The North Dakota Nurse - August 2018

ANA Hill Day & 

Membership Assembly 

Page 1, 4-5 

THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATION 

Sent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter 

does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.” 

Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota 

Vol. 87 • Number 3 August, September, October 2018 

ANA Member 

Benefits 

Page 6-7 

SAVE THE 

DATE! 

Conference in 

Bismarck 

President’s Message 

Speak to be Heard 

Tessa Johnson, MSN, BSN, RN 

Greetings North Dakota Nurses! Did you know 

ANA had deemed this year ‘The year of Advocacy’? 

We know advocacy is defined as the act of pleading 

for or actively supporting a cause or proposal, but 

what we need to think about is what does that 

mean to us as nurses and more importantly to the 

patients that we serve. According to Zolnierek, 

(2012) “The American Nurses Association’s Code 

of Ethics for Nurses and Scope and Standards of 

Nursing Practice clearly identify nurses’ ethical 

and professional responsibility for protecting the 

safety and rights of their patients; State nursing 

practice acts may establish a legal duty for patient 

advocacy as well” (p.1). We all need to consider if 

we are doing our part on a state level to fulfill that 

professional responsibility that we carry. Advocacy 

can mean many things in many different ways. 

Advocacy means using one’s position to support, 

protect, or speak out for the rights and interests 

of another. Nurses have long claimed patient 

advocacy as fundamental to their practice. Since 

we have made this commitment to advocacy, others 

care what we have to say and that is why we need 

to speak to be heard. 

There are many ways that we can speak to be 

heard. One of those ways is to start on a local 

level. There are so many things we can do here 

in our home state in order to be heard. One of 

those ways is by joining NDNA/ANA and getting 

involved. Luckily NDNA has a voice at the table 

with the legislatures in our state as well as 

other groups such as the Center for Nursing. By 

becoming a member of your local professional 

organization, you can have the opportunity to 

be heard and support our local platform of many 

nursing issues that arise. We are the experts 

and our legislators want to hear what we have to 

say. Of course, we all know 

that being an advocate 

isn’t always easy. It takes 

dedication, passion and 

love for our profession to 

continue to push forward. 

One misconception of nurses 

who do direct patient care 

is that they don’t have a Tessa Johnson 

voice; this couldn’t be more 

wrong. Direct-care nurses are poised especially 

well to identify and speak up about conditions 

that may result in near misses or actual adverse 

events. Cultures of safety promote and encourage 

staff to raise issues, yet most workplace cultures 

are imperfect, and nurses may face challenges in 

their advocacy efforts (Zolniere, P.1). This is when 

we find an internal struggle about what has been 

normal to us in some environment and when we 

know we need to speak up and make a change. 

One of the benefits of being involved in a group 

such as a professional association is you have 

support and a unified voice. We all know that 

nurses may fear retaliation and lack knowledge 

about established processes and protections for 

patient advocacy activities. Raising a concern 

disrupts the status quo and challenges the 

organization to confront problems. This, my 

friends, is EXACTLY what we need; we must 

challenge and disrupt the status quo to ensure we 

are always advocating for the best possible care 

for the patients we serve. I encourage you all to 

find a way that works for you to get involved. Be 

well, we need all of you!!! 

Zolnierek, C. (2012). Speak to be Heard. American Nurse 

Today, 7(10), 1-3. Retrieved June 13, 2018, from 

https://www.americannursetoday.com/speak-to-beheard-effective-nurse-advocacy/. 

current resident or 

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Princeton, MN 

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2018 ANA Hill Day and Membership Assembly 

Washington, DC June 21-23, 2018 

2018 Membership Assembly in Review: 

Experiences While Representing the NDNA 

NDNA President Tessa Johnson 

and NDNA Membership Assembly 

Representative Tammy Buchholz attended 

the 2018 ANA Hill Day and Membership 

Assembly. The 2018 Membership Assembly 

activities began with an 8:00 a.m. meeting, 

Thursday, June 21st in Washington, DC. 

The meeting provided a federal legislative 

overview and key talking points for nurse 

members to share with their state senators 

and representatives during the day’s scheduled 

meetings. 

Various speakers addressed the group including 

ANA President Pam Cipriano, Michelle Artz, 

ANA Director of Government Affairs, Samuel 

Hewitt, ANA Senior Associate Director, Federal 

2018 Hill Day continued on page 4

Page 2 The North Dakota Nurse August, September, October 2018 

How to submit an article for 

The North Dakota Nurse! 

The North Dakota Nurses Association accepts articles on 

topics related to nursing. We also accept student articles 

& evidence based practice articles. All articles 

are peer reviewed and edited by 

NDNA volunteers. 

Deadline for submission for the next issue is 9/10/2018. Send your 

submissions to info@ndna.org. 

The North Dakota Nurse 

Official Publication of: 

North Dakota Nurses Association 

General Contact Information: 

701-335-6376 (NDRN) 

info@ndna.org 

Welcome New 

Members 

Vickie Ireland 

Betsy Kanz 

Kathleen Rogan 

Jessica Vos 

Ashley Brew 

Eva Cabato 

Kami Lehn 

Shaun Seibold 

Renata Hegle 

Jocelyn Klein 

Delta Carvalho- 

Anderson 

Editor’s Note 

The article “Heart Disease 

Readmission” on page 10 of the 

May 2018 edition of the North 

Dakota Nurse was written by 

Allison Sadowsky MSN, RN. Our 

apologies that we did not catch 

this during proofing to give you 

credit in the May edition. 

The North Dakota Department of Health has employment 

opportunities for REGISTERED NURSES, DIETITIANS 

AND QUALIFIED INTELLECTUAL DISABILITIES 

PROFESSIONALS (QIDP) as a Health Facilities Surveyor. 

How would you like every weekend to be a three-day 

weekend plus have ten paid holidays each year? 

Join our team of dedicated nurses and dieticians and you 

will travel across our great state to assure compliance with 

state and federal standards. 

Overnight travel required and you will be reimbursed for 

your food & lodging expenses. 

Here’s a chance to make a difference in a unique way using 

your education and experience. 

As a state employee, you will enjoy our excellent benefits 

package and a four-day work week. 

Immediate Openings Available 

The position will remain open until filled. 

Competitive Salary 

Please contact: 

Bruce Pritschet, Division of Health Facilities 

600 E. Boulevard Ave Dept 301 

Bismarck, ND 58505-0200 | 701.328.2352 

Website: https://www.cnd.nd.gov/psc/recruit/EMPLOYEE/ 

HRMS/c/HRS_HRAM.HRS_APP_SCHJOB.GBL? 

An Equal Opportunity Employer 

Nominations 

wanted for NDNA 

Board of Directors! 

If you or someone you know 

would make a great candidate for the 

NDNA Board of Directors let us know! 

We are now accepting nominations in 

the following positions for the 2019- 

2020 term: 

President 

Spokesperson for NDNA; liaison 

between state and national office (ANA); 

provides leadership for the state association 

Vice President of Practice, Education, 

Administration & Research 

Coordinate practice, education, 

administration and research activities & 

initiatives 

Director at Large: New Graduate 

Coordinate with the VP of 

Membership to develop recruitment 

strategies & serve as a liaison with 

NSAND 

Please see NDNA website for more 

information at www.ndna.org. 

Contact the following individuals 

on the current nominating 

committee to serve in any of the 

above volunteer positions. 

Jami Falk RN CNML MSSL 

Jami.Falk@va.gov 

Karla Haug MS, RN 

karla.haug@ndsu.edu 

All candidates must be a member in 

good standing with NDNA and will need 

to complete a "Consent to Serve" form. 

The last day of nominations will 

be August 23rd, 2018. Elections 

will occur electronically following 

nominations. Installation of new 

board members will take place at the 

NDNA Annual Meeting in Bismarck 

on September 27th. 

President: 

Tessa Johnson, MSN, RN 

president@ndna.org 

Vice President– 

Communications 

Kayla Kaizer, BSN, RN 

kkaizer8@gmail.com 


Finance 

DeeAnna Opstedahl, 

MSN, RN, CNOR 

Director at Large– 

New Graduate 

Open Position 

Officers 


Membership Services 

Open Position 


Government Relations 

Kristin Roers, MS, RN, CPPS 

advocacy@ndna.org 


Practice, Education, 

Administration, Research 

Sherry Burg, MBA, RN 

sburg@altru.org 

Executive Director: 

Sherri Miller BSN, RN 

director@ndna.org 

Published quarterly: February, May, August and 

November for the North Dakota Nurses Association, a 

constituent member of the American Nurses Association, 

1515 Burnt Boat Dr. Suite C #325, Bismarck, ND 58503. 

Copy due four weeks prior to month of publication. 

For advertising rates and information, please 

contact Arthur L. Davis Publishing Agency, Inc., 517 

Washington Street, PO Box 216, Cedar Falls, Iowa 

50613, (800) 626-4081, sales@aldpub.com. NDNA and 

the Arthur L. Davis Publishing Agency, Inc. reserve 

the right to reject any advertisement. Responsibility 

for errors in advertising is limited to corrections in the 

next issue or refund of price of advertisement. 

