Caring - Dartmouth-Hitchcock

2003 NURSING ANNUAL REPORT

There are 63 licensed 

practical nurses (LPNs) 

and 299 licensed 

nursing assistants (LNAs) 

currently employed at 

DHMC. Combined these 

groups include 38 men 

representing 10 percent 

of LPNs and LNAs. 

LPNs have an average 

age of 48 (ranging from 

25 to 64 years), whereas 

LNAs have an average 

age of 39 (ranging from 

20 to 71 years). 

LPNs have an average 

length of service of 16 

years (ranging from 

months to 40 years) and 

LNAs have an average 

length of service of six 

years (ranging from 

months to 41 years).

Table of Contents 

Nursing Leadership a Strong Force . . . . . . . . . . . . . . . . . . . . . . . 2 

“Hummingbird Lady” Brings Joy to Cancer Patients . . . . . . . . . . . . . . 4 

Nursing Expertise Improves Wound Care Management . . . . . . . . . . . . . 6 

Nursing Practice Council: Shared Governance in Action . . . . . . . . . . . . . 8 

Family Partnerships Shape Philosophy of Care in ICN . . . . . . . . . . . . . 10 

Evidence-Based Practices Improve Trauma Care . . . . . . . . . . . . . . . . 12 

Bariatric Surgery: 

Patient Education is Key to Long-term Outcomes . . . . . . . . . . . . . . . 14 

Nursing Education: Learning at Every Stage . . . . . . . . . . . . . . . . . 16 

DHMC Nursing Showcase . . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Certifications Awarded . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 

Educational Updates . . . . . . . . . . . . . . . . . . . . . . . . . . 22 

Awards from Professional Organizations . . . . . . . . . . . . . . . . . 23 

Grants Awarded . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 

Professional Activities . . . . . . . . . . . . . . . . . . . . . . . . . 23 

Scholarships Awarded . . . . . . . . . . . . . . . . . . . . . . . . . 24 

Clinical Nurse Specialists . . . . . . . . . . . . . . . . . . . . back cover 

2003 NURSING ANNUAL REPORT 

1

2 

Nursing at DHMC is 

truly a remarkable force. 

Every day, in simple but 

profound ways, nurses 

touch lives and make a 

difference. 

For the first time in its history, Dartmouth- 

Hitchcock Medical Center (DHMC) is 

recognizing the tremendous achievements 

of its nursing staff through this 

new publication—the DHMC Nursing 

Annual Report. 

We are eager to relate the theory 

and motivation behind some of the most 

interesting work conducted by nursing 

staff last year; acknowledge the Her- 

culean efforts leading to DHMC being 

named a Magnet healthcare organization; 

and highlight the professional 

accomplishments and ongoing development 

of our talented staff. 

The Pathway to Magnet Recognition 

On December 8, 2003, DHMC was 

recognized as the 95th Magnet Organization 

by the American Nurses Credentialing 

Center. DHMC was also the first 

facility so recognized in New Hampshire. 

This award recognizes the attainment 

of excellence in nursing care and 

followed an intensive process of application 

and appraisal. Over the course 

of two years, nurses across our organization 

worked together to conduct an 

assessment of the nursing organization, 

submit an extensive written report, and 

host a two-day site visit. 

DHMC has a long tradition of providing 

excellent nursing care in a collaborative, 

interdisciplinary environment. 

For decades, nursing leadership has val- 

ued and supported approaches such as 

shared governance, nursing participation 

in organizational committees, innovation, 

and a focus on excellent nursing 

care. Our Magnet Recognition 

acknowledges those achievements 

and the “Forces of Magnetism” that are 

apparent throughout DHMC. 

These forces include: nursing leadership 

quality, a strong organizational 

Nursing Leadership a Strong Force 

structure, a supportive management 

style, professional models of care, quality 

patient care, structures and processes 

to support continuous quality improvement, 

a strong nursing image, collegial 

nurse-physician relationships, resources 

for professional development, and other 

characteristics that are recognized as 

essential to the provision of excellent 

nursing care. Organizations with these 

characteristics achieve better patient outcomes, 

including lower mortality rates, 

higher levels of patient satisfaction, 

shorter lengths of stay, and lower utilization 

of ICU days. 

Evidence-Based Practice Shines 

Many have asked, “Is a Magnet organization 

perfect?” The answer to this question 

is “no,” but a Magnet organization 

must have a structure and climate that 

reinforces collaborative working relationships 

and values empowerment, 

pride, mentoring, nurturing, respect, 

integrity, and teamwork. Magnet organi-

zations provide a structure that supports 

and validates professional practice and 

continued professional development of 

nursing personnel. Magnet designation 

also demonstrates how nurses are integral 

to the overall success of the entire 

organization. 

DHMC strives to provide individualized 

patient care and meet the diverse 

needs of both patients and families. 

Throughout the Magnet application 

process, careful examination of the 

nursing discipline at DHMC demonstrated 

the essence of evidence-based 

practice. Numerous nurses participated 

on taskforces and groups, contributed 

to the written report, developed poster 

presentations, and met with the reviewers 

during the site visit. These efforts 

were congruent with DHMC’s institutional 

commitment to provide the highest 

quality patient care within a 

supportive work environment. 

DHMC’s achievement of Magnet status 

is testament to the amazing qualifications, 

commitment, and institutional 

strength of nursing at DHMC and should 

prove to be an important tool in maintaining 

morale, encouraging staff to seek 

even greater professional achievements, 

and recruiting additional staff to our academic 

medical center. 

Nursing at DHMC is truly a remarkable 

force. Every day, in simple but profound 

ways, nurses touch lives and make 

a difference. We are pleased to share 

the following stories that illustrate nurses 

doing their jobs with a sense of inquiry 

and with palpable dedication. 

—Nancy Formella 

Senior Nurse Executive 


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4 

Every February, the hummingbirds begin 

their trip back from their winter home in 

southern Mexico. The journey takes them 

more than two months to complete, and 

when they finally reach their destination 

Joyce Langevin, RN, is waiting for them. 

“I follow a hummingbird Web site to 

track their migration,” explains Langevin. 

“If they pass through Mississippi by 

April, I tell the patients to start looking for 

them around May 5th or 6th.” 

For nearly ten years, Langevin, a 

nurse in the hematology/oncology unit at 

DHMC, has been treating patients, families, 

and staff to the beauty and acrobatics 

of the tiny, ruby-throated birds, and by 

doing so has helped to create an environment 

of care that attends to minds and 

spirits as well as bodies. 

Beginning a Tradition 

“It started with a leukemia patient that I 

was caring for,” says Langevin. “Her 

family put a hummingbird feeder on her 

window to cheer her up, and she loved 

it.” When the patient finished her treatment, 

the family asked Langevin if she 

wanted to keep the feeder. “I said 

‘sure,’ thinking that other patients might 

enjoy it as well.” 

Langevin assumed the job of cleaning 

and filling the feeder, and began learning 

more about hummingbirds on the Internet. 

“Then I got a patient with tuberculosis who 

was admitted for 30 days and became 

very depressed,” she says. “I decided to 

buy another feeder for her window to 

cheer her up. She loved it, too.” 

Langevin managed to buy a few more 

each year and eventually placed one on 

every window in the unit, except the radiation 

area. “I also put several on the 

patio and one on the window where the 

dialysis patients sit—now we have a total 

of 28 hummingbird feeders,” she says. 

A Labor of Love 

The weekly process of cleaning and 

refilling the feeders during hummingbird 

“Hummingbird Lady” Brings Joy to Cancer Patients 

“The birds serve as a 

frequent distraction or 

diversion from whatever 

is bothering the patients 

physically. It gives them 

something else to think 

about, and something 

to look forward to.” 

season—which runs from May to September—requires 

special care to keep 

the birds coming back, says Langevin. 

“We have a double-bucket system 

now,” she explains. “It takes about an 

hour and a half with my husband and I doing 

it together. We clean the feeders with 

a vinegar-water solution, rinse them with 

fresh water, and refill them with a four-toone 

sugar mixture that I prepare myself—I 

find the birds like it better than the red 

granules you can buy at the store.” 

“The feeders must be kept clean,” she 

cautions. “You don’t want fungus growing 

in them. If the birds get it on their 

beaks, it can kill them.” 

At the end of the season, Langevin 

removes all of the feeders, cleans, and 

stores them at her home in Enfield Center. 

“Sometimes, I have to replace the 

suction cups and occasionally the feeders 

break and need to be replaced. People 

in this community are very 

generous—they’ve sent checks in the 

mail to help pay for new ones.” 

Bringing Joy to Patients 

For Langevin, bringing joy to her patients 

doesn’t end with the hummingbirds. “We

have a hillside on the hospital grounds 

that used to look too bare,” she says. “I 

got permission to plant 30 daffodil bulbs 

there, so patients would have something 

to enjoy in April before the birds come.” 

