Embed Size (px)
Citation preview
current resident or
Non-Profit Org.U.S. Postage Paid
Princeton, MNPermit No. 14
INSI
DE
Surgical Smoke is No Joke! Let’s Clear the Air! . . . . . . . . . . . . . . . . . 2
President's Message . . . . . . . . . . . . . . . 3
AzNA/AzNF Calendar of Events . . . . . . 4
Congratulations . . . . . . . . . . . . . . . . . . 4
AzNA PAC Preparing for 2020 Elections Amid COVID-19 Pandemic . . . . 5
A Mother’s Love . . . . . . . . . . . . . . . . . . 5
Nurse Midwives . . . . . . . . . . . . . . . . 6-7
An Arizona Nurse’s Unique History . . . . . 8
Welcome New & Returning Members . . . 9
AzNA’s Superstars . . . . . . . . . . . . . . . 10
Two Year Anniversary Members . . . . . . 10
Research . . . . . . . . . . . . . . . . . . . . 11-14
Can Mindful Meditation Alleviate Burnout . . . . . . . . . . . . . . . . . 15
Resilient Nurses: Resilient Systems . . . . . 15
Quarterly Publication distributed to over 58,000 Registered Nurses in ArizonaVol. 73 • Number 2APRIL 2020
One Profession. Many Roles.
Arizona NurseWe’re Working for You! JOIN US TODAY
Brought to you by the Members of AzNA . For more information on the benefits of membership, please visit www .aznurse .org .
The Official Publication of the Arizona Foundation for the Future of Nursing
Do you have a nurse pride license plate you want to share? Send it to [email protected]. You might be on our next front page!
Charlie C. is an RN, CCRN and hopes you like the plate. Charlie celebrates certification all year with this plate.
Donna H. is proud to display on her tag that she is a nurse in the great state of Arizona.
Greg S. got this plate for his wife for her RN graduation 15 years ago. Every time she sees Az Nurse, she comments on how she should
send in a picture. Greg sent in Shelly’s plate to hopefully surprise her again after all her years
of being a fantastic nurse.
Arizona’s state school nursing programs create proud nurses with unique stories.
NURSE PRIDEDear dedicated and brave nursing professionals:
We are reaching out on behalf of the Arizona Nurses Association (AzNA) to let you know we are thinking about you, support you, and stand with you during this exceptionally challenging time.
The world is experiencing a historic public health crisis and nurses are stepping forward to do what they do best: care for patients and save lives. Many will never fully comprehend the level of hard work, selflessness, and sacrifice it takes to do what you do on a daily basis – let alone during a global pandemic. While none of us are in this for glory and attention, it is clear more Americans and Arizonans are recognizing every day that nurses like you are the beating heart of our healthcare system.
Our message to you is simple: keep doing what you do every day while being vigilant about your own health and safety. Your patients will always come first, but their health and well-being ultimately depends on yours. Take care of yourselves. Stay as well-rested as possible. Wash your hands a little bit longer. Eat healthier. Of course, follow all state and federal guidelines when caring for potential and confirmed COVID-19 patients.
As we all know, the PPE situation is problematic. Though there is a massive public-private effort underway to secure additional protective equipment, the Arizona Department of Health Services acknowledges the “current expectations for re-supply are low.” AzNA will continue to advocate for appropriate PPE usage guidelines so that Arizona nurses are able to do their jobs safely and effectively.
Thank you for all you do – and for making us proud.
Stay well,
Selina Bliss, RNPresident Arizona Nurses Association
Robin Schaeffer, RNExecutive Director Arizona Nurses Association
Page 2 • Arizona Nurse April, May, June 2020
Chair: Rhonda Anderson, DNSc, RN, FAAN, FACHE
Vice Chair: Pat Mews, MHA, RN, CNOR
Treasurer: Melissa Huckins
Secretary: Chloe Littzen, BSN, RN
Scholarship Chair: Sharon Rayman, MS, RN, CCTC, CPTC
Elected Trustee: Carol Stevens, PhD, RN
Elected Trustee: Kimberly Behrens-Grieser
Elected Trustee: Jeff Cox
Elected Trustee: Phillip Guarrera
Executive Director: Robin Schaeffer, MSN, RN, CAE
Board of DirectorsPresident:
Selina Bliss, PhD, RN, CNE, RN-BCVice President:
Heidi Sanborn, DNP, RN, CNESecretary:
Amanda Foster, BSN, RNTreasurer:
Beth Hale, PhD, RNGovernment Affairs Officer:
Denice Gibson, DNP, RN, CRNI, BMTCN, AOCNSDirector-At-Large:
Janice Bovee, MSN, CNMDirector-At-Large:
Jason Bradley, PhD(c), MSEd, RN, CCRN-K, LPCPast President:
Carol J. Stevens, PhD, RNStaff
Robin Schaeffer, MSN, RN, CAE, Executive Director
Debby Wood, Office ManagerWendy Knefelkamp, Communications Manager
Debbie Blanchard, Administrative Assistant
The Arizona Nurse (ISSN 0004-1599) is the official publication of the Arizona Foundation for the Future of Nursing (AzFFN), peer reviewed and indexed in Cumulative Index for Nursing and Allied Health Literature. Arizona Nurse Author Guidelines are available at www.aznurse.org. Call 480.831.0404 or [email protected] for more information.
No material in the newsletter may be reproduced without written permission from the Executive Director. Subscription price: included in AzNA membership or $30 per year. The purpose of the Arizona Nurse is to communicate with AzNA members and non-members in order to 1) advance and promote professional nursing in Arizona, 2) disseminate information and encourage input and feedback on relevant nursing issues, 3) stimulate interest and participation in AzNA and 4) share information about AzNA activities.
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, [email protected]. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Advertisements do not imply endorsement nor approval by the Arizona Foundation for the Future of Nursing (AzFFN) of the product advertised, the advertisers or the claims made. AzFFN shall not be held liable for any consequences resulting from the purchase or use of advertised projects. AzFFN, AzNA and Arthur L. Davis Publishing Agency, Inc. reserve the right to reject advertisements. Rejection of an advertisement does not imply that the offering or product for advertisement is without merit, lacks integrity, or that this association disapproves of the offering or product.
The Arizona Nurses Association is a constituent member of the American Nurses Association.
Arizona Nurse Editorial Board
Alicia Shields, MSN, RN, CENP (Chair)Kimberly A. Callahan, MS, APRN, FNP-C
Anna Hustin, MSN, RN, NE-BCMelisa Salmon, RN, MSN, MBA, CCRN
Sherry Ray, Ed.D., MSN, RN | Melissa Zuber, BSN, RN
The editorial board of the Arizona nurses is comprised of members of the Arizona Nurses Association, who review all submissions, provide expert advice on content, attract new authors, and encourage submissions.
If you are interested in serving on the editorial board, please contact [email protected] for more information.
Surgical Smoke is No Joke!Let’s Clear the Air!
Tamara Uhler, RN and Alana Schmitt, RN
Would you smoke in the operating room? Of course not! Yet, every day up to 500,000 health care providers are exposed to surgical smoke, which is equivalent to smoking up to 27-30 cigarettes a day (Ball, 2012). Chronic exposure to surgical smoke can lead to an increased risk of respiratory illnesses, Parkinson’s disease, Alzheimer’s, collagen and cardiac disease, and lung, breast, and prostate cancers (Schultz, 2014).
Surgical smoke, or smoke plume, is a by-product of the electrocautery devices and lasers used in surgical procedures and cesarean sections. Surgical smoke contains harmful chemical compounds, such as benzene and formaldehyde, which are known to be strong carcinogens (York, 2018). Smoke evacuation systems are effective in limiting exposure to surgical smoke, but they have not been routinely used in the OR. While professional organizations have been aware of this issue, little has been done to mandate the use of smoke evacuation equipment (Dobbie, 2017).
As an experienced OR nurse, I became passionate about the health and safety of patients and staff exposed to surgical smoke. I accepted an opportunity to participate in an EBP/research fellowship program offered by Banner Health. I began with the PICO question, P-In the operating room, I – does staff education about the dangers of inhaling surgical smoke, C- as compared to current awareness, O-impact the staff’s willingness to use smoke evacuation equipment?
Through a literature review and talking with my peers, I identified several barriers within the clinical setting that could prevent the implementation of a smoke-free program: lack of information and education regarding the hazards of surgical smoke, physician and team members’ resistance to change, and the higher cost associated with smoke evacuation equipment.
I began by gathering a team who were also passionate about smoke evacuation. I found an influential surgeon and team members who were willing to help facilitate change. We worked with our supply vendors to choose a device that would be easy to use and was similar to the electrocautery device we were already using.
At a department staff meeting, we administered a pre-test to assess the OR staff’s knowledge about the dangers of smoke in the OR. We were surprised to discover that most of our staff were not aware of the dangers of surgical smoke. We scheduled an educational session about the dangers of inhaling surgical smoke, which included the opportunity to
examine the smoke evacuation equipment. After the session, we administered a post-test to measure the retention of this new information.
We also wanted to measure how often smoke evacuation equipment was used in the OR. We completed a two-week chart audit and discovered that the equipment was only used in 12.5% of the cases.
To raise awareness, we distributed pens with our slogan “Surgical Smoke is No Joke. Let’s Clear the Air.” We placed posters on the walls throughout the perioperative area describing the dangers of surgical smoke and the chemicals contained in the smoke. Many of our surgeons were resistant to trying the new devices, but we persisted in trying to change practice.
