cultural Competence Training in US Medical Education Guided by the Tool for Assessing Cultural Competence Training.Journal of Health Disparities Research and Practice, 9(3), 150–167.

evgeniya-headshotEvgeniya Larionova received her Bachelors of Science in Nursing from MGH Institute of Health Professions. She is a founder and an Artistic Director of AMGITS Drama&Poetry Club at the Boston Living Center. She is a member of the student Leadership Committee of the Harvard Medical School Center for Primary Care. Evgeniya is passionate about infectious diseases, community health and integrating holistic care in modern practices.  In her spare time she plays in the Russian theater, enjoy reading, playing the guitar and hiking.

Beginning Breastfeeding, Breaking Down Barriers

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by, Summer Hunt

You’ve heard it time and again: Breast is the best. But many moms-to-be express concerns over breastfeeding, from doubts about their abilities, to time constraints, and everything in between. However, moms who have experienced challenges and broken down breastfeeding barriers will tell you this—it’s worth it.

Same goal, different struggles

Erin Lee and her family

Pictured above: Erin and Hung Lee with Emersyn, Paxten and Mylo

Pictured above: Erin and Hung Lee with Emersyn, Paxten and Mylo

“Just because something is natural doesn’t always equal easy,” says Erin Lee, RN, BSN, IBCLC, mother of three. As a registered nurse (and now a board-certified lactation consultant), she was fully aware of all the benefits and knew that she would breastfeed. What she couldn’t predict, though, was how many bumps in the road she would encounter.

“I had a long intense labor, and they had to use some suction to get my daughter out,” she explains. “She had a strong oral aversion, and I had flat nipples, which made latching almost impossible. On top of everything else, she was extremely jaundiced. I wanted and needed to breastfeed her, and I was determined to—but it wasn’t easy to get started.”

Lindsey Grissett knew before her daughter was born that she would breastfeed. “It was just something that made enough sense to me not to question,” she says. “I was further encouraged to educate myself on it by both my doctor and my husband.” Birthing at a Baby-Friendly® hospital meant Lindsey had a lot of support. “I was signed up for breastfeeding classes well in advance, and I don’t think I had a single question go unanswered,” she says. “I felt both mentally and physically prepared.” Shortly after giving birth, baby Emma latched right on as both mom and baby got the hang of things.

Breastfeeding wasn’t without its challenges for Lindsey, though. “There were times when I would stand in the shower, stare at the wall, and wonder how it was possible for an individual to function on so little sleep,” she recalls. It felt like the baby was hungry all the time… I was exhausted.” Lindsey learned a lesson in patience and teamwork as mom and baby found their rhythm. “It’s a process—you have to use different hand movements, massaging your breast to get the milk flowing while trying to get her mouth in the right place… or else all that hard work literally just leaks away.”

Finding help when you need it

For Erin, having the support of an International Board Certified Lactation Consultant® (IBCLC) made it easier to focus on one thing at a time. “Even though I’m a nurse, she saw things I couldn’t see,” Erin says. “She realized my daughter was jaundiced. She also helped me establish smaller goals instead of worrying about getting her to latch. I pumped my milk so we could focus on feeding her and getting her to gain weight. Then we worked on overcoming her oral aversion, and then… she latched!”

Lindsey Grissett

Pictured above: Lindsey and Raymond Grissett with Emma

Lindsey agrees that a lactation consultant was a huge help. “They called a few days after being discharged, asking if everything was going okay. They set up appointments for me to come in, show them my progress, and make sure she was taking in enough.” It was a lactation consultant who recognized that Lindsey’s baby girl was also jaundiced, she adds. “Several months after I had Emma, I still received phone calls to see how I was doing. I was so well taken care of!”

An indescribable feeling

While you can read a bundle on the benefits of breast milk, there’s one thing that you can’t find in a class or a book—the physical and emotional closeness that develops between mom and baby. “The bond you feel while you’re feeding your baby… it’s incredible,” Erin says. “Until you experience it, you can’t know how powerful it is.”

“The most valuable thing about breastfeeding was definitely how close it brought me to Emma,” Lindsey says. “There so many times when I just wanted to sleep, or eat, or shower in peace… but even when I was at the end of my rope, it was such a great feeling knowing that she needed me. That was my motivation to keep going.”

Turning lemons into… breast milk?

After a difficult breastfeeding journey, Erin knew she could use her experience to help other women. “I was working in pediatrician’s office, and I shadowed the IBCLC there, seeing the moms and babies come in, some of them having the same issues I did. I wanted to help them overcome it—I became very passionate about it.” She became an IBCLC in 2013, and in 2015 she cofounded a private practice lactation business.

“Most people will encounter some sort of struggle,” she says. “For some it might be a few days or weeks, others might take months to get the hang of it. Just because the baby doesn’t latch right away, or you have a little discomfort at first doesn’t mean it’s the end. With the right support system, you can do it. It’s so empowering—being able to provide this essential need for your baby.”

For first-time moms (or first-time breastfeeding moms), Erin offers up this advice:

Educate yourself. Not just about the basics of breastfeeding, but also on normal infant development. The more you know, the more prepared you’ll be for what’s to come.

Build a support system. Find a health care provider that’s supportive of breastfeeding and understands that it’s something you want. Find an IBCLC, and attend La Leche League meetings even before you give birth. Talk to your mom if she breastfed, or your friends who did – these are the people you’ll be texting at 1am when you’re at your wit’s end and you need someone to tell you it’s going to be okay.

Be gentle with yourself. Your only job right now is to nourish your baby. The rest of it, cleaning the house, putting dinner on the table, losing baby weight… it can wait. You take care of your baby—everything else will fall into place.

 

Summer Hunt

 

Summer Hunt is the editorial coordinator for publications at AWHONN.

 

 

 

Resources for Moms

Ask Our Nurses: How Will My Baby and I Begin Breastfeeding? (video)
Ask Our Nurses: How Do I Prepare For Breastfeeding? (video)
How to Overcome the Challenges of Breastfeeding (article)
Breastfeeding Fixes (article)
Download our brand-new Breastfeeding Parent Pages here.

Erin Lee, RN, BSN, IBCLC has worked as a registered nurse in the Pediatric Intensive Care Unit at Boston Children’s Hospital, Georgetown University Hospital and All Children’s Hospital, among others. She is the cofounder of Suncoast Lactation Consultants in Bradenton, FL, where she lives with her husband and three children.

Lindsey Grissett is a mental health community court liaison in Anniston, AL, where she lives with her husband and daughter. She enjoys working out, traveling and hanging out with her family,  and watching her little girl grow.