DNA is continuing to make strides in providing more services and increasing the size of our membership. DNA is proud to introduce a few new services that will hopefully enhance your nursing practice. First, DNA has improved its job site, Delaware Nurse Jobs. Now employers will be able to post their own jobs and job seekers will be able to post their resumes and have job notifications sent directly to their inbox.

DNA looked for ways to provide affordable opportunities for researchers and organizations to publicize their research recruitment requests and education activities and events. Researchers can now post research recruitment notifications on the DNA website for up to twelve weeks and organizations, schools, and hospitals can post their educational activities and events on the DNA Events Calendar. The Research Recruitment Notices and Events Calendar will be actively promoted through various mediums to ensure exposure of the postings. Additional information on each of the programs can be found on the website at www.denurses.org

There is no better time to be a nurse and there is no better time to join your state nurses association. I hope during the Delaware Nurses Association Centennial Year, you will consider joining us

by Linda Sydnor

Linda Sydnor earned her nursing diploma from Milford Nursing School in 1974. She then returned to college to earn her BSN in Nursing from Wilmington University complet ing her degree in 1998. She went on to further her education as a Geriatric Clinical Nurse Specialist, graduating from the University of Delaware in 2005. Recently, she has completed her post masters degree as an Adult / Geriatric Nurse Practitioner.

She has worked at Christiana Care for over 25 years in several different positions. Currently, she is the Geriatric Clinical Nurse Specialist on the ACE (Acute Care for the Elderly) Unit at Christiana Hospital.

Linda has been involved with the Alzheimer’s Association for the past 7 years as a team captain, raising money and awareness for the cause. For the last 5 years, she served on the committee for the Walk to End Alzheimer’s (formally the Memory Walk) and this year is serving as the chairperson for the committee. Because of her hard work and dedication in 2010, she was named Volunteer of the Year for the Alzheimer’s Association.

Welcome to this edition of the DNA Reporter. The focus of this issue is on Special Populations. You

Constituent member of ANA

The mission of the Delaware Nurses Association is to advocate for the interest of professional nurses in the state of Delaware. The Delaware Nurses Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.

Quarterly circulation approximately 12,000 to all RNs, LPNs, and Student Nurses in Delaware.

Volume 36 • Issue 3 August, September, October 2011

Victims of Disaster in Haiti

Page 4

Inside DNA REPORTER

Reporter The Official Publication of the Delaware Nurses Association

current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371 Executive Director’s Column. . . . . . . . . . . . 1

Delaware Board of Nursing Update . . . . . . . 2President’s Message . . . . . . . . . . . . . . . . . . 3DNA Has Moved! . . . . . . . . . . . . . . . . . . . . . 3BPA Bill (SB 70) Signing . . . . . . . . . . . . . . . 5Special Populations: Obese Patients . . . . . . 6School Nursing . . . . . . . . . . . . . . . . . . . . . . 7

The Impact of Poverty on Malnutrition . . . . 82011 DNA Fall Conference and Membership Meeting . . . . . . . . . . . . . . 10Continuing Nursing Education Series . 12-14Save the Date! . . . . . . . . . . . . . . . . . . . . . 14Welcome New and Reinstated Members . . 14Data Bits . . . . . . . . . . . . . . . . . . . . . . . . . 15

Executive Director’s Column

Sarah CarmodyLinda Sydnor

Guest Editorwill read articles written by nurses who work in various clinical areas, each nurse will share their experiences involving their special population.

When you look up the definition of “special” in the dictionary, it says “a distinctive mark or quality” or “a special object or class of objects”. There are many populations that have unique care needs requiring specially trained people or programs focussed on promoting and maintaining healthy behaviors and lifestyles. When patients receive the specialized care they need, we see good outcomes. As I work each and everyday with the geriatric population, I witness just how important this is in ensuring success for these patients.

In this issue, we are examining a wide variety of “special populations” seen in health care everyday. Some of these include: healing touch in the pediatric intensive care patients, patients with malnutrition, school nurses, the bariatric patient, those patients with Parkinson’s disease and victims of natural diasters, specifically those in Haiti. When looking at each of these topics, we see similarities as well as differences. Each of these populations has specific needs, and each requires specially trained people to care for them in order to achieve good outcomes. Maybe more importantly, these populations call for nurses who have a strong desire and passion to improve the care these groups receive.

The purpose of this issue of the DNA Reporter is to help us all to realize that special populations include not only male/female, age, or socioeconomic status, but can also consist of many other groups of people, some we may not have even thought of as a “special population.” As nurses, we have a unique opportunity to care for and make a difference in each of these areas; we should consider this an honor and a privilege. Executive Director’s Column continued on page 3

Mercury Thermometers

Page 11

Page 2 • DNA Reporter August, September, October 2011

OFFICIAL PUBLICATION of the

Delaware Nurses Association5586 Kirkwood Highway

Wilmington, DE 19808Phone: 302-998-3141 or 302-998-3142

FAX 302-998-3143Web: http://www.denurses.org

The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.

EXECUTIvE COmmITTEEPresident TreasurerBonnie Osgood, MSN, Nat’e Guyton, RN, MSN, RN, CNA-BC NEA-BC, CPHIMS

Past President SecretaryNorine Watson, MSN, Carol Dye, MSN, MBA, RN, NEA-BC RN-BC, CNML

COmmITTEE CHAIRSContinuing Education Advanced PracticeNancy Rubino, EdD, RN Leslie Verucci, MSN, RN,Marylou Hamilton, MS, RN CNS, ARPN-BC, CRNPCo-Chairs

Nominating Professional Development Cheryl Layfield, RN, MSN, May Oboryshko, MSN, RNCFNP

Legislative CommunicationsAlana King, MSN, RN Donna Shanosk, MSN, RN, NE-BCEnvironmental Ad-Hoc Monica Boyle, BSN, RNC-NICSandra Reddy, RN, BSNNursing Healing Our Planet (NHOP)

DNA DELEGATES to the ANA House of Delegates

New Castle County: VacantKent County: Karen Panunto, EdD, RN, APN

Sussex County: Kelly Davis, MSN, RNDNA President: Bonnie Osgood, MSN, RN, CNA-BC

Alternates-at-Large:Marianne Ford, BSN, MSHCA, RN

Betty Stone, MSN, RNJo Ann Baker, MSN, RN, FNP-C

Executive DirectorSarah J. Carmody, MBA

Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising

is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement

does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association

disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any

consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions

of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local

associations.

managing EditorsMonica Boyle, BSN, RNC-NIC

Donna W. Shanosk, MSN, RN, NE-BC

The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Monica Boyle, BSN, RNC-NIC @ mboyle@nemours.org or Donna Shanosk, RN, MSN, NE-BC @ dshanosk@christianacare.org.

Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.

Reporter

vision: The Delaware Nurses Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.

mission: The Delaware Nurses Association advocates for the interest of professional nurses in the state of Delaware.

Goals: The Delaware Nurses Association will work to:1. Promote high standards of nursing practice, nursing

education, and nursing research.2. Strengthen the voice of nursing through membership

and affiliate organizations.3. Promote educational opportunities for nurses.4. Establish collaborative relationships with

consumers, health professionals and other advocacy organizations.

5. Safeguard the interests of health care consumers and nurses in the legislative, regulatory, and political arena.

6. Increase consumer understanding of the nursing profession.

7. Serves as an ambassador for the nursing profession.8. Represent the voice of Delaware nurses in the national

arena.

by Pamela C. Zickafoose, EdD, MSN, RNExecutive Director

Delaware Department of StateDivision of Professional Regulation

Greetings to the nurses of Delaware and belated Happy Nurses’ Week! Since this is my first update I would like to begin by providing basic information related to the Board of Nursing. The Delaware Board of Nursing is considered an umbrella board under the Division of Professional Regulation which provides administrative and investigative support for 34 boards and commissions and regulates 45 professions, trades, and events. There are 15 board members who are appointed by the Governor for a three year term, and members may be reappointed once after their first three year term. Last year, the composition of the board was changed to add a Nurse Educator member so the current composition is 5 public members, 5 RN members, 3 LPN members, 1 RN Educator member, and 1 APN member. The board meets the second Wednesday each month (except August and December) at 9AM in the Cannon Building in Dover and all meetings are open to the public.

When I assumed this position in December last year, one of my goals was to get the Rules & Regulations updated to current practice. This committee has been working diligently to review, revise, and update the rules incorporating the National Council of State Boards of Nursing (NCSBN) Model language. At this point we hope to have them published in July and to hold public hearings in August. Another goal I have is to complete a Data Integrity Project with the NCSBN using Nursys©

Delaware Board of Nursing Update June 1, 2011

which is a national database for nursing licensees. The Board of Nursing was recently awarded a $90,700 grant to achieve this initiative. We have begun scanning paper licensure records into a computerized program and uploading missing or incomplete information into our licensure database to improve its integrity. Eventually, we would like to go paperless as you may have experienced with recent license renewals. The Division is constantly working to improve systems and processes to be more user-friendly and convenient for our customers while protecting the citizens of Delaware.