Our data showed that by increasing awareness of the dangers of inhaling surgical smoke, we observed an increase in the use of smoke evacuation equipment. The pre and post-test scores increased from 67% to 87%. Chart audits revealed the use of smoke evacuation equipment increased from 12.5% to 41% after implementation.
One unanticipated barrier that we encountered was a temporary decrease in the availability of the products. The surgeons became frustrated when the equipment was not available and had to be reminded to use it once it was available again. We began posting the names of the surgeons who were using the smoke evacuation equipment, which helped drive participation.
Maintaining a smoke-free environment is a challenge. The surgeons and OR staff must be committed to providing a healthy environment for our staff and patients. Banner Health has now created a system task force to implement smoke evacuation equipment in all its facilities. Becoming a smoke-free environment is a possibility, it just takes hard work and a passion to drive change.
Tamara Uhler MSN-L, RN and Alana Schmitt MHA, BSN, NEA-BC, RNC-OB
References:Ball, K. (2012). Compliance with surgical smoke
evacuation guidelines: implications for practice. ORNAC Journal 30(1), 14-15.
Dobbie, M., Fezza, M., Kent, M., Lu, J., Saraceni, M., Titone, S. (2017). Operation clean air: implementing a surgical smoke evacuation program. AORN 106(6), 503-504. https//doi.org/10.1016/j.aorn.2017.09.011
Schultz, L. (2014). An analysis of surgical smoke plume components, capture, and evacuation. AORN 99(2), 289-290, http://dx.doi.org/10.1016/j.aorn.2013.07.020
York, K., Autry, M. (2018). Surgical smoke: putting the pieces together to become smoke-free. AORN 107(6), 693-694. http://doi.org/10.1002/aorn.12149
Call for Article SubmissionSubmit your article or research for publication in AzNA’s quarterly print publication.
The Arizona Nurse is mailed to all 89,000+ RNs in the state.
AzNA welcomes submission of nursing and health related news items and original articles. We encourage short summaries and brief abstracts for research or scholarly contributions with an emphasis on application.
To promote inclusion of submitted articles, please review the article guidelines available on the AzNA website at www.aznurse.org/Guidelines.
An “article for reprint” may be considered if accompanied by written permission from the author and/or publisher as needed. Authors do not need to be AzNA members.
Submission of articles constitutes agreement to allow changes made by editorial staff and publishers. See article guidelines for more information.
Submit your article to [email protected].
April, May, June 2020 Arizona Nurse • Page 3
PRESIDENT’S MESSAGE
What’s the Catch?The other day, I was
chatting with one of the nurses in the medical-surgical unit at our local hospital and asked her what she thought about AzNA offering the Success Pays Program for Arizona nurses. I was referring to my President’s Message from the October 2019 edition of the Arizona Nurse where we rolled out information on the Success Pays Program. Her response was that when she read about this program she thought it was too good to be true and wondered what the catch was?
This conversation made me realize in our day-to-day world, when so much is thrown at us, sometimes important opportunities can slip by.
Simply put, the Success Pays Program is a no-risk opportunity to earn a certification in the specialty of your choosing from the American Nurses Credentialing Center (ANCC). You can take the exam twice and only pay if you pass. As a bonus, to kick off the program in Arizona, the Sasmor Foundation is covering the cost for the first ten applicants who pass in 2020 and each year after. For those of you already certified by the ANCC, you can renew your certification for a reduced rate.
Go to the AzNA website and click on Membership to see the link for information on the Success Pays Program.
Now that we are a couple of months into the year 2020, I am happy to report that 11 nurses have taken advantage of this program. Of the 11 nurses, six Arizona nurses have earned initial certification and to date, none have renewed their certifications through the Success Pays Program.
We just celebrated National Certified Nurses Day which is observed every March 19th. This day of recognition provides an opportunity for employers, certification boards, education facilities, and healthcare providers to celebrate and publicly acknowledge nurses who earn and maintain the highest credentials in their specialty. While our RN license allows us to practice, certifications affirm advanced knowledge, skill, and abilities to meet the challenges of nursing. I urge you to take advantage of this opportunity from AzNA to advance your nursing career by choosing certification. Then next year you can enjoy National Certified Nurses Day which honors and recognizes nurses and their significant achievements in the profession.
Personally, I was inspired to earn the Medical-Surgical Certification (RN-BC) by another nurse on our unit who had taken and passed the exam and proudly wore the initials of her certification on her name badge. Perhaps you will unknowingly inspire another nurse to achieve certification. Make it a priority in 2020 to take the next step in your career and get certified. The catch is you advance your career while promoting positive patient outcomes. It is a win-win situation for you, your employer, and the patients you care for!
Until next time,
Selina Bliss, Ph.D., RN, CNE, RN-BC, ANEF
Selina Bliss, RN
AzNA Board of Directors Meeting Highlights - April 2020
The AzNA Board of Directors meets monthly. The following are highlights from the January and February 2020 meetings.
• Planning Committee, Bylaws Committee, and Nominations Elections Committees will convene over the next 3-6 months
• Update on Citizens Initiate for 2020 ballot proposition during Arizona November Elections. AzNA to work with Arizona’s healthcare organizations.
• Approved statement of concern regarding LaJuana Gillette, public member, Arizona State Board of Nursing
• Approved Uniform Chapter bylaws for submission to AzNA Chapters.
• AzNA’s planned events for Nurses Week and Year of the Nurse to include highlights of AzNA members and nurses throughout Arizona history.
For a complete copy of the approved minutes, please contact [email protected] or call 480-831-0404. YAVAPAI COLLEGE
invites applications for the position of: Associate Professor, Nursing
HIRING FOR 2 POSITIONS ONE AT THE VERDE VALLEY CAMPUS AND
ONE AT THE PRESCOTT CAMPUS
To see the full job description and qualifications, please see our job posting on nursingALD.com.
YC is an equal opportunity employer.
For more information and to apply: www.yc.edu/hr
Click on Current Job Opportunities928-776-2217
Page 4 • Arizona Nurse April, May, June 2020
Saturday, July 25 - Sunday, July 2632nd Annual Southwestern Regional Nurse Practitioner SymposiumLocation: Chandler
Friday, August 21, 2020Annual NAHN Phoenix Chapter ConferenceLocation: Phoenix
May 28, 2020 & June 4, 2020CCRN/PCCN Certification Review Course (Presented by the Greater Phoenix Area Chapter of the AACN) Location: Phoenix Friday, October 2, 2020AzNA Annual Membership MeetingLocation: Phoenix
Registration and event information can be found at www.aznurse.org/events
AzNA/AzNF Calendar of Events
Congratulations to the following nurses who have taken advantage of the Success Pays offering by ANCC to AzNA Members!• Elizabeth Garrison, RN-BC; certified Nursing Professional Development
• Melania Kamler Flores, RN-BC; certified Nurse Executive
• Lori Williams, RN-BC; certified Informatics Nurse
• Lisa A. Palucci, RN-BC; certified Nurse Executive
• Robert William Adams, RN-BC; certified National Healthcare Disaster
• Terry Watson, RN-BC; certified Adult-Gerontology Acute Care Nurse Practitioner
aznurse.org/SuccessPays
AzNA partners with the American Nurses Credentialing Center (ANCC) using the Success Pays Program to support professional development of nurses, increase the number of certified nurses in the workforce, decrease test-taking anxiety and reduce financial burden for our members.
Take the exam up to two times and pay the reduced rate of $260 only if they pass the exam.
Save time, money and anxiety.
Certifications with ANCC can also be renewed through AzNA at a reduced price of $250.
Success Pays is offered to all AzNA Members. Not a member? Join today aznurse.org/JoinToday
April, May, June 2020 Arizona Nurse • Page 5
Open Positions Available for
Leadership – Call for Nominations
AzNA’s Board members oversee the direction of the association, take responsibility for specific projects and teams, recruit new members, ensure a balanced budget, and represent AzNA members at the American Nurses Association. AzNA’s Board of Directors is an active board that makes a difference in our profession.
Board members have been elected annually for two-year terms. A recent bylaws change requires that board positions are elected in a staggered fashion. Job descriptions and additional information are posted at www.aznurse.org/page/2020Election.
If you wish to run for one of the AzNA Board of Directors, please submit a bio consent to serve form, available at www.aznurse.org/page/2020Election. Deadline for submission is August 3, 2020.
The committee is seeking nominations for the following:
Officer Positions Two Year Term:
Vice President
Treasurer
Director at Large
AzNA leadership positions provide opportunities for career advancement as well as being professionally and personally rewarding. Volunteer to take a seat at the table.
Nominations Committee: Debbie Dyjak (Chair), Roni Collazo, John Risi, Kathy Wruk, & Board liaison, Heidi Sanborn.
AzNA PAC Preparing for 2020 Elections Amid COVID-19 Pandemic
As our community is feeling the effects of the COVID-19 virus outbreak, it is a time when nurses and frontline health providers are tasked the greatest. Yet, as in any crisis, nurses continue to step up and provide the leadership and expertise that we need to get through these difficult times. It is during these times, that we often look to government to make honest and rational decisions (nurses call these “evidence-based” decisions) that can help us manage and mitigate the effects of the COVID-19 pandemic.