“The flowers come up to greet us 

every spring, and it always makes me 

think of Joyce,” says Marilyn Bedell, 

director of nursing for the unit, who 

arranged payment for the bulbs from a 

grateful patient. “They’re so pretty—there 

must be more than 100 now that dot the 

hillside.” 

This year, the daffodils—long considered 

the “flower of hope” by the American 

Cancer Society—may receive even 

greater attention. “Because of infection 

control issues, we won’t be able to allow 

patients to have real flowers in their 

rooms,” says Bedell. “That will make the 

appearance of the hillside daffodils even 

more special.” 

A Healthy Distraction 

According to Langevin, it is the hummingbird’s 

ability to capture attention and to 

fascinate that makes it so beneficial to 

patients. “They’re amazing to watch— 

the way they’re able to hover with their 

wings beating 53 times per second, and 

the way the male’s dark throat turns iridescent 

in the sunlight.” 

“The birds serve as a frequent distraction 

or diversion from whatever is bothering 

the patients physically,” she says. “It 

gives them something else to think about, 

and something to look forward to.” 

On one occasion, a patient became 

so enthralled with the birds “the patient’s 

girlfriend decided the feeder was theirs, 

removed it, and took it home with 

them—I wasn’t very happy about that,” 

Langevin says, laughing. “Thankfully, 

most are content to enjoy them from their 

rooms.” That goes for the daffodils, too. 


5

6 

When it comes to advanced wound care 

management, few nurses have the 

expertise of Nancy Karon, RN, and her 

colleague Melissa Garland, RN, DHMC 

inpatient surgery clinical coordinators. 

“As the clinical nurse leaders on 4 

West (general surgery), we’re often the 

ones that are asked by the physician 

teams and nursing staff to help evaluate 

and treat difficult wounds,” says Karon. 

“The larger and more complex they are, 

the more closely we get involved.” 

Applying VAC Dressings 

Karon and Garland specialize in applying 

negative pressure dressings to 

patient wounds utilizing a VAC (vacuum 

assisted closure) device. 

“We use it on all of our varied surgical 

services patients when there is an 

indication for it,” says Karon. “It can be 

very helpful in cases such as surgical 

wounds (left open because of an infection), 

ulcers, or split-thickness skin grafts.” 

The sponge-like VAC dressing can be 

cut exactly to fit inside the patient’s 

wound bed, leaving the healthy tissue 

surrounding it undisturbed. The wound 

area is then covered with a sticky wrap 

to make the dressing air-tight. 

A tube or suction catheter connects 

the dressing with a machine that contains 

a collection canister. “With wall suction, 

the sponge compresses, pulling away 

excess fluid, and increasing blood supply 

to the area,” explains Karon. “The pressure 

also creates a physical pull on the 

tissue that stimulates cellular growth.” 

Improving Patient Care 

In addition to improving the healing 

process for wounds and reducing the time 

required for skin grafting, the VAC dress- 

ing offers a number of other advantages. 

“Patients have fewer dressing 

changes,” Karon says. “The VAC dressing 

can be changed three times per 

week versus three times per day, as with 

other types of dressings. That means less 

pain for patients, and fewer times they 

may need to be medicated. And with 

drainage contained, they have a better 

sense of well-being.” 

Nursing Expertise Aids Wound Care Management 

“As the clinical nurse 

leaders on 4 West 

(general surgery), we’re 

often the ones that are 

asked by the physician 

teams and nursing staff 

to help evaluate and 

treat difficult wounds.” 

For some patients, it can also mean 

getting a long-awaited shower sooner. 

“A couple of years ago, we had a young 

patient who had been in a bad car accident 

and had a severe leg wound,” says 

Karon. “His dressing was very complex—it 

took three of us to do it. He 

came to us in late December and we 

weren’t able to discharge him to rehab 

until early February—he hadn’t had a 

shower in all that time. Shortly before he 

left for rehab, we were able to get him 

into the shower. He was in heaven.” 

“He’s a patient that I’ll never forget,” 

she says. “I know that nursing’s time and 

dedication spent attending to his dressings 

played an integral role in his recovery. 

He’s had some reconstructive 

surgery, and he always pages us when 

he comes back, to say ‘hello.’ I just smile 

every time he’s been here—it’s very satisfying 

when you know you’ve made a difference 

in a patient’s life.” 

Wound Team Established 

According to Karon, DHMC has formed 

a surgical wound team consisting of Drs. 

Horace Henriques and Paul Kispert, 

Garland and Karon, and nurse specialists 

from the trauma, plastic surgery, and 

discharge planning departments. 

“We’ve just begun to meet on a 

weekly basis to evaluate the large or

complex wounds,” she says. “Our goal 

is to put more evidence behind our practice. 

We want to come up with an algorithm 

that will allow us to improve wound 

care in the short-term, and that will help 

us to collect data and track outcomes 

over the long-term.” 

To help with the documentation 

process, the team will be purchasing a 

digital camera. “It will allow us to take 

serial pictures of the wounds which will 

be ideal as a teaching tool,” says Karon. 

Educating Staff 

Karon and Garland recently traveled to 

San Antonio, TX to attend a special educational 

session at KCI, the company 

that manufactures VAC dressings. 

“Dr. Henriques, a general surgeon 


we work closely with, attended with us,” 

says Karon. “The session focused on 

using VAC dressings for some of the most 

complex and severe wound cases—it 

was very informative.” 

As work within the wound care team 

develops, Karon sees exciting opportunities 

to continue supporting and educating 

nursing staff on the use of VAC 

dressings. 

“We’re making good progress,” she 

says. “We often consult with our counterparts 

Heather Giaccone, RN, and Sherri 

Mongeon, RN, who work in the inpatient 

surgery unit on 3 West (surgical 

specialties) and have expertise with VAC 

dressings, as well. More and more of 

our nurses are gaining experience and a 

higher comfort level in doing them.” 

7

8 

The philosophy of nursing at DHMC is to 

create an environment where patients and 

families can heal. This responsibility 

includes implementation of care for 

patients and their significant others and 

accountability for promoting a professional 

environment conducive to quality 

patient care. Peer review, quality improvement, 

and knowledge about research, 

legal, ethical and economic health issues 

that affect nursing practice are additional 

professional responsibilities. The Nursing 

Practice Council (NPC) makes interdisciplinary 

decisions about issues that affect 

nursing practice throughout DHMC. 

Making the Necessary Commitment 

The NPC is a component of shared governance 

here at DHMC. A movement 

that began in the late 80s and early 

90s, shared governance embraced and 

established a way for nurses to have a 

working discussion about their practice 

environment. Not every tertiary care or 

academic medical center has invested in 

developing the council organization. It 

takes vision to commit financial resources 

to sustain this approach and to provide 

the required staff resources to manage it. 

“We are part of an elite group of 

organizations that have a history of and 

continued process of shared governance 

and nursing practice councils,” 

says Director of Nursing Practice Linda 

Kobokovich, RN, PhD. “We have quite 

a solid tradition.” 

The NPC is comprised of RN representatives 

from all areas where nursing 

care is practiced, including inpatient 

units, ambulatory settings, and ancillary 

service areas such as dialysis, the emer- 

gency department, interventional radiology, 

the poison center, and same day 

surgery. There are 40 members from 

across the campus in a variety of roles. 

Most members are self-nominated 

because of interest or nominated by their 

peers, and some are selected by nursing 

leadership. Governing practice and 

structure trickles down into unit-based 

activities. And most individual inpatient 

Nursing Practice Council: Shared Governance in Action 

“We are part of an elite 

group of organizations 

that have a history of 

and continued process 

of shared governance 

and nursing practice 

councils. We have quite 

a solid tradition.” 

clinical care units also have a local NPC 

where nurses participate in making decisions 

about how care is provided. 

Defining Who and What We Are About 

According to Kobokovich, the key to 

shared governance is that it is grass 

roots versus administratively controlled. 

“Because the NPC allows nurses to 

make decisions about their practice environment, 

there is increasing staff satisfaction 

with work.” 

Through the structure of the NPC, 

nurses make changes, investigate 

ideas, and manage large projects 

such as career ladder management 

changes. As a body, the NPC 

approves policies, such as those controlling 

floating, documentation, and 

managing medical orders. 

The Magnet application process illustrated 

perfectly the value of the NPC. 

Kobokovich explains, “When we started 

the Magnet application process, the first 

question was, ‘How do we let everyone 

know about this?’ The NPC was the logical 

start point because of its representation. 

We also knew members of the council 

could be counted on as champions or 

ambassadors for the project and be able 

to link developments back to other nurses

in their respective units. We educated all 

of the representatives about Magnet.” 

One reason the NPC was successful 

with Magnet was because members 

agreed to stay on the committee through 

the entire process. For some this meant 

staying on beyond the usual two-year 

term. This commitment assured a successful 

education process. As a result, a core 

group extremely knowledgeable about 

the intended outcomes and the whole 

process in which we had become 

involved developed. 