Recently, HB 45 was signed by the Governor into law. This bill places a bar on felony sexual offenders from becoming nurses and provides for permanent license revocation for nurses who are convicted of felony sexual offenses. In addition, we will be introducing legislation to allow a late renewal period for nursing licensure. Currently, licensees must reinstate their license if not renewed by the expiration date, and this process can take up to six weeks by having to obtain a criminal background check (CBC). Overall, this will render the nursing statute similar to other professions under the Division. The Division has added two Hearing Officers and a Paralegal to assist in expediting the adjudication of disciplinary cases. They will be conducting hearings in addition to the ones scheduled by the Board of Nursing and making recommendations to the board for disciplinary action.

Finally, to contact the Board of Nursing please visit our website at www.dpr.delaware.gov and then click on Nursing. We do have a fully staffed information center and the phone number to call is 302-744-4500. The staff members are trained to answer many routine questions, and they will refer other questions directly to the appropriate person(s). I look forward to serving in this role and working with you in the future.

Published by:Arthur L. Davis Publishing Agency, Inc.

http://www.denurses.org

Medical/Surgical Nursing Instructors (2 Positions) Full-Time

Responsible for developing and implementing curricula, instructing assigned courses consistent with syllabi, and evaluating students. Responsible for teaching a variety of nursing medical/surgical classes in the classroom, laboratory, and clinical settings (day/evening hours). Responsible for assisting with the assessment and selection of clinical sites that provide educational opportunities for application and nursing theory.

Adjunct Nursing InstructorsFor the fall semester (2011), day/evening hours in the following areas: Medical-Surgical and Psychiatric Mental Health Nursing. Undergraduate teaching experience preferred.

Minimum Qualifications:Master’s degree in Nursing or Bachelor’s degree and actively enrolled in a NLNAC/CCNE accredited Master’s degree in Nursing program to be completed by December 30, 2011. Four (4) years of relevant work experience.

Request Application and a Job Description from:Human Resources Dept.

Stanton Campus400 Stanton-Christiana Road, Newark, DE 19713

Phone: (302) 454-3916Fax: (302) 453-3028

Email: s-jobs@dtcc.eduWeb Page: http://www.dtcc.edu/hr

CONGRATULATIONSto Chris Price

MSN, RN, CPAN, CAPAof Townsend, Delaware

2011-2012 President of ASPAN

Your colleagues in CBSPANare so very proud of you!

August, September, October 2011 DNA Reporter • Page 3

President’s Message

Bonnie Osgood

and taking part in what we have to offer. As we celebrate our past and look into the future, DNA will be focusing on providing additional education activities, networking events and moving forward with legislation that will have a positive impact on nursing, the environment and healthcare in our state. Join us!

Executive Director’s Column continued from page 1

The new address is:

Delaware Nurses Association726 Loveville RoadHockessin, Delaware 19707

MovingThe Delaware Nurses Association

has moved! The DNA has moved its office to a new location on the Cokesbury Village campus. The new site offers a 250 seat auditorium, various breakout rooms, and more security at a savings to the Association.

Hello everyone. Welcome to this edition of the DNA Reporter. This quarter’s edition is about special populations. We each have an opportunity and a great responsibility to provide contributions to our own practice area. This can be accomplished by promoting excellence in nursing practice through development of clinical expertise promoting quality outcomes, supporting and fostering the growth of a less experienced nurse and achievement of professional certification in your area of specialty. There are opportunities every day to recognize the special care each of us provide within our practice to meet the needs of our populations. I would like to take this opportunity to thank you for all that you do.

To update you on recent events, I have been working with nursing leaders throughout Delaware

on recommendations brought forward from the Institute of Medicine/Robert Wood Johnson Future of Nursing. The Delaware Task Force for the Future of Nursing is actively working issues in transition to practice. Specifically, 3 key recommendations from the report; nurse residency programs, mentoring, and articulation agreements. Transition to practice issues is a top priority for nursing leaders in Delaware. Concensus model and APN scope of practice issues are also on the radar. Please refer to the DNA website for further information and resources regarding the future of nursing, and stay tuned to the Reporter. Mentoring will be the theme of the next edition.

There’s a lot of work to do in Delaware. I want to thank all of our brilliant, engaged, active leaders who work each day to make a difference for their special populations and the profession at large through their involvement in issues that impact our practice. It is also imperative that you support your professional practice through participation in your professional nursing organization. So, if you’re not a member, please take the time and join. Your participation can make all the difference.

Westminster Village

Where you don’t “Flip Flop” jobs. Once you work for us, you won’t want to leave! Interested?? Please stop by for an application!

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Page 4 • DNA Reporter August, September, October 2011

Geetanjali Chatterjee, RN, BSN, PCCN, CCRN

Geetanjali (Joya) Chatterjee is a staff nurse on the Pulmonary Stepdown Unit at Christiana Care. She has worked there for 8 years and is certified as a PCCN (Progressive Care Certified Nurse) and CCRN (Critical Care Certified Nurse). Prior to working at Christiana Care, Joya was a nurse educator in India and taught diploma nurses. She is a member of ANCC. She was also a member of the second Christiana Care team that went to Haiti in January, 2010, following the devastating earthquake there.

The country of Haiti makes up the one third of the western part of the island of Hispaniola in the Caribbean. It is one of the most densely populated and the least developed countries in the western Hemisphere.

On January 12, 2010 a devastating earth quake struck Haiti. The magnitude of the earth quake was a 7 on the Richter scale and the estimated loss of human life was more than 230,000. However, the exact number of deaths has yet to be calculated.

The general public health situation in Haiti was already in perilous situation, even before the earthquake. There was wide spread malaria, HIV, tuberculosis, malnutrition poor sanitation and hygiene. There was a great need for health professionals for these earth quake victims. It was for this reason that a group of healthcare professionals from Christiana Care Health System, under the title of the Delaware Medical Relief Team determined to join other professionals in Haiti as part of the disaster relief assistance.

The first team (team A) went to Haiti soon after the devastation. On Feb 3rd, (our team) team B started the journey to Haiti. Our team consisted of physicians, a physician assistant, nurse practitioners, nurses, pharmacists, medical students and logistic personnel. As a health care professional we had a strong desire to help, heal and comfort people in distress. So with our strong desire to care the earth quake victims, coupled with inner strength and motivation, we reached Haiti on Feb 5th. There were many complications that we encountered enroute to Haiti, but we were very grateful to be there.

Any natural catastrophe causes different categories of victims. Therefore, as we reached Haiti, after almost after 1 month of planning, we were prepared to see some patients recovering from major physical trauma, along with those needing surgical procedures, patients with minor injuries, malnutrition, and those with complications of untreated existing problems. In addition to these problems, post traumatic stress syndrome or psychological trauma from such devastation is a very prevalent and important issue.

Upon arriving, our first challenge was to erect a make shift clinic in an unfinished, rubble-filled building. It was phenomenal that within few hours we made our clinic viable. We even used rope on fragile hooks to hold IV fluids.

Each day we saw more than 100 patients, lined up in a long queue before 9 o’clock, visiting our make-shift clinic. Patients were standing in the scorching heat to get access to the health care which was almost non existent after the devastating earth quake. Some of them had to walk almost 6 hours to come to our clinic. Our patients ranged from 6 month to 60 years. They

had long waits, in almost 110 degree heat, but their faces were lit with fine streaks of hope to seek health care.

Physical assessments, critical judgment skills, and quick decisions were part of our daily procedures while taking care of this population. Our first patient in the clinic was 9 year old girl who had acute appendicitis. Her parents brought her on their shoulders. She had abdominal pain since the previous night. This poor child was screaming with pain and totally exhausted. She was quickly diagnosed with appendicitis. We started IV fluids, gave her antibiotics and were able to send her to the nearest hospital. An emergency appendectomy was done and the child was survived. On another occasion, a mother brought her 14 year old son who complained of pain abdomen. After a physical assessment he was diagnosed testicular torsion and we were able to send that child to the hospital very urgently.

Haitians speak French and Creole. We had translators to communicate with patients but we always used to keep close observation on their body language and gestures to get the correct information from the patients. Sometimes it was very challenging. Dehydration among children was very common and had to be treated rapidly. Children were crying after such a long wait without food and water, but they had no tears as they were so dehydrated. We treated them with IV fluids and their mothers were given some health advice related to the conditions. We also performed small surgical procedures, such as abscess draining, draining of fluid from infected knees, treatment of ingrown toe nails, dressing burns and wound care.