Acceptance of advertising does not imply endorsement 

or approval by the North Dakota Nurses Association 

of products advertised, the advertisers, or the claims 

made. Rejection of an advertisement does not imply a 

product offered for advertising is without merit, or that 

the manufacturer lacks integrity, or that this association 

disapproves of the product or its use. NDNA and the 

Arthur L. Davis Publishing Agency, Inc. shall not be 

held liable for any consequences resulting from purchase 

or use of an advertiser’s product. Articles appearing in 

this publication express the opinions of the authors; they 

do not necessarily reflect views of the staff, board, or 

membership of NDNA or those of the national or local 

associations. 

Writing for Publication in 

The North Dakota Nurse 

The North Dakota Nurse accepts manuscripts for 

publication on a variety of topics related to nursing. 

Manuscripts should be double spaced and submitted 

electronically in MS Word to director@ndna.org. Please 

write North Dakota Nurse article in the address 

line. Articles are peer reviewed and edited by the RN 

volunteers at NDNA. Deadlines for submission of 

material for 2018 North Dakota Nurse are 9/10/18 

and 12/10/18. 

Nurses are strongly encouraged to contribute to the 

profession by publishing evidence based articles. If you 

have an idea, but don’t know how or where to start, 

contact one of the NDNA Board Members. 

The North Dakota Nurse is one communication 

vehicle for nurses in North Dakota. 

Raise your voice. 

The Vision and Mission of the 

North Dakota Nurses Association 

Vision: North Dakota Nurses Association, a 

professional organization for Nurses, is the voice of 

Nursing in North Dakota. 

Mission: The Mission of the North Dakota Nurses 

Association is to promote the professional development of 

nurses and enhance health care for all through practice, 

education, research and development of public policy.

August, September, October 2018 The North Dakota Nurse Page 3 

Effectiveness of Somatostatin Analogues 

on Patients Diagnosed with Cushing’s Disease: 

A Systematic Review of the Current Research 

Itohan Agbenin, Mackenzie Hedge, 

Curt Koopmeiners, and Lauren Spaeth; 

BA Nursing Students, with Dr. Jennifer Bailey 

DeJong, Faculty Mentor, PhD, FNP-BC, 

Associate Professor of Nursing, Concordia 

College, Moorhead, MN 

Introduction 

The aim of this systematic review was to 

investigate and synthesize the current evidence 

on the effectiveness of somatostatin analogues on 

patients diagnosed with Cushing’s Disease (CD). 

Method 

A literature search was completed using 

four research databases with the search 

criteria using the terms “Cushing’s Disease,” 

“Somatostatin” and “Analogues.” The database 

search strategy yielded a total of 1,454 citations. 

The results were then narrowed to 14 studies 

when the authors included the criteria of: 

published after 2012, full text, and English 

language. Each author evaluated an equal 

number of articles for the review. 

Results 

Findings suggest that the medical 

management of CD with somatostatin analogs 

to be beneficial in patients for whom surgery 

is not an option or has not been efficacious. 

Pasireotide was shown to be effective in the 

treatment of CD. Overall, outcomes were 

positive. They included: decreased serum and 

urine cortisol levels, decreased mean plasma 

corticotropin level, improved body weight, blood 

pressure, and increased satisfaction with quality 

of life. However, negative outcomes were also 

reported. Clients reported side effects while 

taking somatostatin analogues, which included: 

abdominal pain, GI disturbances, and loss of 

glycemic control and rise in glycated hemoglobin. 

All of the studies used sample sizes of less than 

200 patients. The research design varied between 

randomized double-blind studies, case studies, 

and retrospective analysis designs. 

Discussion 

There is supporting evidence that somatostatin 

analogues are beneficial in the treatment of 

patients with CD. However, more research should 

be undertaken that include larger sample sizes 

with surgery-refractory CD to better understand 

the efficacy of these medications. Likewise, more 

in-depth research should be done on combination 

therapy with multiple types of medications for CD 

in patients who did not undergo surgery to treat 

SAVE THE DATE 

NDNA MEMBERS ANNUAL MEETING 

September 27th, 2018 from 4-8 pm 

Holiday Inn, Bismarck 

Cushing’s disease. Pasireotide (a somatostatin 

analogue) was effective in reducing the signs and 

symptoms of CD, and also resulted in decreasing 

plasma corticotropin, serum cortisol and urinary 

free cortisol levels. Therefore, the effectiveness 

of pairing insulin therapy alongside Pasireotide 

from the start of treatment should be explored for 

its effectiveness in decreasing the adverse effects 

of hyperglycemia. 

Conclusions 


investigate and synthesize research completed in 

the last six years to report the current state of 

Cushing’s disease treatment using somatostatin 

analogues. Findings suggest that the medical 

management of CD with somatostatin analogs is 

beneficial in patients for whom surgery is not an 

option or has not been efficacious. 

References 

Colao, A., Petersenn, S., Newell-Price, J., Findling, J. 

W., Gu, F., Maldonado, M., Biller, B. M. (2012). A 

12-month phase 3 study of pasireotide in cushing's 

disease. New England Journal of Medicine, 

366(10), 914-924. doi:10.1056/nejmoa1105743. 

Li, L. Vashisht, K., Boisclair, J., Li, W., Lin, T., 

Schmid, H.A., Kluwe, W., Schoenfeld, H., & 

Hoffman, P. (2015). Osilodrostat (LCI699), a 

potent 11B-hydroxylase inhibitor, administered 

in combination with the multireceptor-targeted 

somatostatin analog paseriotide: A 13-week study 

in rats. Toxicology and Applied Pharmacology, 

286, 224-233. doi:10.1016/j.taap.2015.05.004. 

Mckeage, K. (2013). Pasireotide: A review of its use 

in cushing's disease. Drugs, 73(6), 563-574. 

doi:10.1007/s40265-013-0052-0. 

Orrego, J. J., & Barkan, A. L. (2000). Pituitary 

disorders: Drug treatment options. Drugs, 59(1), 

93-106. doi 10.2165/00003495-200059010-00006. 

Pas, R., Herder, W., Hofland, L., & Feelders, R. 

(2013). Recent Developments in Drug Therapy 

for Cushing's Disease. Drugs, 73(9), 907-918. 

doi:10.1007/s40265-013-0067-6. 

Rajendran, R., Naik, S., Sandeman, D. D., & 

Nasruddin, A. B. (2013). Pasireotide therapy in a 

rare and unusual case of plurihormonal pituitary 

macroadenoma. Endocrinology, Diabetes & 

Metabolism Case Reports, 130026, doi:10.15. 

Web, S.M., et al. (2014). Treatment effectiveness of 

paseriotide on health-related quality of life in 

patients with cushing’s disease. European Journal 

of Endocrinology, 171, 89-98. 

and our annual Fall Conference 

“HEALTHY NURSE, HEALTHY NATION: 

Creating a Culture of Strength Through 

Diversity and Inclusion” 

September 28th 

Heritage Center, Bismarck 

Registration links on the 

NDNA Facebook page and 

website at www.ndna.org 

$10,000 Sign-On Bonus for 

RNs and LPNs! 

New Graduates Welcome! 

Plus an additional shift differential 

and weekend premium. 

To view current nurse openings and what we 

have to offer, please visit our website and 

apply at www.mslcc.com or contact us at: 

2425 Hillview Avenue 

Bismarck, ND 58501 

(701) 223-9407


2018 ANA Hill Day and Membership Assembly 

2018 Membership Assembly in Review: Experiences While Representing the NDNA 

2018 Hill Day continued from page 1 

Government Affairs, and Tim Casey, Policy Advisor, Polsinelli PC. The 

morning’s keynote speaker was Representative Paul Tonko (D-NY-20) who 

shared his passion and commitment to pass legislation that addresses the 

nation’s opioid crisis. His admiration and respect for nurses were evident, 

and his inspiring remarks lifted the spirits of every nurse in the room and 

prepared us for our scheduled meetings. 

After the meeting, we were transported by bus from the hotel to Capitol 

Hill where over 300 nurses from 45 states and the District of Columbia, 

Guam, and the Virgin Islands attended 277 meetings scheduled with state 

senators and representatives. In addition, ANA nurse members unable 

to attend Hill Day in person delivered over 700 messages to senators and 

representatives via Phone2Action and 5.7 million impressions via Twitter. 

Upon arrival at Capitol Hill, we joined our colleagues for a group picture, 

which has become customary for the ANA Hill Day participants. 

Our first meeting was with Senator John Hoeven, and his Legislative 

Correspondent, Ben Bergstrom who is from Devils Lake, ND. The next 

meeting was with Representative Cramer’s Legislative Assistant, Bree 

Vculek who is from Oakes, ND. Last we met with Senator Heitkamp and her 

Health Policy Advisors, Megan DesCamps and Legislative Counsel, Santiago 

Gonzalez. While attending our meetings with senators, representatives and 

their staff we had an opportunity to share our state and national priority 

issues related to nursing and the health and well being of all. 

Our first point of discussion centered on H.R 5052 / S. 2446, The 

Safe Staffing for Nurse and Patient Safety Act which is bipartisan 

legislation that presents a balanced approach for promotion of development 

and implementation of valid, reliable, unit-by-unit staffing plans to ensure 

patient safety. This legislation would require Medicare-participating 

hospitals to establish a committee, composed of at least 55 percent direct 

care nurses, to create nurse staffing plans that are specific to each unit. 