Growing Knowledgeable Leadership 

The experience of the NPC helps nurses 

to see the organization on a larger 

scale. They look at their practice through 

an organizational lens and better understand 

environmental tensions or factors 

that may not be apparent in their particular 

unit. Some choices are difficult and 

not well-received. Shared governance 

dictates that those affected by changes 

should be the ones to help decide what 

to do. As a result, nurses understand 

front line changes better and can ask of 

themselves, “What do we have to do, 

what has to change?” 

“I think nurses want to work in an 

environment where they are making 

important decisions about their practice,” 

says Kobokovich. “At DHMC, 

staff nurses participate in developing 

and modeling ideas for their direct 

practice environment…that is huge.” 

The NPC offers a way for nurses to 

learn leadership, communication and 

decision making skills, and to collaborate 

with one another. 

Kobokovich summarizes: “If you had 

to choose between having no voice 

globally or having a structure in place to 

provide direct input into decision making, 

which would you pick? That is why 

so many nurses have chosen DHMC as 

their place of employment.” 


9

10 

In the CHaD (Children’s Hospital at Dartmouth) 

Intensive Care Nursery (ICN), Jen 

Huckins cuddles her baby daughter Julia 

and takes a break from reading Dr. 

Seuss. “She’s doing well and making 

progress every day,” says Huckins. 

Weighing only one pound, nine 

ounces at birth at 27 weeks the tiny girl 

now weighs over four pounds and has 

been removed from critical care status. 

“She’s just starting to nurse,” says Huckins. 

“We’re talking about adjusting her feedings 

and weighing her before and after to 

get an idea how much she’s taking in.” 

Since breastfeeding her baby was 

important to Huckins, ICN staff have 

helped her begin the process while recommending 

an additional step to ensure 

that Julia continues to gain weight. 

“We’ve initiated bottle feeding at 

night,” says Jackie Hodge, RN, one of 

the ICN nurses assigned to the Huckins 

family. “It’s allowing us to supplement 

Jen’s breast milk so Julia gets more calories. 

Now that she’s finally on a good 

growth curve, we want to keep it going.” 

Partnering with Parents 

Since arriving at CHaD, Huckins and her 

husband Jeff have become integral members 

of their daughter’s healthcare team. 

“It’s very family-oriented here,” says Huckins. 

“They encourage us to be here as 

much as we can and do as much as we 

feel comfortable doing for our baby.” 

“We view moms and dads as our 

partners in care,” explains Hodge. 

“Since many parents like the Huckins 

have been in the nursery from day one 

and spend hours each day at the bedside, 

they become very adept at picking 

up their infants’ cues, what they respond 

to, what they don’t, and what types of 

things work well with them.” 

According to Hodge, this awareness 

not only helps to enhance the care of 

babies during their stay in the ICN, it is 

also an important part of the educational 

process for parents. “Because we work 

Family Partnerships Shape Philosophy of Care in ICN 

“By developing more 

consistent guidelines 

and basing our care on 

the indications the 

baby is showing, 

we’ve been able to 

reduce the number of 

painful procedures 

significantly.” 

so closely with parents, we’re able to 

help them achieve a comfort level 

through each stage of their baby’s care,” 

she says. “As a result, they’re confident 

in their ability to take care of their baby 

when it’s time for them to go home.” 

Making the Rounds 

The unit’s family-oriented approach even 

extends to its interdisciplinary rounds 

where ICN staff and consultants from 

other units encourage parents to participate 

in daily care planning and decision-making. 

This approach is still fairly new 

among ICN units across the country, 

says Dr. Bill Edwards, neonatologist and 

medical director of the unit. “Many units 

ask parents to leave during rounds and 

then come back,” says Edwards. “But 

we feel that a parent who’s involved and 

knowledgeable is going to be more 

effective and less stressed.” 

Huckins agrees. “We try to be here 

every day for rounds,” she says. “It’s nice 

to have the full team come by and discuss 

what’s going on. They’re very good about 

explaining everything and listening to any 

concerns or questions we might have.”

Evaluating Care 

To improve quality and safety, and to 

advance the practice of family-centered 

care, the unit has developed a tool for 

evaluating care from the parents’ perspective. 

The tool, a Web-based survey 

called “How’s Your Baby?,” asks a 

number of questions about outcomes of 

care including how well parents feel 

they know their baby as a unique person, 

how often they feel like a parent 

during the time their child is in the hospital, 

and how prepared they feel they 

are to take care of their baby at the 

time of discharge. 

“We now have 15 centers participating 

in the survey across the country,” 

Edwards says. “Our unit looks pretty 

good for most of the outcomes. It’s proving 

to be a very valuable tool, particularly 

in learning from others who are 

doing a better job than we are in some 

areas, and also looking at how we’re 

doing over time.” 

Reducing Painful Procedures 

Another project undertaken by the unit 

involves reducing the number of painful 

procedures for infants in their first 48 

hours of admission, says Caryn McCoy, 

RN, MSN, a clinical nurse specialist 

who has led several quality improvement 

initiatives within the ICN. 

“By developing more consistent guidelines 

and basing our care on the indications 

the baby is showing, we’ve been 

able to reduce the number of painful procedures 

significantly,” says McCoy. 

Working closely with parents, the 

ICN has also implemented non-pharmacological 

pain management techniques 

such as using sucrose to alleviate pain 

for babies undergoing mild procedures 

like heel sticks to draw blood. 


11

12 

Caring for patients with spinal injuries is a 

high-risk endeavor. Injuries to the spine 

can be difficult to rule out, and they 

carry the risk of potentially devastating 

neurological complications. 

“That means we have to prove nothing 

is wrong with patients before removing 

devices that immobilize their neck 

and spine,” says JoElla McCarragher, 

RN, MSN, a clinical nurse specialist in 

DHMC’s Level 1 Trauma Center. 

Prolonged cervical immobilization 

has its own set of complications. “For 

starters, it’s uncomfortable for those 

patients who are conscious,” says 

McCarragher. “It affects how we can 

position patients—if we can’t sit them up 

in a natural position for breathing or 

coughing, they may have to be intubated 

longer which leaves them more at 

risk for respiratory difficulties and potential 

pneumonias.” 

Other complications include delayed 

mobilization and its associated risks. “The 

longer they are bedridden, the higher the 

chance they may develop complications 

such as blood clots in their legs,” she 

explains. “It also delays our ability to get 

them into physical or occupational therapy, 

and they become more susceptible 

to skin breakdowns and pressure ulcers.” 

Identifying Areas for Improvement 

To better manage this dilemma, McCarragher 

and her colleague Ingrid Mroz, 

RN, MSN, a clinical nurse specialist in the 

Intensive Care Unit (ICU), spearheaded a 

collaborative effort—utilizing an evidence-based 

nursing model—to improve 

the care of patients with spinal injuries. 

“We recognized early on that we 

couldn’t just focus on the ICU—we 

needed to look at the whole spectrum of 

care for these patients,” says McCarragher. 

“So we pulled together a diverse 

group of clinicians from the emergency 

department (ED), neuroscience, pediatrics, 

the ICU, the surgical floor, the 

trauma program, orthopedics, physical 

therapy, and discharge planning.” 

The multidisciplinary task force began 

meeting monthly in February 2002. 

Evidence-Based Practices Improve Trauma Care 

The next steps for the task 

force will be measuring 

post-implementation 

outcomes which will 

include tracking the time 

patients spend on 

backboards, examining 

the thoroughness of 

orders, and measuring 

the timeframe for 

replacing extrication 

collars with in-house 

collars. 

Several areas were targeted for improvement. 

“One of our biggest challenges 

was we had multiple services managing 

patients,” she says. “This led to problems 

like inconsistent precautions, prolonged 

backboard time for patients, and care 

issues associated with cervical collars.” 

A Standardized Approach 

To address the inconsistencies, the task 

force developed a standardized order set 

for spine injury management. “We 

agreed that the orders should be written 

the same way, whether the patient was in 

general surgery, trauma, neurology, or 

orthopedics,” McCarragher says. “We 

implemented it in December 2002, 

revised it after six months, and continue to 

monitor it monthly—it’s been very helpful.” 

In conjunction with the group’s efforts, 

the ED initiated a project to reduce the 

time some patients were spending immobilized 

on backboards. “They developed 

a policy and procedure that allows nurses 

to make the assessments—the result is lowrisk 

patients are now removed from backboards 

more quickly.” 

McCarragher also felt that an assessment 

of cervical collars needed to be 

done. “We looked at the literature and 

had the two leading companies come in 

and present their products,” she says.

“We compared them for support, fit, skin 

protection and wearability, and ended 

up staying with the brand we had.” 

Re-educating Staff 

“We learned a couple of things in the assessment 

process,” she says. “We weren’t 

using all of the sizes that were available, 

and staff often didn’t know how to fit cervical 

collars properly.” McCarragher 

worked with central distribution to keep a 

full line in stock and began an extensive 

product education campaign. 

“In the spring of 2003, we began a 

massive inservicing of staff and put a 

total of 328 people through a re-education 

process with the collars,” she says. 