It seems as if the health care crisis after such natural calamity is only tip of the iceberg of the crisis in a country like Haiti. There is a huge need for simply providing food and shelter for themselves and their loved ones. One 55 year old grandmother was almost in tears and asking that I take her beautiful little 4 month old granddaughter to live with me in the United States. She is unable to feed or provide shelter for the child and the child’s mother died in this earth quake. She stated that the child would be able to survive with me and that she thought the child would perish in her care despite her best efforts. So many people lost their children, and many children were orphaned. People are struggling to live without food, without water, without shelter on a daily basis. There is a huge future need for Haitian to survive in all spheres of life.

We stayed there for almost 7 days. We were physically and psychologically drained from the demands of working in such a disaster area. But in spite of all of the poverty and sorrow, I am positive that our intense desire and passion to work as voluntary health personnel will keep us moving forward in the future. It was a very challenging time, but it was also a very rewarding time as we were able to make even a small difference in the lives of those we served and treated.

victims of Disaster in Haiti

Geetanjali Chatterjee with earth quake victim child.

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Dover–On June 30, 2011, members of the Delaware Nurses Association along with stakeholders and sponsoring legislators attending the bill signing of Senate Bill 70, which bans the use of BPA in protects the health of young children by prohibiting the chemical bisphenol-A in certain children’s products such as bottles, cups, and other containers used for food or beverages.

Bisphenol-A, or BPA is a chemical used to help harden plastic and is found in many plastic food storage containers. BPA is a known hormone disruptor. Tests have shown that trace amounts leach out of the containers and into foods and liquids. BPA-free products exist.

BPA Bill (SB 70) Signing

Governor Jack Markell standing with members of the DNA as well as other stakeholders and sponsoring legislators.

“The passing of SB 70 ensures that the health of babies and children are protected from the proven endocrine disrupting chemical bisphenol A. In addition, the passing of SB 70 with unanimous support in the House and Senate shows that Delaware is committed to protecting children’s health. This nurse sponsored bill truly shows that nurses can affect change, as we are well trained to understand environmental health issues and risks,” says Sarah Bucic, MSN, RN, DNA member who was instrumental in getting this bill passed.

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Page 6 • DNA Reporter August, September, October 2011

Tina Fisher, BSN, RN, CBN

Tina Fisher obtained her Associate degree in nursing from Delaware Technical & Community College and her BSN from Immaculata University. Tina joined Christiana Care Health Systems in 2002. She has been a member of the Bariatric Program Team since 2006. She is a certified Bariatric Nurse, and is currently the Bariatric Surgical Coordinator for the Christiana Care Bariatric Program. Tina may be contacted at Tifisher@christianacare.org

Healthcare Providers aim to provide safe and effective care to all their patients, but one group of patients that often are over looked are the morbidly obese. Although it is common that healthcare providers discuss the physical issues raised by weight gain, the social and psychological ones are more likely overlooked. It is not enough to tell a patient that they need to lose weight. Chances are good that the patient is already aware of the fact that they are overweight and in many cases have tried numerous efforts to lose weight, succeed and gain it back. What providers may not be aware of is the discrimination and weight bias the patient experiences on a regular basis. The negative stigmatization of obesity is all to often accepted in our culture, and many patients report experiencing discrimination. Weight discrimination is thought to be more prevalent than racial discrimination and crosses all barriers of gender, race and physical ability. In other words one individual could experience discrimination based on their gender, race, physical disability and Body Mass Index (BMI).

To help a patient that is struggling with weight it is important for healthcare providers to address the recognition of weight bias in the healthcare setting. According to the Yale Rudd Center, weight bias is a common occurrence in healthcare settings, particularly among professionals. Their studies show that this includes physician, nurses, psychologist, dietitians, medical students and others. Some of these professionals according to the Yale Rudd Center perceive over weight patients as unintelligent, unsuccessful, weak-willed, unpleasant, overindulgent,

and lazy. The clinicians will sometimes blame patients for their non-compliance versus acknowledging the limited effectiveness of current weight loss treatments. When persons perceive weight bias by health care providers this leads to physical and emotional consequences. A research study reported by the Rudd Center with more than 2,400 obese adults’ states that 79% of those patients reported coping with weight bias by eating more and 75% reported they refuse to keep dieting in response to weight bias by their provider. Adults that experience weight bias were also shown to increase binge eating. The message here is that weight bias affects health because patients are more likely to avoid seeking care and to cancel appointments or delay preventive care if they feel they have been discriminated against or judged. When asked why they did this in the Rudd Center study the patients reported feelings of embarrassment about being weighed and medical equipment that is too small for their body habitus. This could range from blood pressure cuffs, to gowns that are too small to MRI tables. Sometimes the bias begins in the waiting room, where chairs are often restrictive or not sturdy enough, or even in public restrooms with limited weight capacity toilets.

Interestingly some patients report a perception of less weight bias by their primary care providers after a bariatric surgery but are sometimes reluctant to seek care if they have a small weight regain for fear of being perceived as a failure or experience a return of weight stigma.

Providers will serve their patients well by making sure their medical equipment can serve all their patient

Special Populations: Obese Patients

Tina Fisher

populations appropriately and safely. They should address their patient’s health issues based on weight in a supportive manner versus a disparaging tone and to recognize their own feelings about obesity and avoid weight bias in their delivery of care.

The obesity epidemic continues with 33% of adults in America falling into the obese category and a significant increase in obesity for our children. Many organizations are actively pursuing ways to minimize this epidemic such as the Yale Rudd Center, the Obesity Action Coalition, the National Institute of Diabetes and Digestive Disease and Weight-Control information Network (NIDDK, www.win.niddk.nih.gov) among others. Many have free tool kits available for healthcare providers and patients online.

The Yale Rudd Center offers tools to health care providers and schools to help combat weight bias in our community. The Yale Rudd Center Provides a free DVD and online education on the topic of weight bias for healthcare providers and educators with an online request at www.yaleruddcenter.org.

References Rand C. W., Macgregor A. M., Morbidly obese patients’

perceptions of social discrimination before and after surgery for Obesity. South Med. 1990;83:1392-1395

Reto C. S. Psychological aspects of delivery of nursing care to the bariatric patient. Critical Care Nursing Quarterly. 2003;26:139-149

Puhl R. M., Heuer, CA. The stigma of obesity: A review and update. Obesity. 2009;17:1-24

Rudd Center for Food policy and Obesity, Yale University: http://www.yaleruddcenter.org/home.aspx

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August, September, October 2011 DNA Reporter • Page 7

by Loretta Newsom, RN, MSN, NCSN

Loretta received her BSN from Holy Family University in Philadelphia, Pennsylvania and her MSN from the University of Delaware. She is a Pediatric Clinical Nurse Specialist with National Certification in School Nursing. Loretta has 28 years of maternal/child clinical experiences and has worked for the past 11 years as a school nurse. She is currently a school nurse at the Alfred G. Waters Middle School in the Appoquinimink School District. Loretta has developed and facilitated numerous health projects for students with special health care needs. She is the Past President of the Delaware School Nurse Association and the 2011 Delaware School Nurse of the Year. Loretta is the DSNA website chair (DSNA.org) and can be reached at Loretta.Newsom@appo.k12.de.us

Delaware school nurses are the front line of health care every day. There are 323 school nurses in Delaware who provide health services to approximately 150,000 students in the public and nonpublic schools.(1, 2) This number significantly increases to include the parent/guardian because in a pediatric population a nurse not only cares for the child, but also their caregiver. Many people do not realize that school nurses provide health promotion and clinical services for the entire school community that includes administrators, teachers, support staff, cafeteria workers, custodians, bus drivers, and volunteers. The nurse’s office truly is a clinic that is operated by one person, the school nurse.

School nurses share commonalities with all nurses, such as education, licensure, and nursing process. However, what makes school nursing so unique is that school nurses provide health services independently and autonomously in a non-health care setting, a school. Nurses who work in a school setting have many roles, such as clinician, health promoter, advocate, researcher, educator, liaison, counselor, social worker, coach, club advisor, and organizer for special events. School nurses are also the gatekeepers of childhood immunizations; upon entry into the education system every student’s immunization record is reviewed and entered into the statewide database. Students without up-to-date immunizations are referred back to their primary care physician. In a review of immunization data Delaware has a high compliances rate in childhood immunizations;(3) perhaps this is correlated to the diligent work of all the school nurses.

As every school nurse knows partnerships within the school system and the community are imperative to provide care that is continuous and comprehensive. The nurse is the only member of the school’s multidisciplinary team who represents wellness. Therefore, the school nurse provides the infrastructure needed to keep the school community healthy. The school nurse is a member of numerous committees and events, such as safety, wellness, Individual Education Plan, 504 Plan, Positive Behavior Support, discipline, sports, and Parent Teacher Association. It is also vital for a school nurse to form partnerships with public and private agencies. An alliance with community agencies establishes a united effort to provide the best in health care.