The committee approach recognizes that direct care nurses, working closely 

with managers, are best equipped to determine the most appropriate staffing 

levels for their patients. Without optimal registered nurse staffing, patients 

risk longer hospital stays, increased infections, avoidable medication errors, 

falls, injuries, and even death. 

The Safe Staffing for Nurse and Patient Safety Act protects 

patients and nurses. Hospitals are feeling pressure to reduce labor costs 

by eliminating or understaffing registered nurse positions. This leads to 

lower nurse retention rates and increased readmissions. Increasing the 

number of registered nurses per patient improves clinical and economic 

outcomes. This balanced staffing legislation mirrors state models that have 

been the result of collaborative efforts among state hospital associations, 

nurse executives, and ANA-affiliated state nurses associations. To date, 

seven states have enacted safe staffing legislation modeled after the Act’s 

committee approach including Connecticut, Illinois, Nevada, Ohio, Oregon, 

Texas, and Washington. 

Our next point of discussion was H.R.3692 / S. 2317, The Addiction 

Treatment Access Improvement Act of 2017, bipartisan legislation 

introduced by Representative Tonko that presents an opportunity to get more 

opioid substance use disorder victims into treatment and help them regain 

control of their lives. The Addiction Treatment Access Improvement 

Act of 2017 is one of several provisions within H.R. 6, the Substance Use- 

Disorder Prevention That Promotes Opioid Recovery and Treatment 

(SUPPORT) for Patients and Communities Act that includes Medicaid, 

Medicare, and public health reforms to combat the opioid crisis. 

CARA (The Comprehensive Addiction and Recovery Act of 2016) 

legislation passed in 2016 extended the authority to prescribe MAT to nurse 

practitioners (NPs) and physician assistants (PAs) through 2021. However, 

The Addiction Treatment Access Improvement Act of 2017 would build 

on the successes of CARA by making MAT prescribing authority for NPs 

and PAs permanent and would expand the ability to prescribe to certified 

registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs) and 

registered nurse midwives (NMs). Advanced Practice Registered Nurses 

(APRNs) are on the front lines of the opioid crisis and are well-positioned 

to make a significant impact on many fronts, including expanding access 

to much-needed medication-assisted treatment (MAT). This prescribing 

authority is within their respective scopes and would improve access to 

lifesaving opioid substance use disorder treatment. 

A vote on H.R. 6 was slated for the following morning; thus, we had a sense 

of urgency to relay our message regarding this legislation during our scheduled 

meetings. As is often the case, there was a looming threat to Representative 

Tonka’s provision in the form of an amendment. The amendment, referred to 

as the Dunn Amendment, was introduced by Representative Neal Dunn, 

R-FL, a member of the GOP Doctors Caucus, and would have eliminated 

language that allowed APRNs the ability to prescribe MAT. We strongly 

encouraged our legislators to vote NO on this amendment during our meetings. 

The following day, we began the ANA Legislative Assembly meeting with 

an announcement that the House had passed H.R. 6 with an overwhelming 

majority, and the Dunn Amendment had been withdrawn from 

consideration! The meeting room erupted into applause and cheers as we all 

celebrated the passing of this legislation by the House. Once again nurses 

had made an impact and were successful in seeing life-saving legislation 

passed in part, due to our collective efforts. The legislation included 58 

individual bills and is expected to be taken up by the Senate as early as mid- 

July for consideration. 

During our meetings, we shared with our legislators that ANA is 

committed to preventing and reducing gun violence. As the largest single 

group of health care professionals, nurses are increasingly caring for those 

victimized by gun violence, and we are forced to confront the physical and 

emotional consequences of these senseless acts. We strongly urged our 

legislators to request funding for gun violence research by the Centers 

for Disease Control and Prevention, aimed at examining the causes and 

identifying effective prevention strategies. 

Senator John Hoeven Senator Heidi Heitkamp


Washington, DC June 21-23, 2018 

Our last point of discussion with legislators was to urge them to once 

again cosponsor H.R. 959 / S.1109 Title VIII Nursing Workforce 

Reauthorization Act and reauthorize nursing workforce development 

programs through fiscal year 2022. Current authorization for the programs 

is through 2020. Title VIII provides the largest source of federal funding for 

nursing education, and these programs are invaluable to institutions that 

educate registered nurses for practice in rural and medically underserved 

communities. For five decades, these programs have helped build the supply 

and distribution of qualified nurses needed in all health care settings. 

The 2018 ANA Membership Assembly officially began Friday morning, 

June 22nd and business was completed Saturday afternoon, June 23rd. 

President Pam Cipriano provided the opening remarks at the Assembly to 

over 300 attendees and noted that advocacy and activism had represented 

the tone and direction of ANA’s work over the past four years during 

her two terms as president. President Cipriano highlighted some of the 

accomplishments during her term including providing leadership during the 

Ebola crisis, fighting against harmful changes to health care policy after the 

2016 election and addressing workplace violence and safe staffing measures. 

She shared that ANA’s hard work and advocacy had prompted Forbes 

magazine to call ANA “an increasingly politically powerful lobbying force in 

Washington, DC and in state capitals across the country.” 

ANA’s Honorary Awards were presented to twelve outstanding nurses 

including Alexandra Wubbels, a Utah Nurses Association member who was 

awarded the Staff Nurse Patient Advocacy Award for her advocacy of an 

unconscious patient that resulted in her forcible arrest by police. Another 

notable award with President Cipriano’s selection of Jimmy Kimmel as the 

recipient of the President’s Award for Being an Advocate of Improved Health 

Care for All and Recognizing Life-Saving Work of the Nations Nurses. 

Membership Assembly attendees participated in three dialogue forums 

during the afternoon including: 

1) Secondary Opioid Exposure Considerations in Caring for Patients 

with Overdose; 

2) The ANA Presidential Endorsement Process; and 

3) The ANA Position Statement Euthanasia, Assisted Suicide, and Aid 

in Dying. 

During the final day of the 2018 Membership Assembly, eligible 

Assembly representatives approved and adopted recommendations from the 

Professional Policy Committee that were developed following the dialogue 

forums held the previous day. The recommendations call on ANA to: 

• Identify informational tools to inform students and nurses about 

responding to patients who have a potential opioid overdose, and 

advocate for funding and other support for research and development of 

evidence-based protocols regarding opioid overdose. 

• Refer consideration of the ANA presidential endorsement procedure 

back to the ANA Board of Directors for development of a revised 

proposal following further input from ANA members and stakeholders. 

• Incorporate the following into a revised position statement on 

aid in dying: Nurses must respect patients’ right to request aid in 

dying; nurses must be knowledgeable of the law regarding aid in 

dying in the state or territory in which they practice; while nurses 

are ethically permitted to participate in aid in dying, in states or 

territories where it is legal, they retain the right to conscientiously 

object; nurses must be able to provide information on aid in dying 

and provide emotional support to patients and families who face this 

decision at the end of life. 

Regional meetings held Friday evening provided an opportunity for 

state representatives to share updates regarding their state associations 

and accomplishments the past year. Candidates running for election for 

several open ANA positions who were able to attend the Assembly, joined 

the regional meetings and shared information about themselves and 

answered questions from state representatives. The Value-Based Pricing 

Pilot (VBPP) was discussed and states that had implemented VBPP had 

their representatives share updates, pros, and cons as well as suggestions for 

improvements and future considerations. 

Friday morning began with elections for open positions for board and 

committee members. Dr. Loressa Cole, the new ANA Enterprise CEO 

addressed the Assembly and expressed gratitude for her opportunity in her 

new role. She noted that “our nation and our patients are counting on us to 

show up and speak, and we must not fail them.” The day included a Policy 

Café, with six different topics presented for discussion including occupational 

licensing policy reform, assistive personnel medication administration, and 

the opioid crisis. 

Election results were shared in the afternoon, and we learned that Ernest 

Grant, ANA Board Vice-President and member of the North Carolina Nurses 

Association was elected as ANA’s next president. Dr. Grant is the first man 

elected to the position of ANA president. As part of the final business of the 

day, by acclamation, the Membership Assembly endorsed and updated the 

ANA board statement on the Trump Administration’s practice of separating 

children from families at the United States border. 

We cannot express what an honor and privilege it was for us to represent 

North Dakota nurses in our Nation’s Capital while meeting with our state’s 

senators and representative. We were treated with respect by our legislators 

and their staff who were all hospitable and provided us the opportunity to 

engage in meaningful and collaborative discussions. As we noted last year, 

we will once again include our experiences at the 2018 ANA Hill Day to our 

list of “most memorable nursing opportunities” during our nursing careers. 

The 2018 Membership Assembly was another historic event and provided 

us with an opportunity to join with our nurse colleagues around the nation 

to conduct the vital business of the Association. We are proud of the work 

accomplished during the Assembly and are grateful to have had the 

opportunity to be the voice of North Dakota nurses and to represent NDNA. 