“By the summer we realized we were still 

on a learning curve, so we brought our 

product representative back in to do 

‘walking rounds’ to look at all of our 

patients who had collars. That allowed 

us to re-examine our practice and make 

further improvements.” 

Part of the re-education process 

involved updating the cervical collar 

care policies and procedures on 

DHMC’s online library. “We now have 

a revised measuring protocol for staff to 

follow when fitting patients with the collars,” 

says McCarragher. 

Measuring Outcomes 

According to McCarragher, the next 

steps for the task force will be measuring 

post-implementation outcomes which will 

include tracking the time patients spend 

on backboards, examining the thoroughness 

of orders, and measuring the timeframe 

for replacing extrication collars 

with in-house collars. 

“We’ll also be determining if the work 

we’ve done has had an impact on the 

prevalence of pressure sores in patients 

who have cervical collars,” she says. 

“We know we still have those issues, but 

our impression now is that they are related 

to injury rather than the collar itself.” 


13

14 

During the past 20 years, obesity has 

risen at epidemic rates in the United 

States. Over 40 million Americans are 

now classified as obese and 15 million 

as severely obese—those who have a 

body mass index of 35 or greater and 

are at higher risk of developing obesityrelated 

health conditions resulting in significant 

physical disability or death. 

“The first line of treatment for the morbidly 

obese—dietary and lifestyle modifications, 

behavioral therapy, and medications—has 

been largely unsuccessful,” 

explains Maureen Quigley, MS, ARNP, 

clinical coordinator of DHMC’s Bariatric 

Surgery Program (BSP). “That’s why for 

many patients, undergoing gastric bypass 

surgery presents the best chance of achieving 

substantial long-term weight loss.” 

According to Quigley, most patients 

who have gastric bypass surgery through 

the DHMC program—which will perform 

about 250 procedures in its Lebanon 

facility in 2004—lose 50 to 70 percent 

of their excess body weight as predicted. 

“And the vast majority has resolution or 

significant improvement of related medical 

complications such as hypertension, 

diabetes, sleep apnea, joint pain, and 

esophageal reflux,” she says. 

Patient Education Key 

Still, Quigley believes there is room for 

improvement and views patient education 

and informed decision-making as 

keys to attaining successful outcomes. 

“We see education as a process that 

goes beyond imparting information,” she 

explains. “As educators, we also need 

to be able to influence behavior and produce 

changes in knowledge, attitudes, 

and skills patients require to maintain 

and improve their health over time.” 

Quigley has played an instrumental 

role in the development of DHMC’s comprehensive 

program which includes preand 

post-operative education, a BSP website, 

informational/support group meetings, 

graduate gastric bypass patient support 

group meetings, a consumer library, 

patient educational materials, provider 

education, and shared decision-making. 

Informational/Support Group Meetings 

Central to the program’s success are its 

informational/support group meetings, 

held three times per month in Lebanon, 

Bariatric Surgery: 

Patient Education Key to Long-Term Outcomes 

“We stress that the 

surgery is a tool, not a 

cure for obesity. They 

need to become as 

educated as possible 

about all of the lifestyle 

changes that are 

required for long-term 

success.” 

once a month in Manchester, and teleconferenced 

to two Vermont hospitals. 

“We require candidates to attend a 

gastric bypass informational/support 

group meeting prior to their initial evaluation,” 

explains Quigley. The one-anda-half 

hour meetings include a formal 

presentation by a surgeon, guest speakers 

on topics related to gastric bypass 

surgery, and testimonials from graduate 

patients. 

“The meetings attempt to provide a 

realistic view of gastric bypass and its 

implications,” she says. “We stress that 

the surgery is a tool, not a cure for obesity. 

They need to become as educated as 

possible about all of the lifestyle changes 

that are required for long-term success.” 

Patients are evaluated by a surgeon 

only after they attend three support group 

meetings and show a commitment to 

dietary modification by losing 15 

pounds. “Since many people have to 

travel long distances to come here, we 

now provide live online access for those 

participants who are able to view their 

follow up meetings from home,” she says.

Pre-Operative Classes Added 

In February 2004, Quigley implemented 

formal pre-operative education classes to 

improve patient readiness prior to surgery. 

The classes will be taught by 

bariatric surgery nurse Kandy Seace, 

RN. “It’s a new step, after their surgery 

date is determined and they meet with 

the surgeon,” she says. 

“We’ve found that not all patients are 

as well prepared for surgery as we 

would like—they may not read all of the 

information they’re given or they may forget 

what we talked about at support 

group meetings,” says Quigley. “This 

also gives us a chance to make sure 

they’ve purchased the correct vitamins 

and dietary supplements that they need.” 


Educational topics covered in the 

classes include a BSP overview, how to 

prepare for gastric bypass, what to expect 

the first month following surgery, helpful 

hints after gastric bypass, how to prevent 

complications, identifying medications 

that may increase the risk of bleeding, 

and a review of the gastric bypass diet 

recommendations. 

Along with educating providers 

through annual obesity conferences, the 

BSP Web site and staff inservice training, 

the program strongly supports shared 

decision-making between patients, their 

primary care physicians, and DHMC’s 

Center for Shared Decision Making. 

“We also treat obesity as a segment of 

the ‘Doctor is In’ video series,” she says. 

Post-Operative Follow-up 

While the post-operative period offers an 

opportunity to continue educating patients 

about making good nutrition and regular 

exercise part of their lifestyle, follow up 

care remains the biggest challenge for 

program staff. 

“Prior to the implementation of a 

formal bariatric surgery program three 

years ago, there was no long-term 

follow-up for patients after gastric 

bypass,” she says. Quigley, who 

recently spoke at a national meeting in 

Indianapolis on improving outcomes for 

bariatric surgery patients, believes that 

lifetime follow-up is critical to track outcomes 

and help patients achieve 

success over the long-term. 

15

16 

Tammy-Lynn A. Wilson is an LNA with 

responsibility for her keeping her unit 

stocked and in good working order. But 

she wanted more. “I wanted to get on 

the floor and get more one-on-one time 

with patients,” says Wilson. “So, I met 

with Ellen Ceppetelli, Director of Nursing 

Education, and asked, ‘How can I get 

my nursing license? I want to be an RN.’” 

Several other nurses had similar inter- 

ests. That’s when Ceppetelli met with 

New Hampshire Technical College in 

Claremont, NH, to arrange for a program 

on the DHMC campus. Ceppetelli 

spends much of her time building such 

relationships. Wilson is now enrolled in 

NH Tech’s two-year program at DHMC. 

Time requirements vary, but typically are 

one and half weekends per month and 

one evening per week. 

All DHMC employees are eligible for 

education reimbursement. Many also 

take advantage of DHMC’s loan forgiveness 

program initiated last year. Borrowers 

sign a contract promising to stay for 

two years after graduation from whatever 

program in which they are enrolled. 

“The contract says that they will have a 

job for us somewhere within the hospital,” 

says Wilson, who will become a 

registered nurse in December 2004. 

Wide Range of Education Opportunities 

The Office of Professional Nursing leads 

a wide range of nursing and patient 

education opportunities including unitspecific 

nurse orientation, a Graduate 

Nurse Residency Program, a Nurse 

Extern Program, a regular series of 

Nursing Grand Rounds lectures that earn 

nursing contact hours, a Nursing Assistant 

Training Program, and numerous other 

continuing education activities. 

“Our primary investment is to continue 

educating our own staff first and foremost,” 

says Ceppetelli. “That is why 

we’re formalizing more opportunities for 

advanced degrees and preparing for the 

role changes that often come with 

advanced education.” Working with 

nurse training programs throughout the 

Northeast, Ceppetelli is proud of 

DHMC’s many partnerships: “We pro- 

Nursing Education: Learning at Every Stage 

Reviewers during our 

Magnet site visit last 

year were “blown 

away” by the number of 

advanced practice 

nurses we have who 

serve as clinical faculty. 

vide a laboratory where their students 

can expect to have excellent experiences 

in a very rich clinical environment.” 

The exposure helps DHMC, too. 

“Nurses in training interact with all of our 

staff, and if they come back—as they may 

for full-time employment—they have a real 

sense of the place,” says Karen Pushee, 

RN, MA, Nursing Recruitment/Retention 

Manager. Changing demographics and 

the ongoing nursing shortage have influenced 

many changes. “We’re hiring more 

new graduate nurses,” says Pushee. “Two 

years ago we had 12 new grads, last 

year we took on 50, and this year we expect 

as many as 100. That impacts how 

we must prepare for and expand on orientation 

to make sure it is truly exceptional 

preparation for working on the units here.” 

Research and Patient Care 

In 1994, Tammy Mulrooney, MS, ARNP, 

OCN, came to DHMC as an RN intending 

to stay for only five years before 

returning to her native Canada. Instead 

she stayed and discovered a true love 

for oncology nursing. Over the next two 

years—along with 30 other students taking 

two to three courses per semester 

offered at DHMC—she earned her BSN 

from the University of New Hampshire. 

Then, through the Family Nurse Practitioner 

Program at Boston College, Mul-

ooney commuted two days per week to 

earn her masters degree. 