Never before have the stakes been higher. That is why it is critical to have nursing represented in our state legislature! This fall, two Arizona Registered Nurses are running for office:
• LD 1 – Selina Bliss, RN https://sites.google.com/view/SelinaSBliss-
com• LD 6 – Felicia French, RN https://www.frenchforaz.com/
The AzNA PAC is proud to early endorse these two candidates and asks for your help in getting them elected. Here’s what you can do:
• Vote Make sure you know the dates for the primary
election (August 4, 2020) and the general election (November 3, 2020). Put them on your calendar and tell your friends and family!
• Support the nurse candidates’ campaigns no matter where you live!
Both candidates live in Districts representing Northern Arizona, but that doesn’t matter; all nurses across the state can be involved in their campaigns. Check out their websites to sign up and volunteer. Volunteer activities may include making phone calls, virtual canvassing, sending texts, sharing posts on social media, putting up yard signs) and donating to their campaigns. The candidates are waiting to hear from you!
• Contribute to the AzNA PAC Donating to the PAC is critical to supporting
the efforts to get AzNA PAC endorsed candidates elected to state offices. You all know elections cost money, and the AzNA PAC money goes toward endorsed candidates (including the two nurse candidates) and education/communication about the election process. Consider a one-time or NEW THIS YEAR - a recurring donation that helps to maintain a consistent infusion of funds so that the PAC can make a real difference in Arizona’s elected officials. To donate go to: aznurse.org/PACdonate
The purpose of the AzNA PAC is to endorse candidates for the Arizona Legislature based upon the principles of the AzNA Public Policy Agenda.
PAC Chair - Colleen Hallberg, MSN, RN([email protected])
Angela C. Brittain, RN
My mother died from cancer when I was 9 years old. I was so impacted by the nurses who provided her care and knew that this was my purpose. I have been a nurse for 22 years and will graduate in August with a Ph.D. I wish to transform healthcare through teaching/mentoring the next generation of nurses and advocating for environments that help them nurse well. Although my journey has not been an easy one, it has been joyful as I get to do what I truly love.
A mother’s love and affection pervade the expanse of time,Reaching across the waters that separate the living from those now gone.Her legacy persisting in the hearts of those whom she loved,Giving birth to a vision of what might yet be.
A daughter dismayed upon learning her mother’s plight.For cancer, a dreaded foe had staked its claim on the one she loved.Ever faithful and strong, her mother valiantly fought.But the strength of a vile enemy quickly stole bits of her away.
Treasured nurses rendered care to this beloved mother,Giving full care, love, compassion, and skill.While the daughter watched with wondering eyes and open heart,Filled with knowing that she too would someday give such care.
Now betwixt times past and present, though one’s spirit has taken flight,A mother’s love intertwined with nurses’ devotionHas made the way for a once young dreamer’s vision.For she is now too, a nurse valiant and strong Paying forward the everlasting care, love, compassion, and skill.
Ever onward, always forward, never doubting, full of joy.Life’s purpose from the dawn of time - to love and be loved, To gladly serve those in need.All precious and worthy, regardless of color, code, or creed.
Angela C. Brittain, MSN, RN is a PhD candidate at the University of Arizona College of Nursing.
A Mother’s Love
Northland Pioneer College seeks an innovative leader committed to the mission, vision, and values of the College to serve as Director of Nursing and Allied Health. The Director, who reports directly to the Dean of Career and Technical Education, has oversight of the Nursing and Allied Health accreditation, operations, services and resources. The Director also serves on various instructional and services committees designed to assist with strategic initiatives and planning for the institution.
The Director is tasked with providing institutional leadership for the Nursing and Allied Health programs across the four campuses and five centers. The Director leads the faculty and staff in Nursing and Allied Health to provide high quality education and support for students. The Director has a responsibility to serve as a liaison with advisory committees, affiliated institutions professional organizations, and local regional, and state agencies to insure the program meets the educational needs of the area and conforms to state regulations. The opportunities are vast and plentiful for the Director Nursing and Allied Health at Northland Pioneer College. For detailed job announcement go to www.npc.edu
EEO/AA
Director of Nursing and Allied Health
Page 6 • Arizona Nurse April, May, June 2020
NURSE MIDWIVESA Day in the Life of One Arizona Midwife
Maria Sienkiewicz Lennon, RN
It’s 7:00 am on a cold winter morning and snow flurries are flying around as the day dawns. Walking to the hospital in thin scrubs the freezing wind is a bit of a shock to the system. It’s nearly time to start the day shift as a Certified Nurse Midwife at Tuba City Regional Health Care Corporation (TCRHCC), a 70-bed hospital in very rural northern Arizona, located on the Navajo Nation.
Of the 10,483 advanced practice nurses in Arizona, Certified Nurse Midwives (CNMs) make up about 3% of the total. There are 283 of us. The largest majority live and work in the Phoenix metro area, but there are a fair number of us who live and work in rural areas far from tertiary care medical centers. CNMs care for women of all ages – from those entering womanhood to great-grandmothers; from all walks of life, all socio-economic groups. We are women’s health providers who care for women throughout the lifespan.
7:30 am: The CNM from night shift gives report on the patients on the unit. There is one patient in labor; one mother who gave birth an hour ago and is experiencing heavier than normal bleeding; three other postpartum patients, one of whom is experiencing difficulties breastfeeding a sleepy late preterm baby; and a 28-week pregnant patient in triage who has just arrived and is complaining of severe back pain. I am precepting a second-year midwifery student today; she and I put our heads together and quickly make a plan to tackle the day.
The World Health Assembly has designated 2020 as the “Year of the Nurse and Midwife.” This is a year of celebrating what we do and examining the challenges we face. Certified Nurse Midwives work in various practice settings all over Arizona: private practices, hospital-based practices, birth centers, and home birth practices. We work as faculty in higher education teaching midwifery and medical students, in Federally-Qualified Health Clinics and for the government in tribally owned and Indian Health Service facilities. Our practices are as diverse as our individual personalities.
9:30 am: Rounds made; labs reviewed. The patient who was bleeding has improved but still bears close watching. Antibiotics were started on the 28-weeker who has a UTI. The mother with the late preterm infant needed quite a bit of support and assistance with breastfeeding. We communicated the plan to the pediatrician. Our laboring patient is a high-risk induction of a primigravida at 37 weeks due to pre-eclampsia with severe features. We checked in with the OBGYN who is on call.
Our practice is an evidence-based midwifery practice of seven Certified Nurse Midwives. It is somewhat unique in that we care for a mixture of both healthy, low-risk patients, and pregnant patients who have high-risk conditions such as gestational and type-2 diabetes, pre-eclampsia and other hypertensive disorders, and other co-morbidities. We work as a team with five ObGyn physicians who are available when needed for consultations, assistance, and surgery. Our cesarean births are done on the unit and the CNM working labor and delivery serves as First Assistant.
11:00 am: Two discharges completed. One patient lives two hours away on the other side of the Hopi reservation. We will coordinate with the Hopi Public Health Nurses to visit the mother and baby at home for the weight check since the patient and her family plan to participate in a cultural ceremony which requires that the mother and baby stay home for twenty days after the baby’s birth.
Tuba City Regional Health Care Corporation provides services to a 6000 square mile area and serves as a referral center for the western part of the Navajo and Hopi reservations. Native American tribes located and served here are the Navajo, Hopi, and Southern Pauite. Providing individualized, culturally sensitive care is a priority for the midwives in our practice.
12:00: Two midwives who have been in clinic all morning come over to the midwifery office on L&D to eat lunch and to discuss some of the day’s patients and to plan for those who may come in to give birth in the coming days. During
our discussion, a physician at one of the outlying clinics 75 miles away from Tuba City, calls and has a patient in labor who needs to be transferred to our hospital for delivery.
1:30 pm: A mother and baby discharged from the hospital two days ago have returned for the baby’s scheduled weight check. I show the student midwife how to assess the four-day-old baby’s weight, level of jaundice, and observe breastfeeding for effectiveness. We teach the mother signs that breastfeeding is going well, when assistance is needed and set an appointment for her to return to Pediatric clinic for a two-week checkup.
TCRHCC is proud to be one of only six hospitals in Arizona designated as a Baby-Friendly hospital. The Baby-Friendly Hospital Initiative is a global program that was launched in 1991 by the World Health Organization and UNICEF to encourage and recognize hospitals that offer optimal evidence-based practices for infant feeding and mother/baby care.
3:05 pm: The helicopter arrives with the transfer. Our patient is a 39 yo G7 P4 at 39 4/7 weeks gestation, VSSA, normotensive, seven cms dilated, in active labor, and contracting every three minutes. Once she is admitted, the lights are turned down low and the mother labors in the room with her close family - including two of her daughters - in attendance. She progresses
Announcing Career Opportunities You’ve Been Waiting For!
Now Hiring:• Central Arizona Correctional Center - Florence, AZ
RNs & LPNs, Full time, Part Time and PRN• Saguaro Correctional Center - Eloy, AZ
LPN• Red Rock Correctional Facility - Eloy, AZ
LPN Full time and PRN, RN
Contact: Valerie at 615-263-6616
New Licensed Graduates Welcome!Competitive Salary and Pay Based on Experience.
Apply online at jobs.corecivic.comCoreCivic is a Drug Free Workplace & EOE - M/F/Vets/Disabled.