Respectfully, 

Tammy Buchholz, MSN, RN, CNE 

NDNA Membership Assembly Representative 

Tessa Johnson, MSN, RN 

NDNA President 

2018 ANA Membership Assembly with President Pam Cipriano 2018 ANA Membership Assembly with Janet Haebler


Appraised by: Brittni Berg, RN & 

Christina Torgerson, RN 

Mayville State University RN-to-BSN students 

Clinical question: 

Does intermittent catherization for patients 

with urinary retention reduce the risk of 

urinary tract infections (UTIs) versus placing an 

indwelling catheter? 

Articles: 

Kelley, K., Johnson, T., Burgess, J., Timothy, J.N., Weireter, 

L., & Jay, N.C. (2017). Effect of implementation of 

intermittent straight catheter protocol on rate of 

urinary tract infections in a trauma population. The 

American Surgeon. 83(7) p.747-749. 

Kidd, E.A., Stewart, F., Kassis, N.C., Hom, E., & Omar, 

M.I. (2015). Urethral (indwelling or intermittent) 

or suprapubic routes for short-term catheterization 

in hospitalized adults. Cochrane Database of 

Systematic Reviews. 12 doi: 10.1002/14651858. 

CD004203.pub3 

Nyman, M.H., Gustafson, M., Langius-Eklof, 

A., Johansson, J., Norlin, R., & Hagberg, L. 

(2013). Intermittent versus indwelling urinary 

catheterization in hip surgery patients: A 

randomized controlled trial with cost-effectiveness 

analysis. International Journal of Nursing Studies. 

50(12) p. 1589-1598. 

Zhang, W., Liu, A., Hu, D., Xue, D., Li, C., Zhang, K., 

& Pan, Z. (2015). Indwelling versus intermittent 

urinary catheterization following total joint 

arthroplasty: A systematic review and metaanalysis. 

PlosONE, 10(7), 1-13. doi:10.1371/journal. 

pone.0130636 

Synthesis of evidence: 

This synthesis includes four studies related 

to evidence supportive of the proposed research 

question. The first study was conducted by Kelley, 

Johnson, Burgess, Timothy, Weireter, and Jay 

(2017), focuses on trauma patients and reviews 

infection rates with utilization of indwelling 

catheters compared to the use of an intermittent 

catheterization protocol. This is the only study 

which concluded improvements in catheter 

associated infection rates with utilization of 

intermittent urinary catheters. 

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The second study was conducted by Kidd, 

Stewart, Kassis, Hom, and Omar (2015), and 

was a review that analyzed 14 trials with 4,577 

participants comparing indwelling catheters with 

intermittent catheterization. Participants were 

randomly selected to either get an indwelling 

catheter or have intermittent catheterization. 

This Cochrane review concluded that there was 

insufficient evidence to support one method of 

catheterization over the other for reducing the risk 

of urinary tract infections. 

Nyman, Gustafson, Langius-Eklof, Johansson, 

Norlin, and Hagberg (2013), completed the next 

study, which involved two randomized controlled 

trials comparing the incidence of urinary tract 

infections between intermittent catheterization 

and indwelling catherization for surgical patients. 

There was a total of 170 participants between the 

two groups, 18 patients developed UTI symptoms; 

however, the study concluded that there was no 

significant difference of urinary infection rates 

between the two types of catherization. 

The last study by Zhang, Liu, Hu, Xue, Li, 

Zhang, and Pan, (2015), is a meta-analysis 

comparing the rates of urinary tract infections 

in patients following joint arthroplasty who are 

susceptible to post-operative urinary retention. 

The study involved nine random controlled trials 

and 1771 participants and again concluded that 

there was no increase in risk for urinary tract 

infections when using indwelling catheters versus 

intermittent catheter use. 

Bottom line: 

Evidence suggests that there is no 

significant increased risk for developing 

a urinary tract infection when using 

intermittent catheterization versus indwelling 

catheterization. Considerations to prevent 

urinary tract infection in catheter use are 

length of time the catheter is in place, need for 

catheter use, and maintaining proper technique 

when inserting catheters; however, currently 

there is insufficient evidence to recommend one 

method of catheterization versus the other when 

comparing urinary tract infection risks. 

Implications for nursing practice: 

When a patient is experiencing urinary 

retention, using a urinary catheter to relieve the 

bladder of urine is common practice. However, 

this practice puts patients at an increased risk 

of acquiring a urinary tract infection. The 

development of a urinary tract infection can 

prolong hospital stays, cause pain and discomfort 

to the patient, and will lead to additional costs 

to the healthcare organization. Nurses need to 

be aware of the correlation between catheter use 

and urinary tract infections to prevent catheter 

associated infections. It is the nurses due diligence 

to advocate for their patients utilizing evidencebased 

indications on whether a catheter is needed 

and beneficial to their care. Nurses can also 

support removal of catheters in the recommended 

time frame and utilize proper technique during 

catheterization to decrease the risk of urinary 

tract infections. The role of the nurse is crucial 

in the implementation of catheter use, care 

throughout the duration of catheter utilization; the 

goal being decreased infection rates for patients. 

The outcome of efficient processes will support 

patient satisfaction and quality care. 

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Appraisal by: Carissa Bucholz, RN; 

Kelly Stangl, RN; & Paul Koppinger, RN 


Clinical Question: 

Does the use of bedside reporting versus 

traditional nurse to nurse report affect patient 

satisfaction scores? 

Synthesis of Evidence 

Nursing care has been constantly evolving 

since it first began with the lady and the lamp. 

As time has gone on care has made a circle and 

now has a goal to be patient centered. One of the 

current issues faced is, once admitted to an acute 

facility how are patients involved in their care? A 

common problem seen in acute and ICU patient 

care setting is some patients are not even aware 

of what their admitting diagnosis is (source, year). 

With a different structure of report now taking 

place there has been a positive correlation noted 

between patient satisfaction scores and the use 

of bedside report (source, year). Nurse to nurse 

report is being taken out of an enclosed report 

room and brought back to the most important 

person involved in care, the patient. Report is 

now completed at bedside. Patient diagnoses 

are discussed, current therapies reviewed, and 

progress evaluated towards the goal of discharge. 

Bedside report is also utilized to introduce the 

oncoming nurse, allow the patient to participate 

in their plan of care and a safety check is typically 

completed at this time illustrating patientcentered 

care. 

Bedside Reporting 

In the article, Interprofessional collaborative 

care characteristics and the occurrence of 

bedside interprofessional rounds (2016) 29,173 

patients were assessed. 21,493 of them received 

some form of bedside report. The article goes 

on to explain that of the 74% of the patients 

that received this bedside reporting all 74% 

of those patients stated to have been more 

satisfied with this process and their care overall 

(Gonzalo, Himes, McGillen, Shifflet & Lehman, 

2016). This study was completed in a large 

501-bed university-based acute care hospital. 

The facility conducting the study were out to 

achieve >80% compliance to bedside reporting 

per day on each unit in the hospital to set clear 

expectations and understanding with the 

patients. Further evidence shows a positive 

backing that patient satisfaction scores have 

increased across the board where bedside report 

is utilized. In a literary review published in 

Med Surg Nursing (2013) barriers of bedside 

reporting reported were; lack of patient privacy 

that could potentially result in a HIPPA breach, 

time restraints issues increasing overtime and 

keeping nursing staff on board. It was found 

that 90% of nurses encountered one of the above 

issues (Sherman, Sand-Keclin & Johnson, 2013). 

Through research these barriers appear to 

occur in the majority of the studies. In an article 

published in BMC Medical Services Research 

(2016) the use of bedside report added patient 

validity to their care and this was beneficial in 

the development of patient centered care (O’Hara 

et al, 2016). 

Bottom Line and Implications for the 

Nursing Practice 

With the implementation of bedside reporting, 

a more elaborate professional relationship has 

developed between patient and nurse. With the 

goal of making care patient centered the patient 

officially becomes a member of their own care 

team. Though bedside report has shown promise, 

further research needs to be completed to better 

understand what bedside reporting adds to patient 

care. With further research the current barriers 

that are being faced by multiple facilities will be a 

thing of the past. 

References 

Gonzalo, J. D., Himes, J., McGillen, B., Shifflet, V., & 

Lehman, E. (2016). Interprofessional collaborative 

care characteristics and the occurrence of bedside 

interprofessional rounds: a cross-sectional 

analysis. BMC Health Services Research, 161-9. 

doi:10.1186/s12913-016-1714-x 

O’Hara, J. K., Lawton, R. J., Armitage, G., Sheard, L., 

Marsh, C., Cocks, K., . . . Wright, J. (2016). The 

patient reporting and action for a safe environment 

(PRASE) intervention: A feasibility study. BMC 

Health Services Research, 16(1). doi:10.1186/s12913- 

016-1919-z 

Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). 

Investigating bedside nursing report: a synthesis of 

the literature. MEDSURG Nursing, 22(5), 308-318. 

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Does Bedside Reporting 

Affect Patients Perception of 

Involvement in Their Plan Care? 

Appraised by: Kayla Beauchamp, RN; Shanda Harstad, RN; 

Carla Monjaras, RN; Mayville State University RN-to-BSN students 


Does bedside reporting affect patients' perception of involvement in their 

plan of care? 

Articles: 

Ford, Y., Heyman, A., & Chapman, Y. L. (2014). Patients' perceptions of bedside handoff: 

The need for a culture of always. Journal of Nursing Care Quality, 29(4), 371-378. 