Due to the independent role of the school nurse it is highly recommended that a nurse have at least three years of clinical experience and a Bachelor of Science Degree in Nursing prior to applying for a public school nurse position. This has established a rich background of clinical experiences that Delaware school nurses bring to the profession. All Delaware public school nurses must obtain a license in school nursing that is mandated by the Department of Education. The licensure process includes:• ABachelorofScienceDegreeinNursing• Complete the Basic School Nursing Cluster

comprised of 90 hours of academic courses and modules

• BecertifiedinCPR

Loretta Newsom

• PasstheDelaware’sPraxis1exam

Many Delaware school nurses have national certification and advanced degrees in various areas including administration, counseling, education, pediatrics, psychology, and social work. There are 112 Delaware school nurses with National Certification in School Nursing.

In addition to the 30 hours of continuing education (CE) needed to maintain registered nurse licensure, Delaware school nurses need additional CE to meet state licensure (90 Department of Education clock hours every five years) and national certification (75 hours of continuing education related to school nursing every five years).

In comparison to other states Delaware is a stellar state for school nursing. The National Association of School Nurses (NASN) ranks Delaware as 6th in the nation for student to nurse ratio.(4) Not all states have a nurse in every school. In Delaware there is state legislation to support funding for a school nurse in every public school and subsidized funding for many nonpublic school nurses. All 19 Delaware school district nurses are contracted employees and share in the same benefits as their teaching staff as state employees.

Delaware nurses are known nationally for their many leadership contributions to school nursing. To name a few of the many contributors, Linda Wolfe, RN, Department of Education, is a former NASN President; Dr. Janice Selekman, RN, University of Delaware is the Editor of School Nursing: A Comprehensive Text; Susann Hoffmann, RN, school nurse Caesar Rodney School District, is a national presenter of NASN’s Helping Administer to the Needs of the Student with Diabetes in School (HANDS); Anne Biddle, RN, Newark Charter School, is the liaison with the News Journal Delaware Mom’s Magazine, for the column School Nurse-states current pediatric health topics; Pat Guilday, RN, Brandywine School District conducted an outcomes indicator project to evaluate school nurse outcomes; and Beth Light, RN, Sussex Technical High School, is the Delaware School Nurse Association President.

Now more than ever students need a nurse in their school. The configuration of family has changed; divorce, single parent, step-parents/siblings, guardians, foster care, and parents deployed in war. Home has also changed for many children; some students live with multiple extended family members and other are homeless living in shelters. The poor economy impacts family’s ability to have food and clothing. For some students the school is a safe haven and the nurse is the one providing consistent care and advocating for the social, emotional, and economical needs of the student and family.

There continues to be large numbers of students with chronic conditions such as asthma, allergies, and diabetes.(5, 6, 7) It is the school nurse who assesses and evaluates their student’s treatment plan and

educates the student and family in self-care. Severely premature infants are surviving; however, many have life-long medical challenges.(8) These medically fragile students require school nurses proficient in ventilators, intravenous fluids/medications, and gastric tube feedings.

In addition to providing care for students with acute illnesses and injuries, health screening and health promotion are vital components of the school’s health care delivery. Identifying a student with a vision or hearing deficit and assisting them to get the appropriate interventions can only help a student achieve. Every encounter with a student is a teachable opportunity for health promotion. Many Delaware school nurses have utilized creative projects such as, after school health clubs for students with chronic conditions, to empower students to self manage and advocate for themselves. (9)

Many times it is the school nurse who is called upon when there is a national health concern. This was made known during the H1N1 School Based Vaccine Clinics of 2010. Every Delaware school nurse took on a leadership role to develop a plan, educate the school community, and facilitate the vaccine clinics in their schools.

Delaware school nurses continue to be the health experts and maintain a leadership role in their schools and on a state and national level. The students of Delaware receive more than an education while at school they receive the best in health care from their school nurse.

References:1. Department of Education. Delaware Public School:

Enrollment Trends. (2011) Retrieved from http://www.doe.k12.de.us/reports_dara/files/EnrollmentTrends11-12.pdf

2. Krebs, Robert interview by Loretta Newsom 04/18/2011. Print. May 18, 2011. Student Enrollment 2010/2011 Diocese of Wilmington-Office of Communication.

3. Grantee Fact Sheet—Delaware—updated for CY2008 on 5/27/2009 Retrieved from http://www.cdc.gov/vaccines/stats-surv/default.htm#nis

4. Healthy Children Learn Better! School Nurses Make a Difference. National Association of School Nurses. (2011) Retrieved from http://www.nasn.org/portals/0/about/press_room_faq.pdf

5. United States Environmental Protection Agency. Report on the Environment. Asthma Prevalence. (2007) Retrieved from http://cfpub.epa.gov/eroe/index.cfm?fuseaction=detail.viewInd&lv=list.listByAlpha&r=219646&subtop=381

6. Branum, A., & Lukacs, S. Food allergies among US children: Trends in prevalence and hospitalizations. National Center for Health Statistics Data Brief, No. 10. October 2008.

7. Centers for Disease Control and Prevention. Children and Diabetes SEARCH for Diabetes in Youth. (2010) Retrieved from http://www.cdc.gov/diabetes/projects/diab_children.htm

8. Clement, K. M., Barfield, Ayadi, & Wilber. Preterm birth-associated cost of early intervention services: An analysis by gestational age. Pediatrics. 2007;4: 866-874.

9. Newsom, L. After-school health clubs. NASN School Nurse. 2008;5:163-164.

School Nursing

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Page 8 • DNA Reporter August, September, October 2011

Meriam L. Dennie, APN, MSN, MS, ACNS, BC, CEN

Meriam earned her BSN and MSN from the University of Delaware. Meriam is an Adult Health Clinical Nurse Specialist. She also has a Master in Human Resource Management from Wilmington College.

Meriam worked as a staff nurse in multiple critical care units for over 10 years. She also worked in the Christiana Emergency Department for over ten years and spent 8 years with LIfenet, The flight team at Christiana Care Health System. She also was a Staff Development Specialist on the acute stroke unit for 2 ½ years.

She is currently a Nutritional Support Advanced Practice Nurse for Christiana Care Health System.

Meriam can be reached by email at mdennie@christianacare.org. Her office phone is (302) 733-6675.

What is the first thing that comes to mind when you think of malnutrition? Many people might say that the image that comes to mind would be the people that are starving in third world countries. These are people that have such extreme poverty and no end in sight; food is just one of their worries. Adequate shelter and steady income are often two other major concerns. Their biggest worry is not the nutritional composition of their food but will there be enough for another meal. The second image might be all of those people who are no longer able to eat. There may be a medical or surgical condition that prevents adequate ingestion and/or absorption of necessary nutrients. For some this may be a temporary problem, for a limited period of time, for others a permanent change in lifestyle. This type of malnutrition seems to hold a different significance for each individual as one tries to make sense of the conditions associated with their particular disease.

In order to fully understand the complexity of malnutrition one must understand the standard definition for the terms involved. The US Department of Agriculture and/or the Food and Agriculture Organization define Hunger as “the uneasy or painful sensation caused by an involuntary lack of food. Hidden Hunger is when an individual suffers from subclinical deficiencies but does not have obvious clinical signs of undernutrition (for instance iron deficiency in pregnant women). Food Insecurity

is when individuals do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”(1)

Based on these definitions it is easy to understand how both hunger and food insecurity would lead to malnutrition, which is usually associated with undernutrition. It is also easy to derive that poverty, or lack of sufficient funds, has a significant impact on hunger and food insecurity. Interestingly enough there is another component to malnutrition that shows a relationship between poverty, food insecurity and malnutrition which is obesity or overnutrition.(2) This situation arises because many individuals who live in poverty consume diets that have inadequate kilocalories to meet or exceed their daily energy requirements, but lacks the quality necessary to promote optimal health.(3) Thus malnutrition must be extended to include not only undernutrition but also overnutrition as it relates to poverty or the inability to be able to obtain an adequate food supply. It has been “estimated that by 2015 noncommunicable diseases associated with overnutrition such as diabetes, hypertension, and coronary vascular disease will pass undernutrition as the leading cause of death in low-income countries.”(4)

Hunger in itself has been a public issue for a long time. On the other hand, food insecurity as it relates to hunger has only recently emerged in the United States as a public problem.(5) In the United States, the number of residents in 1999 experiencing hunger was 7.8 million. This increased to 9.6 million in 2003, a 24% increase.(6) The most basic form of food insecurity is a household that runs out of food before they have the money to replenish the supply. This in turn causes the individual to begin to compromise the quality of the food that is purchased. Compromising the quality of the diet often leads to a diet that derives a higher intake of energy from foods high in fats and carbohydrates and lower in nutritional value.(7) Often these energy dense foods, like refined grains, added sugars, and added saturated/tran’s fats are less expensive than higher nutrient dense foods such as fruits, vegetables and whole grains, allowing the consumer to stretch their food dollars. Research has shown an inverse relationship between dietary energy density and diet quality as determined by the content quality of micro and macronutrients. “Low-energy-dense diets of higher nutrient content were associated with higher energy-adjusted diet costs.”(8) Households that have been characterized as being food insecure have also been found to have the highest body mass index with a high prevalence of obesity.(9) In the United States, adults living in food insecure households are noted to consume fewer weekly servings of fruits, vegetables, and dairy products, as well as, lower levels of micronutrients, including the B complex vitamins, magnesium, iron, zinc and calcium.(10)

Geographically speaking, rural areas tend to see

The Impact of Poverty on malnutrition

Meriam Dennie

a prevalence of undernutrition and poverty while overnutrition and obesity predominates urban areas.(11) This being said, geographical location did not alter the familial impact that at times both undernutrition and overnutrition can co-exist.