April, May, June 2020 Arizona Nurse • Page 7
NURSE MIDWIVESquickly and the student nurse midwife attends the birth under my close supervision. The baby is placed on the mother’s abdomen, gently dried, and after the umbilical cord stops pulsating, the father of the baby proudly cuts the cord. The baby is left undisturbed, skin-to-skin on the mother’s chest, until after the first breastfeeding. The nurses quietly take vital signs and assess both mother and baby as they rest after birth.
The number of CNM-attended births continues to rise. In 2017, we attended 351,968 births - 9.1% of total US births.
4:50 pm: The patient we are inducing for preeclampsia is uncomfortable and requesting an epidural for pain management. The Pitocin is infusing at 14 milliunits per minute, her contractions are every two minutes, the electronic fetal monitoring strip is Category 1, and her cervix is six centimeters. Anesthesia is on the way to see and evaluate our patient for pain management.
Many organizations in the United States and around the world are committed to reducing the steadily rising C-Section rates. In 2017, the national rate was 32%, the rate in Arizona was 27.5 %. Nearly one-third of all babies are born via surgery! Our rates in Tuba City have averaged about 15% over the last five years – a remarkably low statistic considering many of our patients’ pregnancies are high risk.
6:00 pm: A provider from the ER calls to discuss a patient who needs medication and is exclusively breastfeeding her four-month-old baby. The student quickly researches the medication; we share that this med has a low milk: plasma ratio and is compatible with breastfeeding.
7:45 pm: It’s now 8 pm, report has been given by the student, charting is finished and the student and I turn over the unit to the CNM who is working night shift.
Did you know that Certified Nurse Midwives are
licensed, independent health care providers with prescriptive authority in all fifty states, the District of Columbia, American Samoa, Guam, Puerto Rico, the USVI, and are defined as primary care providers under federal law?
We care for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, reproductive health, and gynecology. We also provide a broad range of essential health services in local communities and throughout the state.
Tomorrow will be a day in the clinic – an 0800 to 1700 day. The schedule is packed with prenatal visits, NSTs and ultrasounds for high risk women, collaborating with OBGYN and perinatologists regarding care of high risk women, well-women visits, annual exams, and problem visits.
The American College of Nurse Midwives (ACNM), our professional organization, sets the standard for midwifery education and practice in the United States. Midwifery philosophy affirms the power and strength of women and the importance
of their health in the well-being of families, communities, and nations. Midwives promote active participation in health care decisions, involvement of family members, incorporating cultural traditions, and individualizing care and healing guided by the best evidence available. We honor the normalcy of events in the cycles of womanhood. We believe in watchful waiting and non-intervention in normal processes, the appropriate use of interventions and technology for current or potential health problems and consultation, and collaboration and referral with other members of the health care team as needed to provide optimal health care for women,
8:15: Walking home. The sky is pitch black except for the light of the crescent moon peeking through the clouds and reflecting off the dusting of snow that remains on the ground. Dogs are barking. The smell of wood-burning stoves permeates the air. The chill in the air is invigorating, enough to stir the life essence that makes us thankful to be a part of this great universe and here to serve for another day.
For more information regarding Certified Nurse Midwives in the US: www.midwife.org.
Check out the AZ Nurse Midwives’ community: www.aznursemidwives.org.
And here’s more information about the Tuba City nurse midwifery practice: Grady, D. March 6, 2010 Lessons at Indian Hospital About Births, NY Times, accessed 12/20/2019. https://www.nytimes.com/2010/03/07/health/07birth.html
Maria Sienkiewicz Lennon, MSN, RN, CNM, IBCLC is a Certified Nurse Midwife at Tuba City Regional Health Care Corporation in Tuba City, AZ. Her love for serving the native population in northern Arizona began when she came to the reservation as a student 26 years ago. In addition to being trained as a Sexual Assault Nurse Examiner in both Adult and Pediatrics, Maria is a board-certified lactation consultant, chairs the hospital’s Baby-Friendly Hospital Initiative and is the secretary for the AZ Affiliate of the American College of Nurse Midwives.
Different Types of Midwives in ArizonaMidwife Type Education
RequiredNational
ExamLicensed/ Regulated
Professional Organization
Scope of Practice
Prescriptive Authority
Care Setting Medical Physician Affiliation
Hospital Privileges
Certified Nurse-
Midwife (CNM)
Advanced Practice RN, Masters or Doctorate
Yes, American Midwifery
Certification Board
(AMCB)
State Board Nursing
American College
of Nurse-Midwives (ACNM)
Pregnancy
Birth
Newborn
Gynecology
Women’s Primary Care
Yes Hospital
Clinic
Birth Center
Home
Yes Yes
Certified Midwife (CM)
Masters or Doctorate
Yes (AMCB) Not yet licensed in
Arizona
ACNM Pregnancy
Birth
Newborn
Gynecology
Women’s Primary Care
Yes Hospital
Clinic
Birth Center
Home
Yes Yes
Certified Professional
Midwife (CPM)
High School or GED
Yes, North American Registry of Midwives (NARM)
Department of Health Services
Midwives Alliance of North America (MANA)
Pregnancy
Birth
Newborn
No Birth Center
Home
No No
Licensed Midwife (LM)
High School or GED
No Department of Health Services
MANA Pregnancy
Birth
Newborn
No Birth Center
Home
No No
Lay Midwife None No Not licensed None Pregnancy
Birth
Newborn
No Home No No
Page 8 • Arizona Nurse April, May, June 2020
An Arizona Nurse’s Unique History*Shannon E. Perry, RN
Lila Kreibich Van Cuyk has lived and worked as a nurse in Arizona since 1995. What makes her unique is that she was in the first class admitted to the Walter Reed Army Institute of Nursing (WRAIN). WRAIN was developed by the Army as a baccalaureate program in nursing in cooperation with the University of Maryland to meet the demand for nurses due to the escalation of the Vietnam War. As members of the military, students received tuition and expenses, uniform allotment, and housing. Graduates of the WRAIN program were obliged to serve in the military or essential civilian or other federal government services for a specified period of time, usually the length of time they had been in training.
Prior to WRAIN, the Army developed two programs to meet the increased need for nurses due to war. During World War I, the Army created the Army School of Nursing. These nurses were educated in military hospitals but were not members of the military. In World War II, a different strategy was used. The Cadet Nurse Corps, supervised by the United States Public Health Service, focused on accelerated training of nurses to increase the numbers of nursing students to provide care in hospitals freeing graduate nurses for military service.
Of the 1000 individual applicants to the WRAIN program, 135 were selected, including 17-year-old, Lila Kreibich of La Crosse, Wisconsin. In high school, Lila was an exemplary student, consistently on the honor roll while participating in various clubs and organizations. Lila applied to the program because she wanted a college education which her parents could not afford. Lila began the WRAIN program in 1964 and was inducted into the Army prior to
starting classes. Basic pre-nursing courses could be taken wherever the student was accepted. Private First Class Kreibich enrolled as a student at Saint Teresa College in Winona, Wisconsin. At the end of two years of coursework, she transferred to Walter Reed Medical Center in Washington, DC, and began nursing courses. The combined program lasted four years including three summers.
Clinical rotations were largely at Walter Reed and included taking care of some of the 200-250 critically injured soldiers who were evacuated from Vietnam and arrived each week. The obstetrics and pediatric rotations occurred at other military hospitals where military dependents were treated. In addition to typical nursing classes, as members of the military, Lila and her classmates had experiences necessary for the Army which included physical training and setting up a field hospital. Upon completion of the program, the graduates were commissioned as Second Lieutenants in the United States Army. Following graduation, Lila and her classmates went to Ft. Sam Houston in San Antonio, Texas for basic training.
Soon after graduation, Lila married her husband who was stationed at the same base. She was promoted to First Lieutenant and worked in the nursery in the hospital at Fort Knox, Kentucky until she became pregnant. At that time, pregnancy
resulted in an automatic discharge. First Lieutenant Van Cuyk was discharged in August of 1969. Her husband was discharged in September of 1970.
Lila and her family moved to Phoenix in 1995. She obtained a certificate in health management and worked in a variety of settings as a clinical manager in a local hospital, team leader in a hospice, MDS coordinator for the Arizona State Veteran’s Home, long-term care surveyor for the Arizona Department of Health, and in Quality Improvement for eight retirement centers. For the last five years of her work life, she was an Education Consultant for the Arizona State Board of Nursing. Lila retired in 2011.
WRAIN provided valuable knowledge and skills which launched a nursing career. Lila is grateful for the opportunity to become a nurse that the Army provided and from which the citizens of Arizona benefitted.
Shannon E. Perry, RN, PhD, FAAN is a long-time AzNA member and is passionate about the history of nursing in our state and nation.
*Based on Perry, S.E., WRAIN, the Walter Reed Army Institute of Nursing: An Oral History, a Poster Presentation at the American Association for the History of Nursing Conference, Dallas, TX, September, 2019.