Reinbeck, D. M., & Fitzsimons, V. (2013). Improving the patient experience through 

bedside shift report. Nursing Management, 44(2), 16-17. doi:10.1097/01. 

NUMA.0000426141.68409.00 

Rogers, J., Li, R., Clements, R., Casperson, S., & Sifri, C. (2017). Can we talk? The 

bedside report project.Critical Care Nurse, 37(2), 104-107. doi:10.4037/ccn2017369 

Sadule-Rios, N. (2017). Off to a good start: Bedside report. MEDSURG Nursing, 26(5), 

343-345. 

Tobiano, G., Chaboyer, W., & Mcmurray, A. (2012). Family members’ perceptions of 

the nursing bedside handover. Journal of Clinical Nursing, 22(1-2), 192-200. 

doi:10.1111/j.1365-2702.2012.04212.x 


Hospitals encourage bedside reporting to encourage patients be involved in 

their plan of care. The nurse must provide change of shift report promoting 

patient safety and including patients in their plans of care. The literature 

search for our team’s PICO question was conducted by including key 

terms: handoff, bedside, report, nursing, patient's perspective, and patient 

satisfaction. These terms were searched through the EBSCOhost research 

database and the Cochrane database of systems provided by the Mayville 

State University library. 

After collecting data through observation, field notes, and interviewing 

in a rehab ward, Tobiano, Chaboyer, and Mcmurray (2012) concluded beside 

report gives an opportunity for families to be involved in their loved one's 

care. Families appreciate the opportunity to participate. 

Rogers, Li, Clements, Casperson, and Sifri (2017), researched bedside 

reporting by using a guided platform that was created based on SBAR. The 

tool was called the 5Ps and includes the patient, background, plan, problem, 

precautions. Through observation of nursing compliance of bedside reporting 

and patient's satisfaction reports, medication errors and falls reduced by 

80% and 100%, respectively. Patient satisfaction increased 23%, while family 

satisfaction increased 12% (Rogers et al., 2017). 

Sadule-Rios, (2017) studied how patients felt about bedside reporting 

by reviewing Hospital Consumer Assessment of Healthcare Providers and 

Systems (HCAHPS) scores to determine patient satisfaction. Scores improved 

in all four patient areas on the survey, which include communication, being 

treated with respect, being listened to, and having things explained in a 

way they understand. The survey also noted nurses felt better about bedside 

reporting because they were able to lay eyes on their patients and start safety 

checks sooner (Sadule-Rios, 2017). 

Bottom line: 

Bedside report influences patients' perception of involvement in their care. By 

bringing the report to the bedside, patients are able to hear the plan for their 

day and participate in their plan of care. As the trend continues to provide 

patient-centered care, bedside report is an instrumental intervention. Patients 

can also clear up missing information and help ensure effective communication. 


It is important to adapt this nursing practice in healthcare settings. 

Bedside reporting promotes patient safety and autonomy. Ford, Heyman, 

& Chapman, (2014) suggested a culture of bedside reporting by conducting 

a "flash mob" (unannounced observation of compliance) and sharing 

positive highlights in huddles or meetings. Reinbeck and Fitzsimons (2013) 

state "bedside report has been shown to empower staff, improve patient 

involvement, and allow for a safe transition of care between providers. It 

establishes and promotes trusting relationships between patients and staff 

members, which serve as a foundation for teamwork" (p. 17). 

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A Systematic Review of 

Parkinson’s Disease Research 

in the United States 

Summer Hayes, Ben Maurer, Taylor Trager, and Maria Zutz; BA Nursing 

Students, with Dr. Jennifer Bailey DeJong, Faculty Mentor, PhD, FNP-BC, 

Associate Professor of Nursing, Concordia College, Moorhead, MN 

Purpose 

The aim of this systematic review was to investigate and synthesize 

research on the current state of Parkinson’s disease (PD) research in the 

United States. 

Methods 

A systematic literature review was conducted and the authors equally 

divided the studies using both CINAHL and PubMed databases. Eligibility 

criteria for the population included subjects diagnosed with Parkinson’s 

disease, and/or the pharmacological or nonpharmacological intervention 

being assessed was being investigated as a potential treatment for PD. Only 

English-language articles were included. The database search strategy 

yielded 13,625 citations. These results were narrowed to 510 studies when 

the terms were limited to “Parkinson’s disease” and “Nursing.” The results 

were reduced further with the search criteria of “Parkinson’s disease,” 

“Nursing,” and “Treatment,” resulting in 99 articles published between 

2011 and 2018. 

Results 

The biggest gaps in the literature were the absence of specific 

treatments based on differing severities and comorbidities of PD. This 

is likely due to PD manifestations commonly being inconsistent between 

individuals. This often makes care of the PD client complex because 

the multispecialty team must design care from a very individualized 

approach. In addition, no evidence-based templates for such care models 

to describe how Parkinson’s treatment should be organized have been 

developed. The studies assessed that included nursing, were primarily on 

how to manage PD in the community, used sample sizes of 9 to 400 and 

used a multi-site, single-blinded, patient-level randomized-controlled trial, 

and longitudinal designs. 

Nursing Implications 

Findings suggest that a community-based interdisciplinary approach to 

treating Parkinson’s disease is most effective, combining physical therapy 

for postural instability, pharmacotherapies, and community health nurses 

to ensure compliance to the treatment plan. Dance therapy is also an 

emerging therapy to treat tremors associated with Parkinson’s. A major 

theme throughout the articles focused on the development of the specialist 

nurse role, who could individualize a patient-centered holistic approach to the 

patient’s PD treatment. 

Discussion 

Gaps in the literature exist. Further research should be conducted on 

the physical, medical and surgical interventions in advanced stages of 

Parkinson’s disease when postural instability is increasingly unresponsive 

to treatment. In addition, research should continue to branch into known 

successful treatments and therapies for other chronic conditions and 

diseases. Although some studies did not directly apply treatments to patients, 

research did provide evidence of future frameworks and therapies to help 

better the lives of patients with Parkinson’s disease. 

Resources 

Cassimatis, C., Liu, K. Y., Fahey, P., & Bissett, M. (2016). The effectiveness of 

external sensory cues in improving functional performance in individuals 

with Parkinson's disease: a systematic review with meta-analysis. 

International Journal of Rehabilitation Research, 39(3), 211-218. doi:10.1097/ 

MRR.0000000000000171 

Connor, K., Cheng, E., Siebens, H. C., Lee, M. L., Mittman, B. S., Ganz, D. A., & 

Vickrey, B. (2015). Study protocol of "CHAPS": a randomized controlled 

trial protocol of Care Coordination for Health Promotion and Activities 

in Parkinson's Disease to improve the quality of care for individuals with 

Parkinson's disease. BMC Neurology, 15(1), 1-13. doi:10.1186/s12883-015- 

0506-y 

de Natale, E. R., Paulus, K. S., Aiello, E., Sanna, B., Manca, A., Sotgiu, G., & 

... Deriu, F. (2017). Dance therapy improves motor and cognitive functions 

in patients with Parkinson's disease. Neurorehabilitation, 40(1), 141-144. 

doi:10.3233/NRE-161399 

Gibson, G. (2017). What can the treatment of Parkinson's disease learn from 

dementia care; applying a bio-psycho-social approach to Parkinson's disease. 

International Journal of Older People Nursing, 12(4), n/a. doi:10.1111/ 

opn.12159 

Heisters, D. (2011). Focus on Parkinson's: causes, treatment and support. British 

Journal of Community Nursing, 16(4), 182-183. 

Kim, S., Allen, N., Canning, C., & Fung, V. (2013). Postural Instability in Patients 

with Parkinson's Disease. CNS Drugs, 27(2), 97-112. doi:10.1007/s40263-012- 

0012-3 

Magennis, B., Lynch, T., & Corry, M. (2014). Current trends in the medical 

management of Parkinson's disease: implications for nursing practice. British 

Journal of Neuroscience Nursing, 10(2), 67-74. 

Siok Bee, T., Williams, A. F., & Kelly, D. (2014). Effectiveness of multidisciplinary 

interventions to improve the quality of life for people with Parkinson's disease: 

A systematic review. International Journal of Nursing Studies, 51(1), 166-174. 

doi:10.1016/j.ijnurstu.2013.03.009 

Van der Marck, M. A., & Bloem, B. R. (2014). How to organize multispecialty care for 

patients with Parkinson's disease. Parkinsonism & Related Disorders, 20S, 167- 

73. doi:10.1016/S1353-8020(13)70040-3


Hourly Rounding Falls 

Appraised by: Crystal Graening, RN; 

Breanna Hanan, RN; & Kathyrn Kapocius, RN 



When caring for an elderly patient in the 

hospital, how do hourly rounds affect the incidence 

of falls on the unit compared to a unit that doesn't 

utilize hourly rounding? 

Articles: 

ECRI Institute. (2016) Falls. Retrieved from https:// 

www.ecri.org/components/HRC/Pages/SafSec2. 

aspx?tab=2# 

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, 

J. (2015). Hourly rounding and patient falls: What 

factors boost success? Nursing, 45(2), 25-30. doi: 

10.1097/01.NURSE.0000459798.79840.95 

Hicks, D. (2015). Can Rounding Reduce Patient Falls 

in Acute Care? An Integrative Literature Review. 