Working as a breast cancer nurse 

practitioner, Mulrooney is in the second 

year of a predominantly “distance learning” 

three-year doctoral program through 

the University of Utah. She has “live” 

weekly meetings via video camera and 

interacts with her fellow students face to 

face two weeks per year. Dr. Tim Ahles, 

in DHMC’s Psychiatry department, will 

serve on her “Qualitative Study of 

Chemotherapy Treatment on Cognition” 

dissertation committee. “The doctors and 

my nurse practitioner colleagues have 

been extremely supportive of what I’m 

doing.” She also credits the Office of Professional 

Nursing staff who offer ongoing 

support and were “champions in helping 

to meet the technological challenges.” 

Mulrooney took advantage of a combination 

of continuing medical education 

credits and tuition reimbursement. She’s 

also earned an American Cancer Society 

scholarship for the balance of her participation 

in the doctoral program. A devoted 

learner, she loves the combination of 

research and patient care. “I will never 

leave oncology nursing.” 

Depth and Breadth of Learning 

Reviewers during our Magnet site visit last 

year were “blown away” by the number 

of advanced practice nurses we have 

who serve as clinical faculty. Numerous 

clinical nurse specialists are available to 

trouble-shoot, educate, and look for research 

opportunities. “The way nursing is 

done here, you see how practice and academics 

come together,” says Ceppetelli. 

The national reputations many of our 

nurses enjoy is testament to our working 

environment and their numerous professional 

development activities. Illustrating 

a clear DHMC advantage, Ceppetelli 

says, “This commitment to professional 

development isn’t present in every setting, 

but an academic medical center provides 

many unique learning opportunities.” 


17

18 

At the 69th annual meeting of 

the New Hampshire Hospital 

Association in September, 

Donna Crowley, RN, MS, 

received the Nursing 

Management Excellence Award 

from the New Hampshire 

Organization of Nurse Leaders. 

Donna became the new 

president of this organization in 

January 2004. 

CERTIFICATIONS AWARDED 

ONCOLOGY NURSING CERTIFICATION 

CORP.: Advanced Oncology Certified Nurse 

Wendye M. DiSalvo, ARNP, MS, AOCN, 

Hematology/Oncology 

AMERICAN NURSES CREDENTIALING 

CENTER: Certificate in Advanced Practice 

Nursing, Palliative Care 

Brenda L. Jordan, ARNP, MS, Kendal at 

Hanover 

Joanne Sandberg-Cook, ARNP, MSN, 

CRRN, APRN-BCPM, Kendal at Hanover 

CERTIFICATION BOARD OF PERIOPERATIVE 

NURSING: Certified Perioperative Registered 

Nurse 

Deanna Orfanidis, CNOR, Perioperative 

Services/Operating Room 

AMERICAN BOARD OF PERIANESTHESIA 

NURSING CERTIFICATION: Certification in 

Post-Anesthesia Nursing 

Carla R. Sandstrom, CPAN, Post Anesthesia 

Care Unit 

TRANSPORT NURSES ASSOCIATION: Certified 

Flight Registered Nurse, Air and Surface 

Mark Vojtko, RN, BSN, CCRN, CFRN, 

Dartmouth-Hitchcock Advanced Response 

Team 

AMERICAN BOARD OF NEUROSCIENCE 

NURSING: Certified Neurological 

Registered Nurse 

Auralie M. Achilles, RN, CNRN, 

Neuroscience Unit 

Linda S. Coutermarsh, RN, CNRN, 


Jennie L. Kangas, RN, BSN, CNRN, 


Gail M. Schmitt, RN, CNRN, 


Cynthia G. Tebbetts, RN, BSN, CNRN, 


Carole L. Usher, RN, BSN, CNRN, 


DHMC Nursing Showcase 

PUBLICATIONS 

Bakitas, M. A., & Dahlin, C. (2003). 

Palliative and End-of-Life Care. In T. M. 

Buttaro, J. Trybulski, P. P. Bailey & J. 

Sandberg-Cook (Eds.), Primary Care: A 

Collaborative Practice (2 ed., pp. 48-56). St. 

Louis: Mosby. 

Bakitas, M. A., & Stephany, T. M. (2003). 

End-of-Life Care. In P. L. Swearingen (Ed.), 

Manual of Medical-Surgical Nursing Care: 

Nursing Interventions & Collaborative 

Management (5 ed., pp. 84-98). St. Louis: 

Mosby. 

Bakitas, M. A. (2003). Development of a 

Clinical Care Screening Tool to Assess 

Patient-Defined, Nonphysiological Palliative 

Care Needs. Journal of Terminal Oncology 

2(2), 75-85. 

Beyea, S. C. & Majewski, C. A. (2003). 

Blood Transfusion in the OR – Are You 

Practicing Safely? AORN Journal, 78(6), 

1007-1010. 

Beyea, S. C. (2003). The National Patient 

Safety Goals and Their Implications for 

Perioperative Nurses. AORN Journal, 77(6), 

1241-1245. 

Beyea, S. C. (2003). Setting a Research 

Agenda on Patient Safety in Surgical 

Settings. Seminars in Laparoscopic Surgery, 

10(2), 79-83. 

Beyea, S. C., & Hicks, R. W. (2003). Patient 

Safety First. Patient Safety First Alert – 

Epinephrine and Phenylephrine in Surgical 

Settings. AORN Journal, 77(4), 743-747. 

Beyea, S. C., Hicks, R. W., & Becker, S. C. 

(2003). Medication Errors in the OR – A 

Secondary Analysis of MEDMARX. AORN 

Journal, 77(1), 122, 125-129, 132-124. 

Beyea, S. C., Hicks, R. W., & Becker, S. C. 

(2003). Medication Errors in the Day 

Surgery Setting. Surgical Services 

Management, 9(1), 65-70, 73-66. 

Beyea, S. C. (2003). Patient Safety First. 

Patient Identification – A Crucial Aspect of 

Patient Safety. AORN Journal 78(3), 478, 

481-2.

Bill, J. (2003). Medication Errors: Will It 

Happen to You? The Sensor, XIII(1), 6-8. 

Boardman, M. B. (2003). Chronic 

Obstructive Pulmonary Disease. In T. M. 



Collaborative Practice (2 ed., pp. 391-399). 

St. Louis: Mosby. 

Carney, P. A., Miglioretti, D. L., Yankaskas, 

B. C., Kerlikowske, K., Rosenberg, R., 

Rutter, C. M., Geller, B. M., Abraham, L. A., 

Taplin, S. H., Dignan, M., Cutter, G., & 

Ballard-Barbash, R. (2003). Individual and 

Combined Effects of Age, Breast Density, and 

Hormone Replacement Therapy Use on the 

Accuracy of Screening Mammography. 

Annals of Internal Medicine, 138(3), 168-175. 

Caron, P. A. (2003). Cancer Care. In P. L. 

Swearingen (Ed.), Manual of Medical- 

Surgical Nursing Care: Nursing Interventions 

& Collaborative Management (5 ed., pp. 31- 

61). St. Louis: Mosby. 

Caron, P. A. (2003). Cancer Care. In P. 

Swearingen (Ed.), All-in-One Planning 

Resource (pp. 1-39). St. Louis, MO: Mosby. 

Caron, P. A. (2003). Psychosocial Support. 

In P. L. Swearingen (Ed.), Manual of 

Medical-Surgical Nursing Care: Nursing 

Interventions and Collaborative Management 

(5 ed., pp. 61-71). St. Louis: Mosby. 

Caron, P. A. (2003). Psychosocial Support 

for the Patient’s Family and Significant 

Others. In P. L. Swearingen (Ed.), Manual 

of Medical-Surgical Nursing Care: Nursing 

Interventions & Collaborative Management (5 

ed., pp. 71-75). St. Louis: Mosby. 

Craig, K. M. (2003). Lactation. In T. M. 

Buttaro, P. P. Bailey, J. Trybulski & J. 


Collaborative Practice (2 ed., pp. 31-34). St. 

Louis: Mosby. 

DiGeronimo, C. L. (2003). Perioperative 

Care. In P. L. Swearingen (Ed.), Manual of 

Medical-Surgical Nursing Care: Nursing 

Interventions & Collaborative Management (5 

ed., pp. 1-12). St. Louis: Mosby. 

DiGeronimo, C. L. (2003). Care of the 

Renal Transplant Recipient. In P. L. 

Swearingen (Ed.), Manual of Medical- 

Surgical Nursing Care: Nursing Interventions 

& Collaborative Management (5 ed., pp. 

246-249). St. Louis: Mosby. 


Eilertsen, A. (2003). Telenursing in 

gynecologic oncology: A review of calls for 

reasons, outcomes and nursing interventions. 

Journal of Gynecologic Oncology Nursing, 

13(2), 20-21. 

Gilbert, K. L. (2003). Seizures in an 

Emergency Setting. In T. M. Buttaro, J. 