April, May, June 2020 Arizona Nurse • Page 9
New & Returning AzNA MembersDecember 2019 – February 2020
AnthemKaren CoxSherry Razo
AvondaleDaisy HernandezNicole Jojola
BuckeyeBrenda CorreaTiffany Meintel
Casa GrandeCourtney Hill
Cave CreekElizabeth Sharpe
ChandlerLinda AlvarezAnqi ChenElisa MartinezMelissa NicklausJennifer PaceMichelle QuintonEster RuizThomas ScarpellinoNikki ScheffnerRachel Wilkins
CottonwoodJason LitzingerGina Rinehart
El MirageAmy Todoran
FlagstaffShay DavisSarah JaquithBarbara MatookMaureen McGarrity-YoderRachel Minton
GilbertNneka AguwambaGloria BrooksSheree DabrowskiFarheen KhanLaura MendonsaMichelle NealNeerja SethiAmanda Stanford
GlendaleKaytlin MuscatoKathy Nelson-HawksCatherine Samuel-OjoShannon SantoHa SeungMartin Smith
Golden ValleySheri DonaldChristie Yingling
GoodyearAngela Davis-TaylorElaine JewettSandra MaasKimberly MontiPatricia Navarro
KingmanMirannel MacaranasCarrie SparkmanSarah Stacks
Lake Havasu CityMarie O’HaverSusan J. Zarp
LaveenValery Ayafor NkendongAnnalyn RasulShanik Womack
Litchfield ParkVickilyn AlveyHelena HooverYvonne MaeseCaesar Rangel
MaranaAmy CarlsonJames FiskeJean FolarinKarina Navarro
MaricopaBrenda ButronErika Scott
MesaTyler AmanCinthia Arredondo ParamoVicky CastilloTheresa ChmidlingCathy GuinanHolly HansenDonna HornyakDonald HuemillerRebecca McDowellLisa PriceAmie SeitzJanine SutterSuzanne WalkerJanice Wentworth
New RiverMichelle FigueroaSarah Giunta
Oro ValleyBrett CurranAmanda HatchAntonia LandauMichelle McNally
Paradise ValleyShannon Myers
ParkerAmythest Osuna
PeoriaShari DavisRosie DavisChrista GoodwinMeaghan GreenAmory Godwin GrijaldoMindy MadoskiMelissa PachakKatherine White
PhoenixElena AminovTiffany BentonAmy BlanchardRobin BurkellAlana CallinghamMargaret CapozziAbbie DavisLettie Debber
Evan EisenbergMargaret GarciaRegina GurevichAmanda HaslVirginia HenryHolly HirschNicole IrwinVirginia KimerlingMary Sherne MahelonaMarissa Marquez VicenteKaren MartinMichelle McCrearyBrian McCulloughAnitra McKnightJennifer MindalaTanya Osborne-MckenzieKristin RoanAnna RobinsonRuth RodieAliza RosenbergDr. Ronnie SheridanTrisha SpoerlTracee StevensWanda TrimmStephen WeddingLei-Lani WhiteJonathan Wingfield
PimaMarjean Poindexter
PrescottJacqueline Hall
Pamela LuskJoseph Rodriguez
Queen CreekAgnieszka Pisiak
SaffordKeisha Thompson
SahuaritaTina Workman
San Tan ValleyMindy BeckRebecca RileyFelicia Straughter
ScottsdaleShannon BurneyChelsea CannonKaleigh CrozierSamantha HolliganSheila JanischAlexa KucharoAlyssa LehnMichelle MuladyJulie MulroyNatalia SheesleyDonna TewSteve ThompsonKatie WalshCaitlin Woerner
Sierra VistaArleene Djordjevic
SnowflakeDeborah Huish
SpringervillePam Lowry
St. MichaelsLorraine Kelwood
SurpriseBose AnifowoseDiane PummellMelinda To
TempeMaya OgdenLindsey TriemstraTeresa Tuznik
TollesonNatalie JacksonBrittany Prosev
Tuba CityMichele Cunniff
TucsonGloria AnyaejiRobert AtencioLilly BejaranoKaren BrownAmy CannAmber ChanezDelia FrancoFelicia Goraj
Colleen GreenRebecca GriffinHolly HillKathleen InselElsa JacobsDiana LakeCynthia LeeJulia MendezRoberta PurrierLindsay ReardonTricia RivasMegan SanchezMichael ValeriusTaylor VernonIsabella WaszkiewiczKelly White
VailJessica Rose
YumaLeanna BabbMazhar BajwaAnne FlanaganGenevieve GivensGregory LarsonManuela MirandaBose Ogidan ObadinaDeborah PongratzCinthia ReyesLisa TothChristine WatsonRacheal Williams
Because of AzNA nurses can say YES
YESYESYES
YESYESYES
there is a strong state-wide voice for nursing
nurses influence laws, rules and Scope of Practice
collaboration on the local and national level
promotion of a healthy Arizona
nationally accredited continuing education
nurses have access to mentors and role models
www.aznurse.org
aznurse.org/JoinToday
Page 10 • Arizona Nurse April, May, June 2020
AnthemKimberley FlemingMargaret Harrison
BagdadCaroline Wanarua
Bullhead CityJulie Mitchell
ChandlerKelsey CainAllyse HylandAkosua MensahMelissa MoralesMelissa Shelby
CornvilleCybele Saimo
CorondaoCheri Stramecky
FlagstaffSummer LillyRebecca MaslarSummer Williams
Fountain HillsNancy Spahr
GilbertJulianna AnumaRosalind CaumbanSabrina Finklea-StricklandGigi FoxLisa Miller-BrodyDeborah RobertsonAlicia ShieldsAudra Valentino
GlendaleAshley AndradeRachel KurianDebbie RoblesMelissa Traverse
KayentaRuth White
KingmanVivian MartinezBarbara Merritt
Lake Havasu CityMisty Emmert
LongmontCourtney Williams
MesaShannon CampbellHope DunnCraig HerzogJaclyn MalamitsasSelyse MarquezMargaret Varner
Oro ValleyBrett Stewart
PaysonDurward Lynch
PeoriaCorrie BackerPatricia EricksonJacqueline KramerCaroline Pilkinton
PhoenixCamille AquinoViorica Vicky BraicaHeather BurkeWendel FortenberryJulieanne GutierrezMichelle HebardHaley HernandezDivya KalangiKristin KolodziejStephanie LawsonAmy NicholsJohn Ponce De LeonMisty Rhoades
Two Year Anniversary MembersDecember 2019 – January 2020
Shirley StevensDan WadeNancy Webber
PineFelicia French
PrescottCynthia Broening/BranhamKimberly Carlson Stover
Prescott ValleyKathleen Keen
Queen CreekKristen EngelsTracy Holman-SpeightsDeserai Rowley
Red RockJill Prahm
Richlands, North CarolinaAbigail Estelle
San Tan ValleySara Barboza
ScottsdaleAdam AndersonOlivia BourEmily ChandlerLisa DerrickNicole MaidenNicole OrentPhillip SabandoEmily Sellers
SedonaMarian Diamond
Show LowBrian Paronto
Sierra VistaMary Shearer
Spokane, WashingtonFionnuala Brown
Stanwood, WashingtonSabrina Prater
Steamboat Springs, ColoradoJennifer LeRoy
Sun CityDawn Hudgins
SurpriseArmando AbucejoVenona BerglundDarlene HeimmerMargie MaldonadoLauren Treharne
TempeKatherine BrownVicky McNicholl
TollesonCourtney GainesSandra McKenzie
TucsonJennifer ArvizuEjegayehu AsfawLaurel BilboMerianne BrittainElizabeth CogarCassandra Diaz De LeonMartha EnriquezShannon FennieRobin JohnstonRobert JohnstonLoretta KramerNichole KuhnsHancel LopeznavarroWillard LynchMichelle NaourEmily PattersonRuth Taylor-PiliaeShaunte ThomasPaula VolenstineDebbie WilliamsCarla Yrigolla
VailKatrina BickerstaffKathleen MalkinSheila TravlandSherilyn Wollman
YumaShannon McLaughlinMelinda MendezJane RamirezLori Vandersloot
AzNA’s Superstars
Happy Anniversary to our dedicated AzNA members celebrating these special
milestones for this past quarter:December 2019 – Febuary 2020
5-Year MembersOdionyenfe AdelakunHeidi AltonKathryn BaxterJoAnn BeaudoinShannon BellKelley BonowskiBarbara BrowderValerie BurtWendi CampbellLisa ChurchEmily FryeDonna FurlongWendy GallagherDelia GuerrieriJudy HightowerMelissa HomanKathleen McLeodAdelaide Okoree-SiawColleen PetulloAmy RiceLisa RodriguezNajia RussellMeliza SalandananJeannette SasmorNicole SchugKelly SchultzDonna SnowTherese SpeerCheryl SteffenAnabell ThompsonShelley VaughnIsidora VidallonDebra WittharKarla YontsAnthony Zielke
10-Year MembersSherrie BeardsleyKim BlumenfeldPatricia FoldenKatherine KennyGeorge Moussally
Lydia VerattiCathy Wesley
15-Year MembersJanice CristWayne McLeodLeilani Siaki
20-Year MembersAngela GoldenAnn Rodgers
25+-Year MembersJan AtwoodJoyce BenjaminSelina BlissLisa BrackSusan BrownNancy CisarCarla ClarkSally DoshierBarbara DurandImogene EideTeddylen GuffeyM. Shawn HarrellBrenda HosleyMary KelleyJeanette KlineJo KnellRuth LudemannJudith McNabbAnne McNamaraBarbara MillerMary MorenoJessie PergrinLucy RanusNelma ShearerGladys SorensenKristin StumpJolene TornabeniSuzanne Van OrtBarbara Wiles
• UCC Senior Clinical Nurse• Clinical Nurse • PRN Registered Nurse• Clinical Care Coordinator• Public Health Nurse• RN Case Manager• Infection Control Preventionist / Employee Health Coordinator
We are seeking highly motivated nursesExciting nursing opportunities and breathtaking allure of Navajoland await
committed and highly motivated nurses.