MEDSURG Nursing, 24(1), 51-55. Retrieved from 

https://odinproxy04.odin.nodak.edu:2162/ehost/ 

pdfviewer/pdfviewer?vid=1&sid=c98a339e-04c7- 

4ca1- 9a00-3345fe4ae322%40sessionmgr120 

Weisgram, B., & Raymond, S. (2008). Using Evidence- 

Based Nursing Rounds to Improve Patient 

Outcomes. MEDSURG Nursing, 17(6), 429- 

430. Retrieved from https://odinproxy04. 

odin.nodak.edu:2164/ehost/pdfviewer/ 

pdfviewer?vid=1&sid=b268903f-f532-4a20-acb9- 

4b1de6657545%40sessionmgr4008 


As nurses, we are aware of the huge problems 

that falls can cause. Within hospitals, falls are one 

of the top reported adverse events occurring every 

year (Hicks, 2015). Fall rates range from 1.3 to 8.9 

falls per 1000 inpatient days spent in acute care, 

30% of which are estimated to result in serious 

injury to the patient (Goldsack, Bergey, Mascioli, 

& Cunningham, 2015). Through research, we 

attempted to determine if there is any relation 

between the practice of hourly rounding by 

nursing staff within hospitals and reducing the 

number of falls that occur during hospitalizations. 

In looking through research as to what has 

helped hospitals deter and prevent falls, we focused 

on whether the implementation of hourly rounding 

by nursing staff decreased the number of falls 

occurring within inpatient acute care settings. We 

used EBSCOHOST research databases as well 

as the Cochrane database. We focused on articles 

that had been published within the past 10 years 

and within a peer-reviewed journal. If the article 

discussed hourly rounding and fall prevention 

outside the acute care setting, it was dismissed, as 

our focus was on the inpatient setting. 

The studies used various methods to research 

whether or not there is any correlation between 

hourly rounding and fall prevention. Two of 

the studies focused on the actual process of 

hourly rounding, using various ways to look 

at and measure the impact of hourly rounding 

on different units within different hospitals. 

The studies also used multiple methods of 

implementing hourly rounding to try to determine 

what works best for units and what helps nursing 

staff be more receptive of the process. In the first 

study, when nursing leadership and support by 

front line staff for hourly rounding was present 

on a particular unit, falls dramatically decreased 

after the implementation of hourly rounding 

(Goldsack et al., 2015). However, in the same study 

on a different unit that did not have this support 

and simply implemented hourly rounding without 

any guidelines, no significant impact was seen 

(Goldsack et al., 2015). 

Another study looked at 14 articles using 

an integrative review method to help provide 

research to whether hourly rounding is beneficial 

to preventing falls in hospitalized patients 

(Hicks, 2015). While most studies highlighted 

showed a positive effect on fall rates during the 

implementation of hourly rounding, limitations 

of the studies were also identified, such as 

nonrandomized samples, small sample sizes, 

and the time given to collect data for the studies. 

Because of this, most of the studies were unable 

to show whether hourly rounding and the positive 

effect it had on fall prevention could be sustained 

long term. 

Two other articles focused on investigating 

what was causing falls. From there, further 

effort was made to implement hourly rounding 

with specific guidelines and steps to determine if 

hourly rounding could impact fall rates based on 

what was causing them. These studies were again 

limited by sample sizes and time; however, both 

highlighted the significant impact hourly rounding 

can have on fall prevention if it is consistent and 

has the support of leadership and staff. 

SAVE THE DATE 

“HEALTHY NURSE, HEALTHY NATION: 

Creating a Culture of Strength Through 

Diversity and Inclusion” 

September 28th 

Heritage Center, Bismarck 

Topics will include: 

Diversity & Differences: Connecting with Others, 

Yourself, and Your Creativity, 

Music and Expressive Therapies: A Bridge to Inclusivity, 

One Planet, One People: Building Tolerance in a 

Community, 

Overcoming a Cultural Clash: A Medical & Ethical View 

Heart Centered Healing 

Bottom line: 

Studies thus far have identified that with 

strong support by nursing staff and nurse 

leaders, hourly rounding can lead to fewer falls. 

While initial research shows positive impacts on 

decreasing falls in the hospital through hourly 

rounding, research has failed to fully address 

the impact both due to limited longevity and 

patient uniqueness. Because of this, research is 

inconclusive on whether hourly rounding affects 

the incidence of falls on units within hospitals 

compared to units that do not utilize it. Further 

research and better methods to implement hourly 

rounding need to occur to more fully explore the 

impact of hourly rounding on falls within the 

inpatient setting. 


Patient falls have been an important topic in 

nursing as falls have been shown to cause severe 

patient injuries, lengthen days of hospital stay, 

and increase healthcare costs (ECRI, 2016). Falls 

are also happening more and more. Nurses must 

be diligent about fall prevention interventions to 

provide the best care possible and decrease those 

statistics. There is promising research that shows 

hourly rounding that is purposeful and carried 

out each and every shift by all nursing staff can 

decrease the number of falls that occur during 

hospitalizations. Nurses need to be aware of and 

educate themselves on the positive effects hourly 

rounding can have and work to include hourly 

rounds daily. Nurses should also be advocators 

of having hourly rounding implemented on their 

units with support from nursing leadership so that 

it is accepted and practiced to the point that it 

makes a positive impact on decreasing falls. 

Registration online via the 

NDNA Facebook page or 

website at www.ndna.org 

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Emily Goff, Emily Hughes, Emma Mitzel, and 

Brandon Quibell; BA Nursing Students, with 

Dr. Jennifer Bailey DeJong, Faculty Mentor, 

PhD, FNP-BC, Associate Professor of Nursing, 

Concordia College, Moorhead, MN 

Introduction 

ALS, or amyotrophic lateral sclerosis, is a 

progressive neurodegenerative disease that affects 

nerve cells in the brain and spinal cord. In ALS, 

motor neurons degenerate and lose their ability to 

function. With the loss of muscle movement, those 

diagnosed with ALS can lose their ability to speak, 

eat, move and breathe. Symptoms vary from 

person to person. Though the rate of degeneration 

varies, progressive muscle weakness and paralysis 

are universally experienced. Diagnosis of ALS is 

difficult and is usually found by ruling out other 

diseases that mimic ALS. Since discovering the 

disease in 1869, there have been many strides. 

In the recent years, researchers have intensely 

studied the physiology of ALS. Unfortunately, the 

FDA has only approved one drug for the treatment 

of ALS – Riluzole. Though this drug does not 

cure ALS, it does slow the progression of the 

disease. While there are many studies on ALS, 

outcomes to date have not significantly altered 

providers’ approach to treatment (ALS Association, 

2018). The aim of this systematic review was to 

investigate and synthesize research on the current 

state of ALS treatment. 

Method 

A literature search of PubMed using the terms 

“ALS and treatment” within the last five years in 

full-text and English retrieved 2,122 results. The 

same search criteria was used on CINAHL which 

resulted in a total of 35 articles. 

A team of four members each spent one and a 

half hours searching for articles using the above 

search terms, resulting in a total of six hours of 

extensive literature search. From each search, 

the number of articles published exclusively in 

the year 2013 were recorded. This process of 

analysis continued year by year until the team 

finalized its review in present day (March 2018). 

In addition to the number of articles found within 

each year, key terms were recorded in order to 

The State of ALS Treatment: 

A Systematic Review of Current Research 

understand what the predominant themes were 

in each article. 

Results 

Using the terms “ALS and treatment”, the 

numbers of articles retrieved from the two 

databases varied widely between 2013 and 2017. 

PubMed 

CINAHL 

2013- 324 (15%) 6 (17%) 

2014- 397 (19%) 4 (11%) 

2015- 435 (20.5) 9 (26%) 

2016- 446 (21%) 13 (37%) 

2017- 467 (22%) 3 (9%) 

2018- 53 (2.5%) 0 (0%) 

Because of the large numbers of articles and 

wide variability of the themes, the team decided 

to narrow its search further by only examining 

articles published in 2018. This resulted in 53 

articles from PubMed and zero from CINAHL. 

After locating articles, the team identified the 

purpose of each article and separated them into 

one of five overarching categories: a) geneticfocused 

treatment, b) drug treatment, c) nutrition, 

d) alternative treatments, and e) other. Geneticfocused 

treatments were the theme in 40% of 

the articles (21 of 53) and included research 

on the C9OR72 gene, RNA G-quadruplexes, 

SCAAV9-h1GF1, TDP-43, and SOD1. Articles 

discussing drug therapies made up 30% (16 

of 53). Some of the main drugs highlighted 

included Riluzole, anti-inflammatory drugs, 

and immunosuppressants. Nutrition articles 

constituted only three of the 53 articles (0.05%) 

and were related to iron and creatinine therapies. 

Of the 53 articles, eight (15%) highlighted 

alternative treatment therapies, including 

spinal therapies, decreasing fatigue, and the 

use of assistive technology devices. The “other 

treatments” category comprised nine percent (5 of 

53), and primarily discussed access to care. 