Trybulski, P. P. Bailey & J. Sandberg-Cook 

(Eds.), Primary Care: A Collaborative Practice 


Gilbert, K. L. (2003). Seizure Disorder. In 

T. M. Buttaro, J. Trybulski, P. P. Bailey & J. 




Godfrey, M. M., Nelson, E. C., Wasson, J. 

H., Mohr, J. J., & Batalden, P. B. (2003). 

Microsystems in Health Care: Part 3. 

Planning Patient-Centered Services. Joint 

Commission Journal on Quality and Safety, 

29(4), 159-170. 

Hastings, D. P., & Kantor, G. K. (2003). 

Women’s Victimization History and Surgical 

Intervention. AORN Journal, 77(1): 163-8, 

170-1, 173-4 passim. 

Hastings, D. P., & Kaufman Kantor, G. 

(2004). Screening for Family Violence with 

Perioperative Patients. In K. A. Kendall- 

Tackett (Ed.), Health Consequences of Abuse 

in the Family: a Clinical Guide for Evidence- 

Based Practice (pp. 33-44). Washington, DC: 

American Psychological Association. 

Jordan, B. L. (2003). Parkinson’s Disease. In 





Laditka, J. N., Laditka, S. B., Mastanduno, 

M. P. (2003). Hospital Utilization: 

Ambulatory Care Sensitive Conditions: 

Health Outcome Disparities Associated with 

Race and Ethnicity. Social Science and 

Medicine 57(8), 1429-1441. 

Lesar, T., Mattis, A., Anderson, E., Avery, J., 

Fields, J., Gregoire, J., & Vaida, A. (2003). 

Using the ISMP Medication Safety Self- 

Assessment to Improve Medication Use 

Processes. Joint Commission Journal on 

Quality and Safety, 29(5), 211-226. 

DHMC NURSING SHOWCASE 

Malone, M., McKernan, L. J., & Zacharski, 

L. R. (2003). Blood Coagulation Disorders. 

In T. M. Buttaro, J. Trybulski, P. P. Bailey & 

J. Sandberg-Cook (Eds.), Primary Care: A 

Collaborative Practice (2 ed., pp. 1085- 

1093). St. Louis: Mosby. 

Meyer, L. P. (2003). Diverticular Disease. In 





Meyer, L. P. (2003). Jaundice. In T. M. 





Meyer, L. P. (2003). Tumors of the 

Gastrointestinal Tract. In T. M. Buttaro, J. 


(Eds.), Primary Care: A Collaborative 

Practice (2 ed., pp. 663-668). St. Louis: 

Mosby. 

Mroz, I. B. (2003). Pain. In P. L. Swearingen 

(Ed.), Manual of Medical-Surgical Nursing 

Care: Nursing Interventions & Collaborative 

Management (5 ed., pp. 12-23). St. Louis: 

Mosby. 

Nelson, E. C., Batalden, P. B., Homa, K., 

Godfrey, M. M., Campbell, C., Headrick, L. 

A., Huber, T. P., Mohr, J. J., & Wasson, J. 

H. (2003). Microsystems in Health Care: 

Part 2. Creating a Rich Information 

Environment. Joint Commission Journal on 

Quality and Safety, 29(1), 5-15. 

O’Connor, G. T., Quinton, H. B., 

Kneeland, T., Kahn, R., Lever, T., Maddock, 

J., Robichaud, P., Detzer, M., & Swartz, D. 

R. (2003). Median Household Income and 

Mortality Rate in Cystic Fibrosis. Pediatrics, 

111(4), e333-339. 

Proehl, J.A. (2003). The Clinical Nurse 

Specialist in the ED. In V. Keogh (Ed.), 

Emergency Nurses Association Advanced 

Practice Nursing: Current Practice Issues in 

Emergency Care, (2 ed., pp. 45-56). 

Dubuque, IL: Kendall/Hunt Publishing. 

Ptak, J. A. (2003). Influenza. In T. M. 





19

20 

Generous gifts from Peter and Jackie of Fairfield, CT, 

and the David S. Williams Fund of the Lakes Region 

Charitable Foundation this year supported the efforts 

of oncology nurses through the Will and Betty Flatow 

Fund. Established in 1976, this fund was first created 

by Will Flatow in memory of his wife who had been a 

cancer patient at DHMC. Over the years, Flatow family 

members and others have added to the fund. Now in 

memory of them both, the Will and Betty Flatow Fund 

provides nurses with flexible funds for training 

opportunities and other special activities to improve 

the care environment for patients and staff. 

Sandberg-Cook, J. (2003). Purpura. In T. 

M. Buttaro, J. Trybulski, P. P. Bailey & J. 




Sandberg-Cook, J. (2003). Sleep Apnea. In 





Sandberg-Cook, J. (2003). Incontinence. In 





Sandberg-Cook, J. (2003). Obstructive 

Uropathy. In T. M. Buttaro, J. Trybulski, P. 

P. Bailey & J. Sandberg-Cook (Eds.), 

Primary Care: A Collaborative Practice (2 ed., 

pp. 704-705). St. Louis: Mosby. 

Sandberg-Cook, J. (2003). Pap Smear 

Abnormalities. In T. M. Buttaro, J. 


(Eds.), Primary Care: A Collaborative 

Practice (2 ed., pp. 797-798). St. Louis: 

Mosby. 

Sandberg-Cook, J. (2003). Pelvic 

Inflammatory Disease. In T. M. Buttaro, J. 




PRESENTATIONS 

Arsenault, L. A., Ebbighausen, W., 

Markwell, M. A Year in the Life of a Rural 

Trauma Center. Poster Presented at the 

Annual Meeting of Neuroscience Nurses. 

Atlanta, GA. (April). 

Arsenault, L. A. Stroke. Bugby Senior 

Center. White River Junction, VT. (March). 

Arsenault, L. A., McCarragher, J., Mroz, I. 

B., Proehl, J. A., Stevenson, R. J. Spinal 

Precautions: A Trauma Center’s Multidisciplinary 

Standardized Management 

Approach. Poster Presented at the Annual 

Meeting of Neuroscience Nurses. Atlanta, 

GA. (April). 

Arsenault, L. A. Stroke Update. Presented at 

the Central Vermont Hospital Symposium. 

Barre, VT. (September). 


Sandberg-Cook, J. (2003). Barotrauma and 

Other Diving Injuries. In T. M. Buttaro, J. 




Stempkowski, L. M. (2003). Erectile 

Dysfunction. In T. M. Buttaro, J. Trybulski, 

P. P. Bailey & J. Sandberg-Cook (Eds.), 

Primary Care: A Collaborative Practice (2 ed., 

pp. 676-678). St. Louis: Mosby. 

Stempkowski, L. M. (2003). Tumors of the 

Genitourinary Tract (Kidneys, Ureter, 

Bladder). In T. M. Buttaro, J. Trybulski, P. P. 

Bailey & J. Sandberg-Cook (Eds.), Primary 

Care: A Collaborative Practice (2 ed., pp. 

732-734). St. Louis: Mosby. 

Vojtko, M., Hanfling, D. (2003). The 

Sternal IO and Vascular Access — Any Port 

in a Storm. Air Medical Journal. 22(1), 32-5. 

Wasson, J. H., Godfrey, M. M., Nelson, E. 

C., Mohr, J. J., & Batalden, P. B. (2003). 

Microsystems in Health Care: Part 4. 

Planning Patient-Centered Care. Joint 

Commission Journal on Quality and Safety, 

29(5), 227-237. 

Welke, K. F., Stevens, J. P., Schults, W. C., 

Nelson, E. C., Beggs, V. L., Nugent, W. C. 

(2003). Patient Characteristics Can Predict 

Improvement in Functional Health after 

Elective Coronary Artery Bypass Grafting. 

Annals of Thoracic Surgery 75(6), 1849-55. 

Beggs, V. L., DiSalvo, W. M., Meyer, L. P., 

Dragnev, K. H., Gibson, J., Hoopes, P. J., 

Strawbridge, R. R., Hammond, S., Van 

Dyk, E. O., Rigas, J. R. Fatigue and Plasma 

Cytokines in a Randomized Double-Blind 

Placebo-Controlled Trial of Epoetin Alfa in 

Patients Undergoing Combined Modality 

Therapy for Unresectable Non-Small Cell 

Lung Cancer (NSCLC). Presented at a poster 

discussion session at the American Society of 

Clinical Oncology (ASCO). Chicago, IL. 

(June). 

Beggs, V. L. Hematology/Oncology Mini- 

Course: Symptom Management of 

Gastrointestinal Side Effects and Toxicities. 

Presented at Dartmouth-Hitchcock Medical 

Center. Lebanon, NH. (March/September).

Beyea, S. C. Medication Errors in 

Perioperative Settings: A Secondary Data 

Analysis of MEDMARX. Presented at the 

37th Biennial Convention of Sigma Theta 

Tau International. Toronto, Ontario, 

Canada. (November). 

Boehm, J. J. Value of Resuscitation Data in 

the Hospital. Presented at the Zoll Medical 

Corporation Annual Sales Meeting. 