Come join us in Winslow! We are located just seven miles from the southern edge of the Navajo Nation, 45 minutes east of Flagstaff and a few hours north of Phoenix. You can go from Standing on
the Corner of Winslow, Arizona to hiking scenic and majestic landscapes.
NursingALD.comcan point you right to that perfect
NURSING JOB!
NursingALD.com
E-mailed Job Leads
Easy to Use
Privacy Assured
Free to Nurses
April, May, June 2020 Arizona Nurse • Page 11
RESEARCHDecode Delirium: Evidence Based Practice Findings
Maria Nnaji, RNKaren MacDonald, RN (Mentor)
Kris Gomez, RNMary Rivero, RN
Patients 65 and older in the United States now comprise about 50% of surgical patients and due to their age, are at higher risk for post-operative delirium (PD). Delirium is a preventable disorder, but it is not well understood by medical professionals. There are three types of delirium: (1) Hyperactive (2) Hypoactive (3) Mixed. Hyperactive is displayed as heightened arousal such as climbing out of bed or pulling at catheters. Hypoactive is displayed as lethargy or lack of responsiveness. Mixed delirium is a vacillation between the two forms. Identification of delirium risk factors by the Perianesthesia nurse is imperative to preventing PD.
We asked the PICO question: “Among geriatric patients age 65 or older being admitted for surgical procedures, does the use of a preoperative delirium risk assessment tool compared to the standard use of clinical judgment result in the identification of patients at risk for postoperative delirium?” A review of the literature identified 25 common risk factors from which we developed a “Delirium Screening Tool” for use by perioperative nurses. This simple checklist and rating system enabled staff to subsequently intervene to reduce the likelihood of postoperative delirium. The tool selected was adopted because it provided the easiest transition for the current workflow of the bedside nurse. The screening tool requires the nurse to check off risk factors for the patient and if three or more risks are identified then a Confusion Assessment Method (CAM) would be conducted. The literature describes the CAM as the best tool to assess for the presence of delirium. When we searched for the CAM tool in our current electronic medical record (EMR), we identified that the CAM was difficult for peri anesthesia nurses to locate in our current charting system. Additionally, the CAM contains one question that asks if there is a change in baseline mental status (yes or no); if no then the tool ends, but if yes it continues through an algorithm. The tool used independently was not adequate for our project, because our goal was
to predict those at risk, not those who currently have delirium.
The team employed the Iowa Evidence Based Practice (EBP) Model to develop fun-filled learning activities to build interest and increase knowledge about postoperative delirium as well as to promote the implementation of the practice change for including use of the preop risk assessment tool. Strategies included engaging staff in “Delirium Jeopardy,” bingo, crossword puzzles, in addition to 1950’s theme decorations and purple postoperative delirium special order bracelets.
Delirium assessments were conducted in a 342-bed community hospital based in Arizona that has a large geriatric population, between October 21, 2019 and December 21, 2019. As the nurses began using the tool, they expressed a heightened awareness of the risk factors for delirium and recognized the rationale for the interventions they currently practice, which have a more comprehensive role in preventive delirium in this vulnerable patient population (such as making hearing aids and glasses available postoperatively). These preventive strategies are nurse-driven and non-pharmacological in nature.
Of the 129 patients assessed, 109 (84%) scored as moderate risk and 14 (11%) were high risk. These findings confirmed that our patient population was at risk for PD and the assessment tool did identify the patients at risk. The literature estimates that the cost of a single case of delirium is $16,000- $64,000/year, whereas preventive strategies are estimated at $6,000 for a single case per year.
Hypothetically speaking, if every one of the 109 patients that scored as moderate risk for delirium experienced an episode of PD, it would cost an organization approximately $1,744,000- $ 6,976,000/year, compared to implementing a multidisciplinary preventive approach of $654,000/year. This would be a cost savings of $1,090,000 -$ 6,322,000 over the course of the year; all while decreasing mortality and providing exceptional patient care.
This project allowed us to engage our staff in the process of bringing EBP to the bedside to affect patient outcomes and improve our patient care. In the future, we hope to build on this foundation and begin collecting data from rapid responses, code grays, and stroke alerts to identify possible delirium cases with the use of this screening tool.
For nurses in other institutions across Arizona, we recommend the following for implementing a similar tool
• Step 1: Identify your target patient population
• Step 2: Conduct a literature search using keywords such as Postoperative Delirium, screening tool, risk factors and target population i.e. (Pediatrics, geriatrics)
• Step 3: Analyze literature several times to get a deeper understanding of what information is needed for your tool
• Step 4: Create the tool that fits best into the bedside nurses’ workflow, and mimics questions or data that they are already collecting or should be collecting
• Step 5: Make sure to get buy-in from your leadership and physicians
• Step 6: Make sure to make it fun and engaging for staff
References available upon request
Maria Nnaji RN, MPA (Fellow), Karen MacDonald MSN, RN, CNOR (Mentor), Kris Gomez BSN, RN, Mary Rivero BSN, RN
Note: Partially funded by Banner Better Together Nursing Development Fund for EBP Fellows
Nursing Opportunities Available• Emergency Department RN
• Outpatient Clinic RN • Community Health/Diabetes Program RN Supervisor
• Community Health/ Diabetes Program RN • Med/Tele Unit RN
• Healthcare Quality RNContact: Patricia Blosser, MSN, RN, MBA, DON at
928-755-4559 or [email protected] available at sagememorial.com/careers/
Send applications to Human ResourcesFax#: 928-755-4659, [email protected]
Ganado, AZLocated in Northeastern AZ
The Navajo Health Foundation/Sage Memorial Hospital is a drug/alcohol free EOE/AA/Navajo Preference Employer
Page 12 • Arizona Nurse April, May, June 2020
RESEARCHDementia Awareness in Hospital Settings
Angela M. Allen, RN
There is an estimate of 5.8 million Americans living with Alzheimer’s disease and other dementias. The annual number of cases of Alzheimer’s and other dementias is projected to double by 2050 (Alzheimer’s Disease Facts and Figures, 2019). It is estimated that 25% of older-aged hospitalized patients have some form of dementia (Maslow, 2006). These patients admitted into hospital settings have poorer outcomes as it relates to their length of stay, increased mortality and further institutionalization (Calnan et. al., 2012). Furthermore, this group of patients requires more nursing hours of care and is more likely to have delayed discharge, which may result in a decline in health and an increase in hospital costs. One reason related to the poor outcomes is the lack of awareness, understanding, and attitude from hospital staff in providing appropriate care. The primary objective of this study was to assess the hospital staff’s knowledge and attitude of dementia.
AimA multidisciplinary team of hospital staff who participate in a 60-min
educational dementia presentation will demonstrate an increase in awareness, understanding, and an improved attitude toward dementia patients in a hospital setting.
MethodTwo hundred and seventy-three hospital staff in a large healthcare
system participated in a quasi-experimental design program. The program evaluation was conducted to examine changes in their knowledge and attitude of dementia patients in an inpatient setting. A two-part valid and reliable instrument named Questionnaire in Palliative Care for Advanced Dementia (qPAD), originally developed in 2006 (Long et. al., 2012), was used to measure staff’s knowledge and attitudes of persons with dementia.
In this study, the self-administered qPAD was issued before and after a 60-minute educational dementia presentation titled: Understanding Dementia and Communication Tips to Avoid and Manage Problem Behaviors. The analysis of this study consisted of descriptive statistics used
to describe the participant’s role. Differences in overall knowledge scores before and after the dementia presentation were compared using a paired t-test. Differences in overall attitudes, based on the percentage of “agree” or “strongly agree” statements, were assessed using the Wilcoxon signed rank test for ordinal data.
ResultsA total 273 participants were initially enrolled in the study. Of the 273,
260 participants (95%) completed the pre and post-tests. They consisted of: 101 registered nurses (39%); 33 senior nurse managers (13%); 25 therapists (10%); 16 dieticians (6%); 8 advanced practice nurses (3%); 8 directors of professional practice (3%); 5 case managers (2%); 5 certified nursing assistants (2%); 4 behavioral health technicians (2%); 3 informaticists (1%); 2 social workers (1%); and 50 other (16%).
Knowledge and attitude of dementia awareness and understanding in the hospital setting:
The participants demonstrated an increase in the total qPAD knowledge test and attitude scale. Knowledge assessment was divided into four categories by content (behavior, caregiving, communication, and definition). There was a statistically significant increase in the overall percentage of answers in the knowledge assessment portion of 8.1% (78.2% to 86.3%, p<0.0001).
Attitude scale was divided into five categories by content (caregiver communication, knowledge impact, work experience, suggestions heard, and teammate discussion). There was a statistically significant increase in the responses in the attitude assessments portion of 7.1% (57.2% to 64.3%, p<0.0001).
Discussion The participants demonstrated improved knowledge of dementia
following a 60-minute educational dementia presentation. There was also a shift in attitude toward patients with dementia. These results are consistent with previous findings on the effects of pre and post-tests using the qPAD scale. This program has also allowed interdisciplinary teams to participate in other dementia-related programs offered by the health care system.