Discussion 

Based on a systematic review of literature in 

2018, using PubMed and CINAHL, there is a 

need for further investigation of how nutrition 

or alternative approaches in the treatment 

of ALS impacts outcomes. Another area that 

needs more investigation using an experimental 

design is the effects of ALS treatment on actual 

patients. Researchers note that the effects 

of ALS treatment are not clearly identified 

because there is lack of supporting evidence for 

patient outcomes. 

A potential limitation of the systematic 

review is that only two databases were analyzed. 

The team only focused on studies from 2018 

(encompassing 2½ months of study); therefore, 

the research is not reflective of all research on 

ALS that is “current.” If the team had narrowed 

the search using the terms “nutrition” and “ALS,” 

results over the last few years may indicate no gap 

at all. In short, research articles from 2018 may 

not mirror the types of studies completed recently. 

Conclusions 


investigate and synthesize the current state of 

ALS research. While the team found numerous 

articles on ALS, the treatment themes were broad. 

No one specific treatment approach was identified 

as beneficial to all patients with ALS. Further 

research needs to be conducted. Gene therapy 

and drug therapy are trending in 2018 and will 

continue to evolve. Finally, application of findings 

from research studies to actual patients with ALS 

is necessary to fully understand the effectiveness 

of treatment. 

References 

Amyotrophic Lateral Sclerosis (ALS) Fact Sheet. (n.d.). 

Retrieved February 22, 2018 

Dorst, J., Ludolph, A. C., Huebers A., (2018). 

“Disease-modifying and symptomatic 

treatment of amyotrophic lateral sclerosis.” doi: 

10.1177/1756285617734734 

Herrmann, D., Parlato, R. (2018). “C9orf72-associated 

neurodegeneration in ALS-FTD: breaking 

new ground in ribosomal RNA and nucleolar 

dysfunction.” Cell Tissue Res. doi: 10.1007/s00441- 

018-2806-1. 

Oh, J., Oh S.I., Kim, J.A, (2018). “The amyotrophic 

lateral sclerosis supportive careneeds assessment 

instrument: Development and psychometric 

evaluation.” Palliative Support Care. doi: 10.1017/ 

S1478951517001250 

Mathis, S., Le Masson, G. (2018). “RNA-Targeted 

Therapies and Amyotrophic Lateral 

Sclerosis.” Biomedicines. 6(1). doi: 10.3390/ 

biomedicines6010009. 

“What is ALS?” (n.d.). Retrieved February 22, 2018, 

http://www.alsa.org/about-als/what-is-als.html


Effects of Exercise on Patients 

Diagnosed with Multiple Sclerosis: 


Abbey Domyahn, Sadie Ness, Sofia Olesen, Brianna Poppenga, 

Elizabeth Viergutz; BA Nursing Students, with Dr. Jennifer Bailey DeJong, 

Faculty Mentor, PhD, FNP-BC, Associate Professor of Nursing, 


Introduction 


the current evidence on the effects of exercise on patients diagnosed with 

Multiple Sclerosis (MS). 

Method 

A literature search was completed using the Cumulative Index to 

Nursing & Allied Health Literature (CINAHL) database. The database 

strategy yielded 1,580 citations. These results were narrowed to 105 studies 

based on the inclusion criteria by adding “exercise” to search results. 

Results were narrowed further to 50 studies by adding “gait” to the search 

criteria. Team members equally divided the articles for analysis. 

Results 

Search results indicate that extensive research has been done in the last 

five years on this topic. The studies commonly focused on the benefits and 

disadvantages of different forms of physical activity in patients with mild 

and moderate cases of multiple sclerosis. Sample sizes ranged from nine 

to 50 participants. A combination of qualitative and quantitative research 

methods were employed. The majority of the studies were conducted in the 

United States, Australia, Norway, and Canada. 

Discussion 

There is supporting evidence that a variety of exercises for those with 

MS reduces levels of fatigue and depression while also improving quality 

of life and mobility. Exercise was also shown to enhance the mental health 

of patients diagnosed with MS. In multiple articles, the effectiveness of 

behavioral change strategies, such as motivational interviewing, in relation 

to exercise and MS were studied. 

Yet, gaps in the literature exist. Many of the studies only included 

patients diagnosed with mild to moderate stages of MS and didn’t include 

patients with severe disability. Researchers also reported difficulty in 

measuring levels of client fatigue. Other concerns included: the use of vague 

descriptions of the exercises employed, and the use of varying tools when 

measuring levels of disability. 

Galea, M. P., Lizama, L. C., Butzkueven, H., & Kilpatrick, T. J. (2017). Gait and 

balance deterioration over a 12-month period in multiple sclerosis patients 

with EDSS scores ≤ 3.0. Neurorehabilitation, 40(2), 277-284. doi:10.3233/NRE- 

161413 

Jolk, C., Dalgas, U., Osada, N., Platen, P., & Marziniak, M. (2015). Effects of 

sports climbing on muscle performance and balance for patients with multiple 

sclerosis: A case series. International Journal of Therapy & Rehabilitation, 

22(8), 371-376. Retrieved from http://web.b.ebscohost.com/ehost/detail/ 

detail?vid=26&sid=56a8d173-1383-422c-b406-305f6889de90%40sessionmgr10 

4&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=109826392&db 

=rzh 

Krüger, T., Behrens, J. R., Grobelny, A., Otte, K., Mansow Model, S., Kayser, B., 

...et al. Schmitz-Hübsch, T. (2017). Subjective and objective assessment of 

physical activity in multiple sclerosis and their relation to health-related 

quality of life. BMC Neurology, 17(1-12). doi:10.1186/s12883-016-0783-0 

Larson, R. D., McCully, K. K., Larson, D. J., Pryor, W. M., & White, L. J. (2014). 

Lower-limb performance disparities: Implications for exercise prescription in 

multiple sclerosis. Journal of Rehabilitation Research & Development, 51(10), 

1537-1543. doi:10.1682/JRRD.2013.09.0191 

Learmonth, Y. C., Adamson, B. C., Balto, J. M., Chiu, C., Molina-Guzman, I., 

Finlayson, M., ... et al.(2017). Multiple sclerosis patients need and want 

information on exercise promotion from healthcare providers: a qualitative 

study. Health Expectations, 20(4), 574-583. doi:10.1111/hex.12482 

Padgett, P. K., & Kasser, S. L. (2013). Exercise for managing the symptoms of 

multiple sclerosis. Physical Therapy, 93(6), 723-728. doi:10.2522/ptj.20120178 

Smith, C. M., Hale, L. A., Olson, K., Baxter, G. D., & Schneiders, A. G. (2013). 

Healthcare provider beliefs about exercise and fatigue in people with multiple 

sclerosis. Journal Of Rehabilitation Research & Development, 50(5), 733-743. 

doi:10.1682/JRRD.2012.01.0012 

Smith, D. C., Lanesskog, D., Cleeland, L., Motl, R., Weikert, M., & Dlugonski, D. 

(2012). Motivational interviewing may improve exercise experience for people 

with multiple sclerosis: A small randomized trial. Health & Social Work, 37(2), 

99-109. doi:hsw/hls011 

Swank, C., Thompson, M., & Medley, A. (2013). Aerobic exercise in people with 

multiple sclerosis: Its feasibility and secondary benefits. International Journal 

of MS Care, 15(3), 138–145. http://doi.org/10.7224/1537-2073.2012-037 

Conclusions 


research completed in the last five years to report the current state of 

exercise recommendations for patients diagnosed with MS. Findings 

suggest exercise for those with MS reduces levels of fatigue and depression 

while also improving quality of life and mobility. Further research should 

be conducted on the effects of exercise on MS. Likewise, the effects of 

exercise on self-esteem and body image in patients with MS should be 

considered. In addition, research should focus on the short- and long-term 

effects of exercise programs and the levels of exercise required to benefit 

patients of varying levels of disability. 

References 

Brændvik, S. M., Koret, T., Helbostad, J. L., Lorås, H., Bråthen, G., Hovdal, 

H. O., ...et al. (2016). Treadmill training or progressive strength training 

to improve walking in people with multiple sclerosis? A randomized 

parallel group trial. Physiotherapy Research International, 21(4), 228-236. 

doi:10.1002/pri.1636 

Doring, A., Pfueller,C. F., Friedemann, P., & Dörr, P. (2012). Exercise in multiple 

sclerosis–an integral component of disease management. Springer EMPA 

Journal 3(1), 2. doi.org/10.1007/s13167-011-0136-4


Use of Dinutuximab in Pediatric Neuroblastoma Treatment: 


Jordan Martins, Max Nelson, Erik Sneltjes, 

and Becca Trunk; BA Nursing Students, with 

Dr. Jennifer Bailey DeJong, Faculty Mentor, 

PhD, FNP-BC, Associate Professor of Nursing, 


Intro 

The aim of this systematic review is to 

investigate and synthesize research on the 

current state of the drug Dinutuximab when 

used to treat pediatric neuroblastoma. The 

following research was synthesized in the last 

five years to report the current state of the 

science related to Dinutuximab treatment for 

pediatric neuroblastoma. 

Methods 

Eligibility Criteria 

The inclusion criteria were Dinutuximab 

treatment that included children ages 18 months 

to under the age of 21 with sufficient organ 

function in the sample population and original 

national research. The search was limited to 

English-language articles from January 2013 to 

October 2017. 