Cambridge, MA. (October). 

Ceppetelli, E. B. The Journey Back: from 

Trauma to Return to Self. Presented at the 

New Hampshire Acute Brain Injury 

Association Annual Meeting. Concord, NH. 

(May). 

Ceppetelli, E. B. New Hampshire Preceptor 

Consortium. Poster Presented at the New 

Hampshire Board of Nursing Day of 

Discussion. Tilton, NH. (June). 

Ceppetelli, E. B. Setting the stage to Promote 

Critical Thinking on the Novice to Expert 

Journey. Presented at the VTSNA Annual 

Convention. Killington, VT. (October). 

Ceppetelli, E. B. Hiring and Training 

Nursing Assistive Personnel for the Acute Care 

Setting. Presented at the 37th Biennial 

Convention of Sigma Theta Tau 

International. Toronto, Ontario, Canada. 

(November). 

Clayton, H. A. Unique Acute Care Nurse 

Practitioner Role. Poster Presented at the 

New Hampshire Board of Nursing Day of 

Discussion. Laconia, NH. (June). 

Clayton, H. A. Compartment Syndrome. 

Presented at Central Vermont Hospital’s 

Spotlight on Medical-Surgical Issues. Barre, 

VT. (November). 

DiGeronimo, C. L., Slattery, M. J., Lloyd, 

D. C. Knowledge of Pressure Ulcers among 

Nursing Assistants: Ensuring the Continuity of 

Care. Presented at the 37th Biennial 



(November). 

DiSalvo, W. M. Fatigue and Plasma 

Cytokines in a Randomized Double-Blind 

Placebo-Controlled Trial of Epoetin Alfa in 

Patients Undergoing Combined Modality 

Therapy for Unresectable Non-Small Cell 

Lung Cancer (NSCLC). Poster Presented at 

the 10 th World Lung Cancer Conference. 

Vancouver, British Columbia, Canada. 

(August). 


Formella, N. A. Improving Health Care by 

Improving Clinical Micro-Systems. Presented 

at the 37th Biennial Convention of Sigma 

Theta Tau International. Toronto, Ontario, 

Canada. (November). 

Formella, N. A. Promoting and Sustaining 

Infrastructure Support for Nursing Research in 

Practice: Capitalizing on Opportunities and 

Leadership Vision. Presented at the CANS 

Program on Promoting Research Intensive 

Environments in Clinical Settings at the 

National Institute of Health (NIH). 

Bethesda, MD. (September). 

Karon, N. M. Wound Care. Presented at 

Central Vermont Hospital’s Spotlight on 

Medical-Surgical Issues. Barre, VT. 

(November). 

Kobokovich, L. J. The Nature of Infant 

Relinquishment as Described by Two Voices: 

The Relinquishing Mother and the Obstetrical 

Nurse. Presented at the 37th Biennial 



(November). 

Krimsky, W. S., Mroz, I. B., McIlwaine, J., 

Surgenor, S. D., Corwin, H. L., Houston, 

D., Robison, C., Burril, S., Knuth, D. A 

Prospective Observational Study of the 

Implementation Rates of Established Evidence 

Based Interventions in the ICU. Poster 

presented at the Society of Critical Care 

Medicine Annual Meeting. San Antonio. 

(February). 

Laditka, J. N., Laditka, S. B., Mastanduno, 

M. P., Lauria, M. R., Foster, T. F. Impact of 

Medicaid Managed Care on Avoidable 

Maternity Complications in New York State, 

1995-2000. Academy Health Conference. 

Nashville, TN. (June). 

Lavoie Smith, E. M. The Influence of Central 

and Peripheral Nervous System Side Effects on 

Cancer Therapy: A Patient-Focused Model for 

Change. Presented at the National 

Teleconference Sponsored by Lilly and the 

DHMC Center for Continuing Education. 

Lebanon, NH. (December). 

Mongeon, S. L., Wyle, A. B. Total Hip 

Replacements: Hip and Leg Fractures. 

Presented at Central Vermont Hospital’s 

Spotlight on Medical-Surgical Issues. Barre, 

VT. (November). 

Proehl, J. A. CHF Patients in the ED. 

Presented at the Lifeline National Sales 

Meeting. Cancun, Mexico. (January). 


Proehl, J. A. Emergency Nursing Pearls. 

Presented at the Vermont ENA. Montpelier, 

VT. (February). 

Proehl, J. A. Too Much Information, 

Engaging the Learner with Web-Based 

Education. Presented at the ENA Leadership 

Symposium. Albuquerque, NM. (March). 

Proehl, J. A. Developing Competencies 

Workshop. Presented at the Vermont In- 

Service Educators. Gifford Hospital, 

Randolph, VT. (March). 

Proehl, J. A. Five Level Triage, Head Trauma. 

Presented at the New Jersey ENA 

Conference. Atlantic City, NJ. (March). 

Proehl, J. A. Trics of Trauma: Pediatric, 

Obstetric, & Geriatric Patients. Presented at 

the Iowa ENA Conference. Des Moines, IA. 

(May). 

Proehl, J. A. Critical Clinical Thinking; 

Approaching the Pediatric Patient. Presented 

at the Maryland ENA Conference. 

Baltimore, MD. (May). 

Proehl, J. A. Emergency Nursing Pearls; Trics 

of Trauma: Pediatric, Obstetric, & Geriatric 

Patients. Presented at the Royal Darwin 

Hospital Emergency Department. Northern 

Territory, Australia. (July). 

Proehl, J. A. Critical Clinical Thinking. 

Presented at the Alice Springs Hospital 

Emergency Department. Northern 

Territory, Australia. (July). 

Proehl, J. A. Critical Clinical Thinking. 

Presented at the Westmead Hospital. 

Sydney, New South Wales, Australia. 

(August). 

Proehl, J. A. Critical Orthopedic Emergencies. 

Presented at the ENA Scientific Assembly. 

Philadelphia, PA. (September). 

Proehl, J. A., & Rea, R. From Ivory Tower to 

Bedside & Developing an Effective 

Competency Evaluation Program. Presented 

at the ENA Scientific Assembly. 

Philadelphia, PA. (September). 

Proehl, J. A. Trics of Trauma: Obstetric & 

Geriatric Patients; Nurses’ Role in Trauma 

Procedures. Presented at the Chain of 

Survival Conference. Calgary, Alberta, 

Canada. (October). 

21

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Mrs. Carolyn Tenney a long-time supporter of DHMC, 

has made a gift to the 4W Surgical Nurses Education 

Fund to assist with the ongoing professional 

development of DHMC’s surgical nursing staff. 

Proehl, J. A. The Perils of Plenty: Too Much 

Information. Presented at the New 

Hampshire Organization of Nurse 

Executives Conference for Nurse Leaders & 

Managers. New Castle, NH. (November). 

Proehl, J. A. Shock & Multiple Trauma; 

GU/GYN/OB Emergencies; Respiratory 

Emergencies; Taking the CEN Exam. 

Presented at the NH-ENA Emergency 

Nursing Review Course. Meredith, NH. 

(November). 

Proehl, J. A. Canadian Triage & Acuity 

System Workshop. Presented at the Fletcher 

Allen Medical Center. Burlington, VT. 

(November). 

Pushee, K. A. Externship: The First Step in 

the Continuum. Poster Presented at the New 

Hampshire Board of Nursing Day of 

Discussion. Tilton, NH. (June). 

Rigas, J. R., Eastman, A., Dragnev, K. H., 

Gordon, S., Sutton, J. J., Memoli, V., Beggs, 

V. L., DiSalvo, W.M., Hammond, S., 

Williams, I. Effects of Docetaxel on Apotosis- 

Related Proteins in Patients with 

Adenocarcinoma of the Esophagus. Presented 

at the 12th European Cancer Conference. 

Copenhagen, Denmark (September). 

EDUCATIONAL UPDATES 

Jennie L. Kangas, RN, BSN, CNRN, 

Neuroscience Unit. Received a Bachelor of 

Science Nursing Degree 

Ellen M. Lavoie Smith, ARNP, MS, BC, 

AOCN. Accepted to the Doctoral Program 

at the University of Utah 

Marianne Markwell, RN, BSN, Neuro 

Special Care Unit. Received a Bachelor of 

Science Nursing Degree 

Slattery, M. J., Crowley, D. M., Hegel, L. S., 

Kobokovich, L. J. Evaluation of an Evidence- 

Based Back and Musculoskeletal Injury 

Prevention Program for Nurses and Other 

Healthcare Workers in an Acute Care Setting. 

Presented at the 37th Biennial Convention 

of Sigma Theta Tau International. Toronto, 

Ontario, Canada. (November). 

Summers, B. L., Bedell, M. K. Impact of a 

Creative Program Design to Prepare Nurse 

Leaders. Presented at the 37th Biennial 



(November). 