ConclusionAfter completing the study to determine the effectiveness of a 60-minute
dementia education presentation, the overall results demonstrated a need for dementia education. Recognizing this need may provide a better understanding of care for dementia patients in a hospital setting while decreasing the length of stay for hospitalization and the cost of care.
References available upon request
Angela M. Allen, PhD, CRRN
Visit encompasshealth.com/careers to apply
Better Outcomes for Your Career
Recruiting for: Registered Nurse (Day/Night Shift)
Locations:Encompass Health Rehabilitation
Institute of Tucson2650 N Wyatt Dr., Tucson, AZ [email protected]
Encompass Health Rehabilitation Hospital of Northwest Tucson
1921 W Hospital Dr., Tucson, AZ [email protected]
An Equal Opportunity Employer
Apply on our websites today!For more information call us at
928-718-4852.Located in Kingman, AZ
www.gardensrehab.com www.lingenfeltercenter.com
Join our team! RN’s and LPN’sSign-on Bonus Available
To access electronic copies of the Arizona Nurse, please visit
http://www.nursingald.com/publications
April, May, June 2020 Arizona Nurse • Page 13
RESEARCHPatient Position and Nutrition
Sylvia J. Galloway, RN
The population of hospitalized patients aged 65 years and older often experience less than optimal outcomes as a result of inadequate nutrition. A significant number of patients are not sitting in chairs for meals, which leads to impaired digestion and malnutrition. The purpose of this quality improvement project was to educate patients and staff on the benefits and detriments of position during mealtime. A literature search was conducted, with few articles being found. As a result of this search, a deduction was made that the lack of literature proves more attention needs to be given to this matter. Patients and hospital staff were involved in order to focus on awareness and education within the hospital setting. Patients were encouraged to be proactive in their care and recovery. To determine the impact this has on nutritional intake, a select group of mealtime percentages at a rural hospital in the southwest was recorded and analyzed, utilizing a qualitative review of chart audits. Results served to provide awareness of the importance of the relationship between nutrition and position. The significance of this project included better patient outcomes, less need for skilled nursing facilities upon discharge, fewer hospital readmissions, and improved patient satisfaction.
RationaleThe intent of this quality improvement project
was to improve nutritional intake. Two key factors contribute to patient recovery and rehabilitation: nutrition and functional mobility (Resnick & Gershowitz, 2013). The problem of patients becoming malnourished while in the hospital has been identified. The project included education for patients and staff in order to work collaboratively to encourage patients to sit in chairs for meals. Proper position facilitates eating and increases the percentage of meal consumed. As a result, patients experienced better outcomes.
EvidenceNutritional status directly influences factors
that contribute to functional disability (Cederholm et al., 2014). Functional disability may lead to malnourishment (Cederholm et al., 2014). Loss of lean body mass accelerates during bed-rest, putting the hospitalized patient at risk for malnutrition (Tappenden et al., 2013). Muscle strength decreases by five percent a day when hospitalized patients are inactive (Resnick & Gershowitz, 2013). Patients are more likely to need skilled nursing facility placement after discharge when they are not properly nourished or assisted out of bed (PBS, 2016). Addressing the problem of hospital malnutrition has the potential to improve clinical outcomes and quality of care, at the same time reducing costs (Tappenden et al., 2013). Internal data within the rural hospital in the southwest for linking nutrition to patient position was unavailable.
PICOIn selected hospitalized patients aged 65 and older
at a rural hospital in the southwest whose diagnosis and condition permits, (P) how does sitting upright in a chair for meals (I) compared to lying or sitting in a bed for meals (C) affect the percentage of meals consumed (O) within a period of one week (T)?
Problem StatementA significant number of hospitalized patients
aged 65 years and older are not sitting in chairs for meals. As a result, there is a decrease in meal consumption, leading to malnutrition, ineffective digestion, decreased functional mobility and an increase in hospital readmissions.
Significance to NursingNursing is responsible for ensuring safety
and providing care to patients. One element
influencing health outcomes is nutritional status. Hospitalized patients generally eat less than 50 percent of their meals (Robert, Chaboyer, & Desbrow, 2015). Nutritional status is correlated with intake, which is directly under the control of nurses and interdisciplinary team members including subordinate staff. Positioning is one element that affects intake. Nursing can impact health outcomes by optimizing mealtime positioning. A significant number of hospitalized patients, whose diagnosis and condition permits, are not sitting in chairs for meals. When permitted, the most beneficial position for eating is in an upright, sitting position.
PDSA FrameworkPlan
• Design and facilitate an educational program at a rural hospital in the southwest that educates patients and staff on the importance of getting hospitalized patients aged 65 years and older out of bed for meals when diagnosis, condition, and willingness permits.
• This will produce statistical evidence that patients sitting in chairs for meals will experience greater percentages of nutritional intake.
Steps to execute • Surveys will be distributed to nursing staff at
a rural hospital in the southwest to determine reasons patients are not getting out of bed for meals.
• Information gained from the survey will be used to improve modifiable barriers.
• Educational material for staff will be distributed at staff meetings and at shift huddles.
• Laminated cards educating the patient as to the importance of getting out of bed for meals will be included as part of the patient information packet in each hospital room. Nursing will review the cards with patients.
Do• Reflective chart audits will compare
percentages of meals consumed at breakfast, when most patients are in bed and at lunch when most patients are in chairs.
• Chart audits will occur over a period of one week
• Key participants will make observations and identify barriers to getting patients out of bed for meals to determine if the plan should be modified.
Study• Results of the chart audits will be analyzed to
determine if meal consumption increases or
does not increase when patients are assisted to chairs for meals.
• Meal percentages will be compared to the goal of a 25% increase in meal consumption per meal when sitting in a chair.
• Results will be recorded and a determination made as to what was learned and whether the goal was met.
Act• After a study of the results, a conclusion will be
made as to whether the project was a success and if it did not work, what can be modified to improve the results.
• At this time, a decision will be made to determine whether the plan is beneficial and should be expanded throughout the hospital inpatient units at a rural hospital in the southwest.
Goals• By the conclusion of this project, 50% of the
selected hospitalized patients aged 65 years and older at a rural hospital in the southwest whose diagnosis and condition permits will be assisted into a chair for meals.
• By the conclusion of this project, the selected hospitalized patients aged 65 years and older at a rural hospital in the southwest whose diagnosis and condition permits will increase their nutritional intake percentage by 25% per meal over the course of one week, evidenced by data collection analysis.
ConclusionThe plan included meeting with stakeholders and
addressing possible barriers. Education materials were designed including laminated cards in patient rooms, which identified the benefits of spending less time in bed. Interdisciplinary team members worked together to ensure that selected patients were assisted out of bed for lunch. Breakfast was utilized as a comparison variable. The focus was to compare meal percentages eaten in bed and in chairs. The expectation was that meal percentages of patients who are sitting in chairs for meals would increase. Percentages were collected and analyzed with the assistance of the dietary department. With the implementation of this project, success was determined based on an increase of patients sitting in chairs for meals and subsequent increase in nutritional intake.
References available upon request
Sylvia J. Galloway, MSN, RN
Jobs.northwestmedicalcenter.comJobs.orovalleyhospital.comAn Equal Opportunity Employer/VEVRAA
Reinvigorate your passion for Nursing.
We’re Looking for the best!Now Hiring Full-Time, Per Diem & Seasonal Experienced RNs
Sign-On Bonuses May Be Available for Core Positions!
Page 14 • Arizona Nurse April, May, June 2020
RESEARCHTest-Enhanced Stroke Teaching (T.E.S.T.):
Evidence Based Practice FindingBeth Stevenson, RN
Introduction: Stroke is the fifth leading cause of death and the leading cause of serious long-term disability in the United States. The risk of stroke occurrence and reoccurrence is influenced by a patient’s ability to change their modifiable risk factors. This ability to make change is affected by a patient’s ability to understand, initiate, and adhere to health care instructions, as well as the ability to be actively involved in learning, and have the information clarified and reinforced. Currently, teach-back is the preferred method to deliver stroke teaching, however it is unknown if it is the best method. Test-enhanced learning utilizes the testing effect phenomenon, which is the idea
that having to take a test enhances learning and knowledge retention. This evidence-based project examined whether test-enhanced stroke teaching improved retention of stroke knowledge when compared to standard teaching in the acute stroke inpatient population of a community hospital in Arizona.
Methods: All patients involved in this evidence-based project had their stroke knowledge retention evaluated by receiving a quiz at discharge. Quiz questions covered signs & symptoms, risk factors, and when to seek medical attention. Baseline data were collected on 10 patients with a diagnosis of acute stroke or transient ischemic attack (TIA) who received standard stroke teaching. This teaching consisted of receiving a stroke information book
and teach-back education done by the bedside RN. The nursing staff then received instructions to continue to provide standard teaching but also instruct the patient that they will be quizzed on the information at discharge. This test-enhanced teaching method was evaluated in eight patients.
Results: Patients that received test enhanced stroke teaching performed better on the knowledge retention test when compared to patients that received standard teaching (85% vs 78.4%).