Malnutrition negatively affects the overall health of individuals. Nutritional status deteriorates as dependency and care needs increase but does not happen over night. Likewise, an effort to improve the overall nutrition of individuals and families does not change over night. Globally, multiple programs have been implemented in an attempt to alleviate hunger and food insecurity but have not necessarily addressed the emerging issues associated with obesity and poverty.(12) In the United States some of the programs initiated to combat food insecurity are: “the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the National School Lunch and Breakfast Programs for Children, the Food Share (Food Stamp) program for individuals and families, and the Older Americans Act Nutrition Programs.”(13) These programs serve an important role in trying to help meet the nutritional needs of individuals and families but lack one essential element. Education regarding nutrition and how it relates to wellness is the key component. The role of the healthcare provider is essential in educating clients on how to make appropriate choices that ensure optimal health. If healthcare providers can help individuals and families develop the ability to make good choices than overall health should improve as food insecurity decreases. Ultimately, the overall goal is to decrease nutritional risks as it relates to chronic disease.

References:1. Tanumihardjo S. A., Anderson C., Kaufer-Horwitz M.,

Bode L., Emenaker N. J., HaQQ AM, et al. Poverty, Obesity, and Malnutrition: An international perspective recognizing the paradox. Journal of the American Dietetic Association. 2007;107:1966-1972.

2, 3, 4, 5, 6, 7, 9, 11, 12, 13. Above journal as well8. Townsend M. S., Aaron G. J., Keim N. J., Drewnowski

A. Less energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs. American Journal Clinical Nutrition. 2009; 89: 1220-1226.

10. Seligman H. K., Laraia B. A., Kushel M. B. Food insecurity is associated with chronic disease among low income NHANES participants. Journal of Nutrition. 2010;140: 304-310.

Other background referencesKaiser M. J., Bauer J. M., Ramsch C., Dipl-Biomath F.

H., Uter W., Guigoz Y., Cederholm T., et al. Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. Journal American Geriatric Society. 2010; 58: 1734-1738.

Darmon N., A fortified street food to prevent nutritional deficiencies in homeless men in France. Journal of American College of Nutrition. 2009; (28) 2: 196-202.

Martin C. T., Kayser-Jones J, Stotts, NA, Porter C, Froelicher E. S., Risk for low weight in community-dwelling older adults. Clinical Nurse Specialist. 2007; (21)4: 203-211.

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August, September, October 2011 DNA Reporter • Page 9

Jill Connolly, RN, B Ed/BN

Ji l l Connol ly, R N, Clinician Level IV. Jill Connol ly earned her Bachelor of Nursing/Bachelor of Education from the University of the West of England, Great Britain.

Jill has worked as a pediatric nurse for 25 years and has studied energy modalities for many years.

Jill is currently a Clinical Nurse Level IV on the Pediatric Intensive Care Unit at AI DuPont Hospital for Children/Nemours and is a member of the Research and Education Hospital Council, the PICU research committee, the PICU Clinical Informatics committee. Jill is also co-chair of the Service Excellence committee and Chair of the Healing Touch PICU committee.

Jill can be reached by email at JConnoll@Nemours.org.

Without change there is no innovation, creativity or incentive for improvement.

~William Pollard(1)

In 2010 Nemours/AI DuPont Hospital for Children, Wilmington, DE began an Evidence-Based Nursing Practice Fellowship Program (EBNPF). I was fortunate to be one of the Fellows and was told to choose something I enjoy! My interest lies in Healing Touch and bringing this modality in particular to staff in the PICU. This became the focus of my Evidence-Based Practice project.

Healing Touch (HT) is an integrative energy based approach to healing and is defined by the Healing Touch Program as, “an energy therapy in which practitioners consciously use their hands in a heart-centered and intentional way to support and facilitate physical, emotional, mental and spiritual health.” (HT program)(2)

In the 1980s there was an increasing interest in therapies that went beyond medical approaches. Many modalities gained recognition, including; massage, acupuncture and chiropractic. In response to this the American Holistic Nurses’ Association and the American Holistic Medical Association were formed in the early 1980s.

HT was initially designed by Janet Mentgen as a continuing nursing education curriculum, and incorporates the work of many energy work pioneers, such as Dora Kunz and Dolores Krieger,(3) Barbara Brennan(4) and Brugh Joy(5).

Today, HT is endorsed by the American Holistic Nurses’ Association and is a recognized ANCC provider. It is a highly respected energy therapy program offering certification to all those who may wish to become proficient in this healing work.

Healing Touch therapy is based on a holistic view of health and illness, it focuses on creating a balance in the whole body rather than focusing on the dysfunction of a part. There are many theories on how HT actually works, and research is on-going in this area, but it has been postulated that the energy fields are in constant interaction in and around the body and that HT stimulates the internal mechanisms within the body to balance and restore health and harmony.

Evidenced-Based Nursing Projects at Nemours use the Iowa Model of Evidence-Based Nursing to infuse research into practice to promote quality care. The model provides a framework in which to study using a systematic approach. For this particular project I felt it essential to begin with a searchable question: Is there a change in nurses’ perception of HT before and after education and experiential intervention?

In following the algorithm of the Iowa Model the first part was identified. Knowledge Focused Triggers; this included studying the organizations philosophies and also research and literature. AI DuPont/Nemours Philosophies of Care and also the HT program emphasize the need for quality care, “Quality health care can be described as, “doing the right thing, at the right time, in the right way—and having the best possible results,” according to

the USD HHS Agency for Healthcare Research and Quality.

In conducting a literature search on the topic of HT there is little research on Nurses’ perceptions of HT. However, some comprehensive studies were identified in building the framework from which one could begin an Evidence-Based project. One recent study explores the effect of HT on nurse managers, ‘Improving the Well-Being of Nursing Leaders through Healing Touch Training’ (2010)(6). This study found that training nurse leaders in an academic health center in HT is associated with significant improvements in subjective and objective measures of stress.

Ideas without actions are worthless~Helen Keller(7)

There has been support and encouragement from the organization for this project and I felt that I had a positive response to the next decision point within the Iowa Model, Is this Topic a Priority for the Organization? A team was formed which included Nemours Director of Nursing Research, my mentor (a Level IV clinician nurse), the PICU Certified Nurse Specialist and the Healing Touch Certified Practitioner/Instructor. Shortly into the project a HT PICU committee was formed and this team continued to grow as the project progressed. Following a critique of the literature it was felt that there was a sufficient research base to continue to Pilot the Change in Practice. A Baseline Assessment of the registered nurses on the unit was completed and data compiled; 43% of staff rated their knowledge of HT as average, 35% of staff felt HT was important to their practice, 90% of staff wanted to learn more. We felt this data supported the project and we continued with the implementation phase. This began with discussions with members of the multi-disciplinary team and collaboration with physicians. This included a discussion with the PICU attending, an education session and a lecture on HT to the physicians. A HT Committee/Study Group was formed and continues to meet monthly to discuss Healing Touch and practice techniques. The PICU holds monthly staff meetings and I felt that this was an ideal forum to discuss HT with the other nurses. From the beginning of the project I felt that it was imperative for staff to experience the modality. The Experiential Intervention aspect consisted of, ‘Days of Caring’, these are days when staffs are offered Healing Touch for 20–30 minutes.

As part of the Iowa Model I evaluated the project by assessing the nurses’ perceptions of HT following education and experiential intervention; 100% of staff felt that their knowledge had increased, 82% of felt that HT reduced their stress level, 87% of staff wanted to include HT in their nursing practice, 100% of staff would refer a child for HT.

An exciting aspect identified during the project was the staffs’ enthusiasm to complete a course in HT. Prior to the EBNP three staff could offer HT and following the EBNP eighteen staff are able to offer HT. The team felt change was appropriate for the unit and today HT is offered regularly to the multidisciplinary

staff of the PICU at Nemours. The nurses at AI duPont’s Intensive Care Unit work in a high-tech environment and are faced with many challenges but are committed to providing high quality health care and at times this can be a source of stress for staff on the unit. Following the establishment of Healing Touch on the unit we intend to ensure there is time to ‘Care for the Care-Giver’.

The fascination of research provides a path to further investigate HT and offers an avenue to present the modality to others. Healing Touch is a special way to build trusting and intimate relationships and is an Evidenced-Based therapy that will improve nurse satisfaction.