Williams, I., Dragnev, K. H., Gordon, S., 

Sutton, J. J., Black, W., Memoli, V., Beggs, 

V. L., DiSalvo, W. M., Cole, B., Hammond, 

S., Rigas, J. R. A Novel Tri-Modality 

Approach for the Treatment of Stage II-III 

Cancer of the Esophagus. Presented at the 

14th DHMC NURSING SHOWCASE 

International Congress on Anti-Cancer 

Treatment. Paris, France. (February). 

Deanna Orfanidis, RN, BSN, Perioperative 

Services/Operating Room. Received a 

Bachelor of Science Nursing Degree from 

the University of New Hampshire 

Ellen A. Prior, RN, MS, Care Management. 

Received a Master of Science Degree in 

Management from Antioch New England 

Graduate School

AWARDS FROM PROFESSIONAL 

ORGANIZATIONS 

Marie A. Bakitas, ARNP, MS, AOCN, 

FAAN, Palliative Care Nurse Practitioner 

Hospice/Palliative Nurses Association 

2003 Certified Hospice/Palliative Nurse Of 

The Year Award 

Donna M. Crowley, RN, MS, Director of 

the Neuroscience Unit and the Neuroscience 

Special Care Unit 

New Hampshire Organization Of Nurse 

Leaders 

2003 Award For Excellence In Nursing 

Management 

Susan P. D’Anna, ARNP, MSN, Cardiology 

Cardiology Fellow Group 2003 Annual 

Teacher Of The Year Award 

Ingrid B. Mroz, RN, MS, CCRN, Intensive 

Care Unit 

New England Respiratory Research 

Competition And Awards Program 

Award For Abstract On Early Involvement By 

Respiratory Care In Patients With High Levels 

Of Supplemental Oxygen Reduces The Rate Of 

Icu Admission. 


Dartmouth-Hitchcock Advanced Response 

Team (DHART), Award Nominee 

Inova Health Systems Top 25 Nurses 

GRANTS AWARDED 

Marie A. Bakitas, Received a Department of 

Defense Grant to develop a research 

program on the neurological effects of breast 

cancer treatment via doctoral education. 

Virginia L. Beggs, Wendye M. DiSalvo, 

Received two Lung Cancer Awareness Week 

grants from the Oncologic Nursing Society: 

one to provide education for patients and 

families entitled, Living with Lung Cancer; 

and a second to provide awareness and 

education to professionals about lung cancer 

entitled, Lung Cancer; an Evidence-Based 

Review. 

Paula A. Caron, Received the Oncology 

Nursing Society Grant to host two 

community audioconferences regarding lung 

cancer, sponsored by CancerCare. 


PROFESSIONAL ACTIVITIES 

Linda A. Arsenault, RN, MSN, CNRN, 

President of the Green and White 

Mountains Local Chapter - American 

Association Of Neuroscience Nurses (AANN) 

Suzanne C. Beyea, RN, PhD, FAAN, 

Member - National Patient Safety 

Foundation (NPSF) Research Committee 

Suzanne C. Beyea, RN, PhD, FAAN, Chair 

of Committee on Nursing Practice 

Information Infrastructure 

American Nurses Association (ANA) 

Irene H. Bise, RN, MS, MSN, 

Accreditation Appraiser - American Nurses 

Credentialing Centers (ANCC) 

Ellen B. Ceppetelli, RN, MS, Board 

Member - American Lung Association 

Ellen B. Ceppetelli, RN, MS, Visiting 

Scholar - Harvard School Of Public Health, 

Occupational And Environmental Health 

Eileen Corcoran, RN, MS, New Hampshire 

Nurses Association (NHNA) Delegate 

American Nurses Association (ANA) 

Eileen Corcoran, RN, MS, Director 

Vermont Emergency Nurses Association 

(VENA) 

Donna M. Crowley, RN, MS, President- 

Elect - New Hampshire Organization Of 

Nurse Leaders (NHONL) 


Wendye M. DiSalvo, ARNP, AOCN, New 

Hampshire/Vermont Chapter Membership 

Chairman - Oncology Nursing Society (ONS) 

Anne E. Edmunds, RN, BSN, Member, 

Epsilon Tau Chapter - Sigma Theta Tau 

International 

Nancy A. Formella, RN, MSN, CNAA, 

Nominating Committee - American 

Organization Of Nurse Executives (AONE) 

Maureen A. Heyder, RN, BSN, CEN, 

President - Vermont Emergency Nurses 

Association (VENA) 

Peter A. Nolette, RN, BSN, Member, 

Epsilon Tau Chapter - Sigma Theta Tau 

International 

Linda J. Patchett, RN, MBA, Associate 

Leadership New Hampshire 

Jean A. Proehl, RN, MN, CEN, CCRN, 

Chairperson International Faculty 

ENPC/TNCC - Emergency Nurses Association 

June F. Stacey, RN, BSN, CEN, President- 

Elect - Vermont Emergency Nurses Association 

(VENA) 


Appeals Committee and Continuing 

Education Review Panel Member 

American Association Of Critical Care Nurses 

(AACN): Critical Care Registerd Nurse (CCRN) 

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24 

Mr. and Mrs. Sam Levine continued their support of 

the Levine Nursing Continuing Education Fund in 

2003, an endowment established by the Levines to 

help nurses attend important seminars and additional 

educational activities. The Levine’s created the fund as 

a way to recognize the extraordinary dedication of 

DHMC nurses and the important role they play in 

caring for patients. 

SCHOLARSHIPS AWARDED 

THE LEVINE NURSING CONTINUING EDUCATION AWARDS 

Sara Arpin, RN, Surgical Specialties 

Francis Reinfrank, RN, Perioperative Services 

Joyce Truman, RN, Neuroscience 

AUXILIARY NURSING SCHOLARSHIPS 

Moriah Cook, RN, Coronary Care Unit 

Erin Cruff, LNA, 1 East 

Stephen Davis, LNA, Patient Care Technician II, Intensive Care Unit 

Karen Denis, Health Services Assistant, 1 East/West 

Margaret Gaughan, Dialysis Technician, North Country Dialysis 

Lisa Johnson, LNA, Patient Care Technician II, Intensive Care Unit 

Diane Kirn, LNA, Intermediate Coronary Care Unit 

Jennifer Norris, Communication Specialist, DHART 

Marianne Parisi, Certified Research Professional, Hematology/Oncology 

Ann Wescott, RN, Post-Anesthesia Care Unit 

Linda Wooddell, Inventory Specialist, Cardiac Catheterization Laboratory 

DARTMOUTH-HITCHCOCK ALLIANCE SCHOLARSHIPS 

Diane Kirn, LNA, Intermediate Coronary Care Unit 


Katrina Masure, RN, Intensive Care Nursery 

Ann Wescott, RN, Post-Anesthesia Care Unit 

Linda Wooddell, Inventory Specialist, Cardiac Catheterization Laboratory 

Every effort has been made to include all nursing staff members’ achievements in 2003. If you 

notice any omissions or errors – we apologize in advance and ask that you contact the Office of 

Professional Nursing so that updates can be noted in future publications. 

Facts about DHMC Direct Care RNs 

• There is a total of over 1100 Direct Care RNs. 

• 11 percent are men—over twice the national average—the percentage of men is 

equally high for men in positions categorized as nurse manager. 

• Average age of direct care RNs is 44 years, slightly lower than the national average 

and State of NH average. 

• Average years of service is 10, and ranges from months to almost 40 years. 

• Ages range from 22-73 years.

CLINICAL NURSE SPECIALISTS 

Learning Series Project Titles 

Linda Arsenault: Discharge Learning 

Needs 

Judy Boehm: What Makes for a Good 

Resuscitation? 

Holly Clayton: Development and 

Support of 

Novice/Advanced 

Beginner Staff Providing 

Direct Care to Complex 

Patients on 4 West 

JoElla McCarragher: Improving the Care of 

Spinal Cord Injured 

Patients 

Caryn McCoy: Reducing the Frequency 

of Painful Procedures in 

Preterm and Critically 

Ill Infants in the 

Intensive Care Nursery 

Ingrid Mroz: Enhancing the 

Introduction of ICU 

Patient Families to the 

Critical Care Waiting 

Room and ICU Care 

Processes 

Bridget Mudge: Pediatric Asthma 

Education 

Peggy Plunkett: Ethics Consultations at 

DHMC: Nursing 

Needs 

Jean Proehl: Ketamine for Pediatric 

Procedural Sedation in 

the ED 

Gretchen Van Buren: M.A.P - Medication 

Assistance Program 

Mary Wood: Intensive Insulin 

Treatment in 

Cardiothoracic Surgery 

Patients 

Contributors: Suzanne Beyea, Susan Connolly, Timothy 

Dean, Mary Jo Slattery, Andrea Williams 

Design: Roger Goode 

Editing: Suzanne Beyea, Mary Jo Slattery, Andrea Williams 

Photography: Mark Washburn

Dartmouth-Hitchcock Medical Center 

One Medical Center Drive 

Lebanon, NH 03756 

(603)650-5000 • www.dhmc.org

Caring - Dartmouth-Hitchcock

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