Conclusion: Test-enhanced teaching may be a more beneficial teaching method to deliver stroke education. The test questions were a good method to address knowledge deficits and correct misinformation in real-time. Although this method may be more beneficial for knowledge retention, it is only practical in a clinical setting if the bedside RN is able to administer the quiz questions. A more practical approach may be to incorporate the quiz questions in a teach-back structure. Nurses could readily incorporate a statement letting patients know that before they are discharged, they will be quizzed to be sure the nurse taught what they need to know. Such a quiz before discharge would then enable the nurse to further assess understanding and clarify any confusion or misinformation.
References available upon request
Beth Stevenson MS, RN, CCRC
Note: Partially funded by Banner Better Together Nursing Development Fund for EBP Fellows
Nurse Positions Available!• RN • LPN • Student Assigned • Substitute NursesMust have authorization to work in U.S. as defined by the Immigration Reform Act of 1986 and current AZ RN or LPN license. Great Schedule, Excellent Benefits!
To apply or for more information, please visit our website at: www.dvusd.org
“A” Rated Pre-K–12 School District
Visit nursingALD.com today!Search job listings
in all 50 states, and filter by location and credentials.
Find events for nursing professionals in your area.Your always-on resource for nursing jobs, research, and events.
Browse our online databaseof articles and content.
April, May, June 2020 Arizona Nurse • Page 15
Can Mindful Meditation Alleviate Burnout?
Resilient Nurses: Resilient Systems
Justin Fontenot, RN
Reprinted with permission fromThe Pelican News, October 2019
The unforgettable call bell alarm, the insistent ringing of the phone, a faint bed alarm with the associated sinking feeling of a possible patient fall, the new admit, 214 needs her pain medication, 218 needs two units of packed cells, and in 230, a mother is lamenting over her son’s unexpected and irreversible illness; sound familiar? It’s no surprise that nurses frequently feel depleted, stressed out, and emotionally taxed, perpetuating a global peril to the health and wellbeing of nurses and threaten the collective enthusiasm of the nursing workforce. To contend with the unfavorable consequences of burnout and compassion fatigue, one must first understand the nuances of burnout and compassion fatigue and take prompt action to promote impactful vitality and overall wellbeing. Can mindful meditation enhance wellbeing and mitigate burnout?
Although commonly linked contemporaneously, burnout and compassion fatigue, diverge in various fashions (Gentry, 2018). Burnout is physical symptoms that arise among nurses who report their practice settings as demanding, stressful, and overwhelming (Gentry, 2018). Burnout does not occur instantly; instead, it is a zenith of expansive periods of susceptibility to stress (Gentry, 2018). Typical physical manifestations associated with burnout include physical exhaustion, adverse stances regarding one’s role in their setting, and sometimes a dearth of concern for the patients they interact with regularly (Gentry, 2018). Compassion fatigue begins with burnout and develops as a response to prolonged exposure to patient
suffering, engendering a feeling of helplessness, and inducing an onslaught of challenges (Gentry, 2018). Compassion fatigue can lend itself to unfavorable health difficulties, including anxiety, substance abuse, insomnia, and lack of concentration (Gentry, 2018). Statistically speaking, nurses who encounter burnout related illness, which comprises four out of every five nurses, remain in clinical practice indicating an overarching and commonplace quandary, indicating that nurses are not great at self-care (Gentry, 2018).
Some nurses link self-care to grand gestures of self-indulgence, such as dream vacations or elaborate spa days, often associating self-care with opportunities to spend money, which leads to frequent avoidance. In reality, self-care is the small daily gestures that afford a brief but much obliged time out, and in doing so, studies indicate that burnout and compassion fatigue slowly wains. Small periodic gestures demand less time and even require no monetary spending. Mindful meditation regularly surfaces in the literature as a technique that nurses can exercise, which takes little time, is flexible, and has promising results linked to stress and compassion fatigue mitigation. Evidence points to this concept that nurses are unable to express empathy and compassion without first being permitted to formulate self-compassion through self-care methods (Kelly & Tyson, 2017). Mindfulness-based stress reduction (MBSR) is the practice of taking mindful moments allowing thoughts to focus on the surrounding environment, which leads to relaxation and exhilaration. According to Cohen-Katz et al. (2005), who first studied nurses and MBSR, reported that after a two-part study, a statistically significant increase in mindfulness was reassuring and sustained three months following the intervention. Various other
studies designate nearly the same results. Now that we know mindful meditation works, how do we incorporate this practice into our hectic lives as nurses?
Make time to practice mindful moments regularly. Use reminders on your mobile phones to keep you accountable until it becomes an everyday habit. Mindfulness is a tricky skill that warrants time and practice to gain proficiency. Use technology to aid your learning with the basics, such as applications on your mobile phone or using artificial intelligence (AI) such as the Amazon Echo or Google Home. There are several cost-free possibilities, such as the multiplatform and free application Headspace and Calm. Take five minutes before your shift while sitting in your car or five minutes before you go to bed to practice mindful moments, to destress, detox, and watch your stress and compassion fatigue gently wither away. These small everyday practices can save your life, better your health, and fosters safe and effective patient care practice and outcomes. Your family and even your employers will thank you.
Justin Fontenot, MSN, RN
References:Cohen-Katz J., Wiley S.D., Capuano T., Bakers
D.M., Kimmel S., Shapiro S. (2005) The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice 19: 26-35.
Gentry, E. (2018). Fighting compassion fatigue and burnout by building emotional resilience. Journal of Oncology Navigation & Survivorship, 9(12), 532-535.
Kelly, M., & Tyson, M. (2017). Can mindfulness be an effective tool in reducing stress and burnout, while enhancing self-compassion and empathy in nursing. Mental Health Nursing, 12-17.
Reprinted with permission fromGeorgia Nursing, February 2020
What keeps you in the game? What keeps you bouncing back? What do you do and what can health systems do to better support you, your unique, wise and courageous self? How do you stay resilient?
Activist and renown author, Audre Lorde once wrote: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare” (1988). Think about the hospitals in which you work, and I’d argue that they’re likely not the most efficient, nor best designed for your own well-being. Literature on burnout—a rising tide among nurses and physicians across the U.S.—tells us that the systems in which we work do not inherently provide the human support we need to be our best selves and to do our jobs well (Liu et al., 2018). Consider those times that you’ve really needed to take a break, but your unit was short-staffed, or you didn’t feel safe leaving your patient in the hands of someone else. Consider all of the 30-minute lunches that you’ve sacrificed because you were just too busy. I’ve been there many times—and it’s exhausting. Evidence tells us that this kind of non-stop workload, in addition to new technology requirements (think of all the clicking you have to do in the Electronic Health Record), and our ever-increasing ability to keep patients alive (though perhaps to the detriment of their own well-being) can combine to lead towards our own deleterious health outcomes, and saddest of all, in some cases, the deaths or suicides of nurses (Davidson et al., 2019). Burnout is nothing new to nurses, nor is stress. But we need to—and we can—change some things to better support ourselves and each other.
Building resilience requires a two-sided approach. Panagiotti et al. (2017) tell us that it takes an individual-focused approach concurrent with a systems-level approach. Practices like exercise, prayer, meditation, spending time with loved ones and good sleep hygiene are all excellent forms of individual self-care and resilience building. Leaders in healthcare, like me, are also tasked with examining our work cultures to find ways to improve on staffing, time off for our colleagues, decreasing the burden of the EHR and improving patient flow. And both of us, clinicians and administrators, can rely on the wisdom of mentors who have been in this field for decades and have learned the critical and challenging balance of work and of life.
When I worked in emergency departments, full-time as a clinical staff nurse, I was only able to survive the stress by learning from nurses who stayed by my side, answered my questions and gave me support. This camaraderie keeps us all going. My new friend and mentor Florence Lansana, who is a nurse leader here at Emory, has reminded me that to be resilient, we should first remember why we chose to become a nurse—go back to that original inspiration, remember why you are here in the first place and rely on your mentors.
Literature and anecdote combine to tell us the many ways that we can remain resilient and be our best selves. It is for us to listen, at all levels of healthcare, to the needs of ourselves and others so that we can bring health. Self-care can make you more resilient, that much is clear. There is nothing indulgent about self-care then; it’s the best way that we can be ready to care for our patients with compassion and wisdom.
Tim Cunningham, RN, DrPH, FAAN
References:Davidson, J. E., Proudfoot, J., Lee, K., & Zisook, S.
(2019). Nurse suicide in the United States: Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset. Archives of Psychiatric Nursing.
Liu, X., Zheng, J., Liu, K., Baggs, J. G., Liu, J., Wu, Y., & You, L. (2018). Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. International journal of nursing studies, 86, 82-89.
Lorde, A. (1988). A burst of light: Essays. Firebrand Books.Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G.,
Kontopantelis, E., Chew-Graham, C., ... & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. Jama internal medicine, 177(2), 195-205.
Tim Cunningham, RN
Leadership and other nursing positions:New Mexico – DONsOhio – Clinical Nurse ManagersArizona – RN with Cardio-Pulmonary Rehab experience or Respiratory Therapist with experienceVirginia – Clinical Nurse Managers
To apply, contact: Ann Belvin, VP Talent EngagementPhone: 804.649.9340
Email: [email protected] Career Page: diamondhealthjobs.com
Leadership Nursing PositionsAcross the country!
YOU BECAME A NURSE TO HELP PEOPLE. IT’S YOUR TURN TO LEAD OTHER NURSES.
arizonamilk.org/flavored-milk-great-taste-with-nutritional-benefits/