‘The future depends on what we do in the present’

~Mahatma Gandhi(8)

Thanks to Dr. Bayley, Director of Nursing Research at AI duPont /Nemours, Walle Adams-Gerdts, Healing Touch Practitioner/Instructor, Ruth Lebet, Clinical Nurse Specialist AI duPont /Nemours and MargaretAnn Neyman, Clinician Level IV.

Healing Touch sessions.

1. http://thinkexist.com/quotation/without_change_there_is_no_innovation-reativity/15240.html. accessed 4/11/11

2. http.www.healingtouchprogram.com/accessed 4/11/11

3. Krieger D. The Therapeutic Touch: How to Use Your Hands to Help or to Heal, Fireside, New York; 1979

4. Brennan B. Hands of Light: A Guide to Healing through the Human Energy Field, Bantam books, New York; 1988

5. Brugh J. Joy’s Way, Tarcher, New York; 19796. Tang, Tegeler, Larrimore, Cowgill, Kemper, (2010)

Improving the Well-Being of Nursing Leaders through Healing Touch Training. The Journal of alternative and complementary medicine 16(8), 1–57.

7. http://www.great-quotes.com/quote/1150471, accessed 4/11/11

8. http://www.memorable-quotes.com/mahatma+ gandhi,a46.html. Accessed 4/11/11.

Healing Touch and the Pediatric Intensive Care Unit at Nemours/AI DuPont Hospital for Children

Jill Connolly

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Page 10 • DNA Reporter August, September, October 2011

Join theDelaware Nurses

Association!Free and Discounted Products and Services

DNA members are eligible for discounts on nursing books, ANCC certification, professional liability insurance and continuing education. DNA members save up to 45% on registration fees to DNA conferences.

Advocacy and LeadershipDNA advocates on behalf of Delaware

professional nurses and healthcare consumers both at the state and national levels. Opportunities are available for members to take a leadership role in planning our continuing education and networking events, participating on task forces, and act as the voice of Delaware nurses at the national level to name a few.

NetworkingWhen we say networking, we don’t just

mean at the state level. Yes, DNA provides opportunities to network at our conferences, committee and board meetings, and other events but there are also opportunities to network at the national level. Given the close proximity of Delaware to Washington DC, ANA will call on DNA to send a member to national events to speak on behalf of nursing. In addition, there is the ANA House of Delegates and the annual Lobby meeting to meet and learn from other nurses around the country.

These are a few of the benefits nurses receive as a DNA member. State only membership is $159 annually and full ANA/DNA membership is $239 a year with reduced rates for new graduates, unemployed and retired nurses. Go to www.denurses.org to join or renew and start taking advantage of what DNA has to offer.

*Participation at the national level requires full ANA/DNA membership

ANA Speaks Out on Health Impact of Proposed Cuts

to EPA Budget at Capitol Hill Event

The American Nurses Association (ANA) joined a group of health care professionals and lawmakers to speak out against the proposed cuts to the Environmental Protection Agency’s (EPA) budget. ANA contends the submitted cuts represent a serious threat to the public’s health, as they would impede and in some instances prohibit the EPA from enforcing the laws that protect the safety of our air and water and protect against hazardous chemical exposures.

Senator Barbara Boxer (D-CA) Chair of the Senate Committee on the Environment and Public Works spearheaded the event at the Dirksen Senate Office Building. Delaware Nurses Association member Sarah B. Bucic, MSN, RN spoke on behalf of ANA.

“Studies continue to demonstrate a link between chemical exposure and serious illnesses, including cancer, reproductive and developmental disorders, neurological diseases, and asthma,” Bucic remarked. “And it is our most vulnerable populations whose health is most at risk: children, the elderly, the urban poor, and those with chronic conditions.”

Joining Bucic and Boxer at the event were six Senate committee Democrats and speakers from the American Lung Association, Physicians for Social Responsibility, the American Public Health Association, the American Thoracic Society, Trust for America’s Health, the American Academy of Pediatrics, and the National Medical Association.

On behalf of the Delaware Nurses Association, member Sarah Bucic, attended the “50 States United for Clean Air” conference and lobby day May 2-4 in Washington, DC. Earth Justice coordinated with ANA, Physicians for Social Responsibility, the National Council of Churches, and Interfaith Power & Light to bring together 70 health professionals, faith

Sarah Bucic and Senator Boxer.

2011 DNA Fall Conference and membership meeting

October 28, 2011DTCC, Terry Campus-Dover

Agenda and Speakers subject to change

7:00-8:00 REGISTRATION & CONTINENTAL BREAKFAST

8:00-8:15 WELCOME & OVERVIEW OF THE DAY

8:15-9:15 Keynote: Board of Nursing

15 min Break Track A-Women’s Health Track B-Ethics/Legal Track C-Pharmacology (Rx)

9:30-10:30 Contraception Update (Rx) Genome Research Insulin Therapy

10:30-11:00 BREAK with VENDORS

11:00-12:00 Managing/Co morbidities of Child Abuse Meds that can be used in Menopause Identification and pregnant women/breast feeding Reporting women/need speaker

12:00-1:30 LUNCH & MEMBERSHIP MEETING

1:30-2:30 Pregnancy and Obesity Poverty impact on health Antibiotic Stewardship for Nurse in state of DE

2:30-2:45 BREAK

2:45-3:45 Support for patients- Legal Anticoagulation considerations for miscarriage/still birth the hospitalized patient

3:45-4:00 BREAK

4:00-5:00 Drug Addiction: Overcoming and Succeeding

5:00-5:15 EVALUATIONS AND CERTIFICATES

For updated information and to register, visit www.denurses.org.

50 States United for Clean Airleaders, community leaders, and affected citizens to ask Congress and the Administration to stand strong and defend the rights of communities from ongoing Congressional assaults on health-protective environmental standards (e.g. several non-climate standards, including the power plant air toxics rule, smog, particulate matter, coal ash, etc).

August, September, October 2011 DNA Reporter • Page 11

On Friday May 20th, 2011 over 10 pounds of mercury was collected at Christiana Hospital and Bayhealth Medical Center. The Delaware Nurses’ Association, the events’ main organizer, is planning future mercury collections. Other sponsors of the event were the Delaware Division of Public Health’s Healthy Homes Program, Christiana Care Health System, Bayhealth Medical Center and Precision AirConvey. Additional support was provided by the Delaware Academy of Medicine. For more information on mercury, to find out if you have a mercury thermometer, or what to do in case of a mercury spill visit www.DelawareHealthyHomes.org or call 1-800-464-HELP.

mercury Thermometers

ANA Urges Support for Home Health Care Legislation: Ensures Better Patient

Access to Care, Removes Barriers for Nurses as Qualified Providers

SILVER SPRING, MD–The American Nurses Association (ANA) is appealing

to lawmakers to support the “Home Health Care Planning Improvement Act of 2011” (H.R. 2267, S. 227). This bipartisan legislation, just introduced in the House by Reps. Allyson Schwartz (D-PA) and Greg Walden (R-OR), allows Advanced Practice Registered Nurses (APRNs) to sign home health plans of care and certify Medicare patients for the home health benefit.

“This legislation will help improve access to care,” said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. “APRNs are a vital source of care with the education and training to facilitate home health plans of care. In order to meet our nation’s health care needs, an integrated, national health care workforce that optimizes utilization of all qualified providers must be put into action.”

“We have a responsibility to provide America’s seniors with high quality health care, and a key part of that is ensuring they have access to timely home health care services,” Rep. Schwartz added. “These valued health care professionals play a central role in the delivery of primary care, particularly in medically underserved areas, and are essential to the coordination of team-based care.”

“This bill will reduce unnecessary and duplicative burdens on providers and seniors in need of home health services,” Rep. Walden said. “Particularly in rural areas like central, southern, and eastern Oregon where physicians are scarce, nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives are essential components of the health care delivery system. Not only are they serving on the front lines of primary care, but also in many areas they are the only option readily available.”

APRNs are playing an increasing role in American health care delivery. Medicare has recognized the autonomous practice of APRNs for nearly two decades, and these health care professionals now coordinate the majority of skilled care to home health patients. However, a quirk in Medicare law has kept APRNs from signing home health plans of care and from certifying Medicare patients for the home health benefit. These delays in access to home health services inconvenience patients and their families and can result in increased cost to the Medicare system when patients are unnecessarily left in more expensive institutional settings. The Home Health Care Planning Improvement Act would address these problems by specifically allowing APRNs and physician assistants to certify home health services. ANA thanks Representatives Schwartz and Walden for their leadership on H.R. 2267 and urges all members of the House to support APRNs and their home health patients by cosponsoring the Home Health Care Planning Improvement Act (H.R. 2267).

To learn more about ANA’s work on the home health care issue, including the Senate companion bill (S. 227) introduced by Senators Susan Collins (R-ME) and Kent Conrad (D-ND), please visit http://www.rnaction.org/homehealth.

Page 12 • DNA Reporter August, September, October 2011

Karen C. Andrea, MS, RN, BC

Karen Andrea, MS, RN, BC is currently the Continuing Education Coordinator for the Delaware Nurses Association (DNA). She is a graduate of Johns Hopkins University, the University of San Francisco and the University of California, San Francisco. She is certified in Nursing Professional Development. Her career includes OB/GYN, supervision, critical care, nursing faculty and staff development. She recently retired from the Department of Veterans Affairs after a 23 year career as an Education Specialist. One of her responsibilities was managing the Provider Unit for nursing continuing education. She helped launch and is a past President of the national VA Educators Organization. She has long served as a member and is a past Co-Chair of the Continuing Education Committee of DNA. She can be contacted at DNA at karen@denurses.org. In addition to her position at DNA, she is a Fitness Instructor and a Life Coach specializing in career, health and lifestyle issues for nurses. Contact her at coachkarenandrea@aol.com with any coaching questions.

This is the second module in the self-study series on planning continuing nursing education (CNE). The American Nurses Credentialing Center provides the standards and structure for planning high quality education. There are distinct components to the application for CNE. This module highlights the Activity Outline Planning document. There are two types of CNE activities available–“Provider Directed” and “Learner Paced”. Since the Activity Outline Planning document to be used for each type of CNE is different, each will be explained separately. Goal or Purpose of this module: • Toexplainthecontentrequiredfortheparts of the CNE Activity Outline Planning documentObjectives: • CompareandcontrastaProviderDirected and a Learner Paced Activity Outline Planning document. • Distinguishthedifferencesbetweenan objective and an outline of content. • Givenaneducationalobjective,identifyat least two appropriate teaching methods.

Getting StartedPlanning starts with determining the desired

outcome. What exactly should the activity achieve? The answer leads to the goals (or purposes), and one or more behavioral objectives. Part I of the CNE series (DNA Reporter, 36:1, February, March, April 2011) explains this step in detail; therefore to begin Part II, use completed goals and objectives.

Planning a Provider Directed Educational Activity

A Provider Directed educational activity is one in which the provider controls all aspects of the activity. The provider does all the planning and documenting. Some examples of Provider Directed Activities include lecture, guided discussion, or seminar. The learning activity may be designed as a “live” format, or planned as a pre-recorded instruction based experience. The Activity Outline Planning form has five columns which require objective(s), content, time frame(s), presenter(s) and teaching method(s). Explanations of each column follow after the sample form below.

Continuing Nursing Education SeriesPart II: Outline Planning Document for Continuing Nursing Education

PROVIDER DIRECTED ACTIVITY

OBJECTIVES CONTENT TIME PRESENTER METHODS FRAME

List objectives in Provide an outline of the State the List the Describe thebehavioral terms content for each objective. time frame faculty for teaching methods, It must be more than a for each each objective strategies, restatement of the objective objective materials & resources for each objective

Part II continued on page 13

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Sample Provider Directed Activity

Title: How Does Generation and Personality Affect the Healthcare Workplace?

OBJECTIVES CONTENT TIME PRESENTER METHODS FRAME

List objectives in Provide an outline of the State the List the faculty Describe thebehavioral terms content for each objective. time frame for each teaching methods, It must be more than a for each objective strategies, restatement of the objective objective materials & resources for each objective

1. Explore sources of I. Generations 15 minutes Karen Andrea PowerPoint, conflict between A. Veterans (entire discussion, chart generations in the B. Baby boomers presentation) handout workplace. C. Generation “X” D. Generation “Y” (Nexters) E. Sources of conflict

2. Given several II. Personality models 15 minutes PowerPoint, personality A. Big “5” discussion models, apply the B. Myers Briggs questions models to sample C. A, B, C, D personality workplace issues. types D. 360 degree assessment E. What to do with models

3. Using generational III. Improving the (healthcare) 25 minutes Case studies, and personality workplace group problem models, develop A. Mini case studies solving, discussion strategies to B. Strategies using both improve workplace models harmony and C. Questions and answers efficiency IV. Evaluation 5 minutes Paper/pencil activity

Part II continued on page 14

Part II continued from page 12

Objectives ColumnList the learner’s objectives in behavioral terms.

Objectives must be appropriate for the learner, a logical outcome of the purpose or goal of the learning activity, and observable or measurable. The objectives should measure the desired outcomes of the activity. Once the objectives are determined, they are usually listed in the order that they occur in the activity. Space each objective so that the content (in the second column) and all the remaining columns are clearly linked with the appropriate objective.

Content ColumnProvide an outline of the content for each

objective. It must be more than a restatement of the objective. After determining the objectives, the major points, subtopics or blocks of content need to be identified for each objective. Here is a sample objective for the first column:

Explore sources of conflict between generations in the workplace.

The second column lists the major concepts or topics to be included for this objective. There are two methods that can be used. An often preferred method is outlining of the topic with additional subtopics and sub-subtopics (if needed). It is usually organized with Roman Numerals, letters and simple numbers as follows: I. Generations A. Veterans B. Baby boomers C. Generation “X” D. Generation “Y” (Nexters) E. Sources of conflict

Arranging the content in outline form helps to organize ideas, presents content in a logical form and shows the relationship between ideas or concepts.

Another method for outline organization provides the main topic followed by brief bullet points such as the following:Generations • Veterans • BabyBoomers • Generation“X” • Generation“Y”(Nexters) • Sourcesofconflict

There are several more aspects to keep in mind for the content column. The outlined central topics listed must be aligned with (or opposite to) the

corresponding objective. If the activity will be a live or taped presentation, the brief outline will guide the presenter in developing comprehensive lecture notes or learning activities. In other words, the outline does not have to be exhaustive, but rather a sort of snapshot of the main points of the stated objective. Since it is part of the learning experience, evaluation time should also be listed in the content column. An objective for the evaluation portion of the activity is not necessary. Note the evaluation part listed on the completed sample form at the end of this discussion.

Time Frame and Faculty/Presenter ColumnsThe third column documents the number of

minutes needed to complete each objective. With attention to spacing, place the number of minutes at the same level as the objective statement. Adding the word “minutes” provides clarity for the time frame. In order to avoid confusion, use the same time units of measurement for each objective.

The presenter (or faculty) is listed for each objective. If the same faculty will present the entire activity, list the name once and clarify that s/he is responsible for the program or all objectives. Listing academic credentials or title is optional.

Teaching Methods ColumnThis column lists the teaching methods to be

employed with (and opposite) each objective. The learning activities planned must be consistent with the expected outcome stated in each objective. For example, if the objective requires mastery of a psychomotor skill, then the learning methods should include practice, demonstration and/or return demonstration of the skill. If the objective asks the learner to apply concepts to a complex clinical situation, then a simulation or case study would be appropriate. If there are a variety of different teaching techniques being used during the activity, list the techniques opposite each objective. Here is a sample list of teaching/learning methods:

Cognitive: lecture, discussion, panel discussion, guided or facilitated discussion, brainstorming, storytelling, case study*, questions and answers

Psychomotor: demonstration, return demonstration, skill practice*, simulation, role play, game, scavenger hunt, individual* or group activity/assignment

Techniques using materials*: paper/pencil exercise, handout, worksheet, quiz, test, examination, list of references

Audiovisuals: PowerPoint*, slides*, poster*, video*, webinar, audio conference

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Page 14 • DNA Reporter August, September, October 2011

Part I: Goals and Objectives for Continuing Nursing Education

OBJECTIVES CONTENT (Topics) METHODS

List learner’s objectives in Provide an outline of the Describe the teaching methods,behavioral terms content for each objective. It strategies, materials & resources must be more than a for each objective. restatement of the objective.

Distinguish between goals and I. Contrast goals & objectives Read/study article in DNAobjectives when planning an A. Definitions of terms Reportereducation activity B. Outcomes desired C. Attributes of goals D. Attributes of objectives E. ABCD method

Apply domains of learning and II. Domains & taxonomy Read/study article in DNAtaxonomy to sample objectives A. Three domains Reporter B. Bloom’s taxonomy C. Application to examples

Analyze sample objectives for a III. Application of principles Read/study article in DNAmeasurable verb, condition, and A. Mager’s method for Reportercriterion of acceptable performance objectives B. SMART application C. Guided practice

IV. Evaluation Paper/pencil exercises (quiz, A. Self-graded posttest evaluation form) B. Evaluation of module

ConclusionThe Activity Outline Planning document provides

a detailed structure for each of the two types of continuing nursing education. Depending on the type of activity selected, the document will utilize either three or five columns. The more traditional Provider Directed Activity uses the five column form. A Learner Paced Activity uses three columns (which is more suited to a self study format). The outline and teaching strategies are clearly documented with each objective. Regardless of the type of activity, the teaching strategies are congruent with the desired outcome(s) of each objective. When laid out

Part II continued from page 13

according to ANCC standards, the document helps to demonstrate the quality of any continuing nursing education activity.

ReferencesAmerican Nurses Credentialing Center (ANCC). (2009).

Application Manual Accreditation Manual. Silver Spring, MD: American Nurses Credentialing Center.

DNA Continuing Education Committee. (2009). Provider Directed Manual and Learner Paced Manual. Wilmington, DE: Delaware Nurses Association.

Tardiff, E., & Brizee, A. (2010, April 17). Why and How to Create a Useful Outline. Retrieved from http://owl.english.purdue.edu/owl/resource/544/02/

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Here is a sample Learner Paced activity:

Planning a Learner Paced Educational ActivityA Learner Paced activity is one where the time used for learning or completion is determined by the learner.

This type of education was formerly known as Independent Study. Although the activity has been planned, the learner decides when, where and how much to do. For example, the learner might take the materials on a trip and do several portions of the content over a period of time. When the learner has completed the activity, s/he submits the required documents. After the completed documents are evaluated, the learner receives continuing education.

The Activity Outline Planning document has three columns which require objective(s), content, and learning method(s). Here is a sample form:

LEARNER PACED (INDEPENDENT STUDY) ACTIVITY

OBJECTIVES CONTENT (Topics) METHODS

List learner’s objectives in Provide an outline of the Describe the teaching methods,behavioral terms content for each objective. It strategies, materials & resources must be more than a for each objective. restatement of the objective.

Objectives and Content ColumnsThe objectives and content are completed

in a similar manner as those for a Provider Directed activity. The learning outcomes guide the development of the objectives and content. A completed sample form is provided after the next section.

Teaching Methods ColumnTeaching methods for a Learner Paced activity

may vary from those used for Provider Directed

activities. Any of the teaching methods listed with an asterisk (*) in the Provider Directed section may be appropriate for a Learner Paced activity. The learner must either have the content in hand or be able to readily access it. An example of an activity might be reading a journal article on nursing research, analyzing it using a tool, and completing an evaluation. The teaching methods could be stated as follows: read assigned materials, complete research tool, submit evaluation form.

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August, September, October 2011 DNA Reporter • Page 15

Data Bits

Dot Baker

Dot Baker, RN, MS(N), CNS-BC, EdDProfessor, College of Health Professions–

Nursing, Wilmington University

This column about special populations looks different than the usual Data Bits columns. I decided that I could not possibly address all of the numerous special populat ions of cl ients, fam i l ies, commun it ies, nurses, caregivers, interests, etc. So, I decided to find some poems and books of poems that voice nurses as special people who serve members of ALL populations.

Poem of Tribute to Rebecca Rebecca was an LPN that responded to the

Oklahoma City Bombing and courageously gave of herself to help the injured. While she was inside the Federal building caring for the sick, she was struck by a piece of concrete debris from a falling wall. The incident ultimately led to her death (five days later).

This tribute is to pay honor to her memory and valiant act. It is with great pride and a heartfelt sadness I add this nursing tribute to my “Angel of Mercy” collection. © copyrighted 1995 “Angel of Mercy Collection” by E. V. Stankowski, RN

Reprinted with permission from E. V. Stankowsi (5/30/11) “A Smile”

A Smile costs nothing, but gives much.

It enriches those who receive, without making poorer those who give.

It takes but a moment, but the memory of it sometimes lasts forever.

None is so rich or mighty that he can get along without it, and none is so poor, but

that he can be made rich by it.

A Smile creates happiness in the home, fosters good will in business, and is the

countersign of friendship.

It brings rest to the weary, cheer to the discouraged, sunshine to the sad, and it is

nature’s best antidote for trouble.

Yet it cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone, until it is given away.

Some people are too tired to give you a smile;

Give them one of yours, as none needs a smile so much as he who has no more to

give.

~Unknown Author

In the scope of this great earthYou are more than just a nameYou’re an Angel without wingsWon the Golden Heart of Fame

See the Golden Heart of FameIs no easy task to reach

It’s an honor in God’s homeAll the Angels do beseech

And the Angels stand in aweAt the risk that you did takeYou were willing to risk all

For the lives that were at stake

It’s a given fact you knowHow a nursing heart does act

It’s a quality innateSelflessly they do react

And this was the beauty seenIn Rebecca’s heart that dayNever once did she look backAs she saw the victims lay

As a tribute to her lifeThere’s a special gift aboveThat the Angels all admireFor her precious act of love

It’s a heart made of pure goldOn a stand that’s crystal clear

With a radiance so keenEvery night it does appear

If at night we look aboveThere’s a shine we all will seeDon’t mistake it for the stars

It’s Rebecca’s Gift We See.

“The Nurse’s Prayer”

Be me in the world.Be my voice to the deaf.Be my faith where there is doubt.Be my hope where there is despair.Be my light where there is darkness.Be my joy where there is sadness.Be me in the world.

Be my eyes to the blind.Be my consolation to those who need to be consoled.Be my understanding to those who need to be understood.Be my healing to those who need to healed.Be my love to those who need love.Be my forgiveness to those who need to be forgiven.Be my death to those who need me.Be me in the world.

~Unknown Author

Books of Poems about NursesThe Poetry of Nursing: Poems and Commentaries of

Leading Nurse-Poets by Judy Schaefer–Editor Civil War Hospital Sketches by Louisa May Alcott–

Author Between the Heartbeats: Poetry and Prose by

Nurses by Cortney Davis & Judy Schaefer–Editors The Heart’s Truth: Essays on the Art of Nursing by

Cortney Davis–Author Cortney Davis (Author) The History of Nursing Poetry by Ann Webster

Professional Publication about Poetry in NursingPoetry as an aesthetic expression for nursing: A

review by Lauren P. Hunte, MS, PhD(c), CNM in the Journal of Advanced Nursing (2002)

ANA Applauds the Release of Environmental

Safety ReportSILVER SPRING, MD–The American Nurses

Association (ANA) commends the U.S. Department of Health and Human Services (HHS) on the release of the 12th Report on Carcinogens (ROC). The ROC is a congressionally mandated science-based, public health document that identifies agents, substances mixtures, and exposure circumstances that are known or reasonably anticipated to cause cancer in humans. This year, the report added the chemicals styrene and formaldehyde to the list of possible carcinogens.

The report’s release has come after years of delays prompted by critics, including the chemical industry, who claim the studies used to establish the link to cancer are not based on science. In a letter to HHS Secretary Kathleen Sebelius, ANA, along with its coalition partners in Safer Chemicals, Healthy Families, thanked the administration for its efforts, and advocated for greater public health protections from exposures to chemicals.

Registered nurses, who comprise the nation’s largest group of health care professionals, have a crucial role in assessing and addressing environmental health issues and their impact on the public’s health. ANA has been a leader and advocate for public policy that preserves and improves environmental protections vital to a healthy and productive society. To learn more about ANA’s efforts, please visit ANA’s Environmental Health website.

ANA Supports Bill to Improve Health Care Access

for medicaid PatientsSILVER SPRING, MD–The American Nurses

Association (ANA) is urging support for the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (H.R. 2134/S. 56), which would promote greater access to quality primary health care for lower-income individuals, especially in provider shortage areas, by recognizing advanced practice registered nurses (APRNs) and physician assistants as qualified providers.

H.R. 2134/S. 56 would remove legal barriers that restrict APRNs from participating in the fee- for-service Medicaid program, requiring states to acknowledge APRNs as primary care case managers, and Medicaid managed care plans to include the services of APRNs. Currently, it is optional for states to recognize APRNs as case managers, and for APRNs to be included in the roster of providers by Medicaid managed care plans.

“APRNs increase patients’ access to primary and preventive health care, and as a result, the number of hospital admissions and emergency care visits decrease,” said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. “By including the provisions of this act in Medicaid reform, Congress would ensure that Medicaid patients receive care in a timely and cost-effective manner, and they would help ease the shortage of health care professionals that rural and other underserved areas struggle with–while also guaranteeing that APRNs receive adequate reimbursement for the high-quality patient care they provide.”

ANA has written to House and Senate members urging support of H.R. 2134/S. 56. Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists have been disadvantaged by changes to Medicaid which have created obstacles to their participation in the program. These providers perform many of the same essential health care services as physicians. ANA strongly believes that this legislation will increase access to essential health care services while helping to control Medicaid spending.

“We must do everything we can to expand the availability of quality medical care,” said U.S. Rep. John Olver (D-MA), the bill’s House sponsor. “This bill proposes to do just that. State Medicaid agencies choosing not to reimburse for the services of nurse practitioners and physician assistants just doesn’t make sense. In areas with a shortage of physicians, such as rural and inner city communities, these medical professionals should be able to provide the quality health care that would otherwise be difficult for Medicaid beneficiaries to access.” Sen. Daniel Inouye (D-HI) is the sponsor of the Senate companion bill, S. 56.

For information on developments related to Medicaid, visit ANA’s Medicaid website, www.rnaction.org/medicaid.

Page 16 • DNA Reporter August, September, October 2011

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