Search 

A literature search was completed with the 

assistance of a professional academic librarian 

in two databases: PubMed (MEDLINE) and 

Cumulative Index to Nursing and Allied Health 

Literature (CINAHL). Keywords used to retrieve 

sources were ‘neuroblastoma,’ ‘pediatric,’ and 

‘treatment Dinutuximab,’ providing the search 

strategies for both databases. 

Study Selection 

The database search strategy for CINAHL 

yielded 476 citations. These results were 

narrowed down to seven studies based on 

inclusion criteria. The same search strategy 

was applied in PubMed and yielded 3,713 

citations. After adding the key terms once again 

for inclusion criteria, 31 studies were obtained. 

After further inspection of the studies, seven 

more were chosen for further evaluation and 

synthesis. An illustration of the study selection 

is presented in the figure below. References 

of the final 14 articles found were reviewed for 

additional articles. No additional articles were 

added. All 14 of the articles’ studies reviewed 

were conducted in the United States. 

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Dakota College at Bottineau distance site in Valley City, ND 

Seeking an instructor to teach courses in its nursing program to 

undergraduate students in practical nursing and associate degree nursing programs. The 

person selected for this position will be responsible for the planning, implementation, 

teaching, and evaluation of student learning experiences in the classroom and clinical areas 

with nursing students enrolled in the Dakota Nursing Program. This is a 9-month benefited 

position with an opportunity for additional work during the summer. 

Master of Science in Nursing, Nursing Education, or related area, or currently enrolled in a master’s 

degree program with an education plan approved by the CNE which will allow completion of the 

master’s degree program within three years. Candidates also need to possess a current ND RN 

license and maintain continuing education as required by the ND State Board of Nursing 

Competitive salary based on education and experience. Comprehensive fringe benefit 

package including TIAA-CREF retirement plan and full coverage for family health insurance 

for full-time nursing faculty. 

Screening will begin on July 1, 2018 and will continue until a qualified applicant is selected 

APPLICATION INSTRUCTIONS: Send a letter of application, resume, college transcripts 

and the information for three professional references to: HR Manager, 

Dakota College at Bottineau, 105 Simrall Blvd, Bottineau, ND 58318 or 

email to: dcbhuman.resources@dakotacollege.edu 

Dakota College at Bottineau is an Equal Opportunity/Affirmative Action employer. 

Data Collection Process 

A data extraction form was created for the 14 

identified research articles. The authors equally 

divided the studies and individually extracted 

the following data: design, purpose, sample, 

intervention, control, measurements, outcomes, 

limitations, and notes. The data was then 

checked by all four authors and a consensus was 

reached. A summary narrative was conducted. 

Results 

The biggest gap in the literature was an 

inconsistency of studies available. Each study 

had a different focus about Dinutuximab 

therapy such as side effects and nursing care, 

maintainance therapy, side effects, mechanism 

of action of the drug, and how the drug was 

developed. There were few studies on each 

specific topic. 

Designs 

Six studies used a quantitative design, with 

three using experimental design, one quasi 

experimental design, one correlational design, 

and one randomized-experimental design. Eight 

studies used a qualitative design, including six 

literature reviews, one being a review of multiple 

correlational and experimental studies, one being 

a review of quantitative studies, and two literature 

reviews. Two case studies were included in the 

qualitative design research articles. 

Sample & Setting 

All of the quantitative studies had sample 

sizes ranging from 28 - 289 patients, with the 

median of 226. There were two sample sizes 

in the qualitative studies, both were the case 

studies found, including one 3 year old and one 5 

year old child. 

A variety of professions and settings were 

represented in the studies. Pediatric patients 

with neuroblastoma receiving Dinutuximab 

treatment was deemed the priority inclusion 

criteria (n = 14). There were multiple disciplines 

who performed the research with the pediatric 

patients or laboratory mice. Seven studies 

included medical doctors. Seven studies 

included professional researchers. Four studies 

included registered nurses. Three studies 

included pharmacists. Two studies included 

advanced practice nurses. Four different studies 

included one of the following professions; 

transfusionist, nursing student, pathologist, 

and a laboratory technician. 

Nine studies were conducted in the practice 

setting, on a pediatric oncology unit. Three 

studies were located outside of the practice 

setting for literature review. Two studies were in 

a research setting, testing mice. 

Interventions 

The interventions included the treatment of 

either maintenance or induction therapy, using 

the drug Dinutuximab (dosing ranging from 80- 

160 mg/m2), for the pediatric neuroblastoma 

population, adults with low-burden tumor 

follicular lymphoma, or mice that were injected 

with the neuroblastoma cancer cells. 

Bottineau, ND 

Full-Time RN/LPN 

Also hiring CNAs and 

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www.standrewshealth.com 

Measurement Instrument 

The quantitative studies used the EFS 

(five year survival rate) to measure if the 

interventions were successful or had no 

therapeutic effect. The goal of the treatment was 

to remain free of signs of tumor development or 

decrease the growth of neuroblastoma tumors 

in the pediatric population. Another instrument 

used in qualitative designs was observation, 

which then documented the patient's outcomes 

during and after treatment with Dinutuximab. 

Outcomes 

Study outcomes were generally positive, but 

negative outcomes were reported in a number of 

studies. Dinutuximab’s effectiveness primarily 

targeted a specific genotype (KIR3DL1+/HLA- 

Bw4+) when outcomes were positive. Three 

studies focused more on the side effects and 

management of the complicated treatment regimen 

of Dinutuximab, rather than the outcomes. 

Discussion 

Only five studies implemented an experimental 

research design and only one study implemented 

a randomized design. This may be a direct result 

as to why the focus of the research gathered 

is scattered. The search yielded information 

about maintenance therapy, side effects, nursing 

implications, mechanism of action, development 

of the drug, and five year survival rates (ESF) 

of patients using the medication. Although 

there were commonalities throughout the 

articles, the largest was that Dinutuximab is an 

effective drug during maintenance therapy of 

neuroblastoma treatment. In all five qualitative 

studies, the ESF increased when the patients 

added Dinutuximab to the therapy. Patients were 

generally healthy during the treatment regimen, 

therefore there were no delays in receiving 

Dinutuximab, which increased the efficacy of the 

medication. Furthermore, the size of the tumors 

did not increase in size or began to reduce in size 

when the medication was added to treatment. 

Decreasing tumor sizes or allowing the size to 

remain stagnant increases the chance for the 

child to continue in remission with possible 

cure. In addition, nursing considerations such 

as understanding typical side effects of the 

medication were prominent in many literature 

reviews. Nurses should be aware that pain and 

fever are the two most common side effects, 

therefore a patient should be administered 

acetaminophen or morphine prior to induction of 

the medication if they have had the side effects in 

the past. Other common side effects are changes 

in blood pressure, complete blood count (CBC), 

or electrolytes, which are monitored and treated 

daily, and anaphylaxis which occurs in less than 

two percent of all patients. Following standards 

of care, the side effects should be caught before 

irreversible damage occurs to the patient. 

Still gaps in the literature remain; an area 

needing investigation is using the experimental 

design in the treatment regimen of Dinutuximab 

on low risk vs standard risk vs high risk 

pediatric neuroblastoma to see if the effects/ 

outcomes of the treatment differ based on the 

severity of the cancer. Another area of research 

to further examine would be the effects of 

Dinutuximab on pediatric neuroblastoma 

patients in remission and compare that to the 

effects of the drug during induction therapy, so 

the medication regimen can be more regulated. 

Furthermore, the validated instruments in the 

review of research evaluated survival rates, 

therapeutic effects, and side effects of treatment, 

which coincide in both the qualitative and 

quantitative research. Both data types are 

important to assess, whether experimental or 

observational, however, since clinical practice 

using the drug was the primary interest, more 

experimental studies could be done to close the 

gaps in the literature. 

In terms of the quality of studies evaluated 

in this research, there is a need to increase 

the rigor of the research. Approximately 14% 

of the quantitative research studies did not use 

a validated measurement instrument, leaving 

the findings questionable. The lack of research 

that focuses on the survival rate, varying range


Obesity in Children 

in sample sizing, and same diagnoses when 

including which risk type of neuroblastoma 

the pediatric patients had do not allow the 

readers to determine the exact outcome of the 

treatment Dinutuximab. Future studies should 

include the exact diagnosis, including the risk 

type, and which stage of treatment (induction, 

consolidation, maintenance, remission) that 

Dinutuximab is being used for. 

Conclusions 


investigate and synthesize research completed in 

the last five years to report the current state of 

pediatric neuroblastoma treatment, specifically 

Dinutuximab therapy. Findings suggest that 

when the Dinutuximab treatment is used 

in patients with the preferred genotype, the 

result is typically more positive. These findings 

represent a revolutionary treatment that can 

extend the life or cure a patient diagnosed with 

pediatric neuroblastoma. 

References 

1. Anghelescu, D. L., Goldberg, J. L., Funghnan, L. 

G., WU, J., Mao, S., Furman, W. L., . . . Navid, 

F. (n.d.). Comparison of Pain Outcomes between 

Two Anti-GD2 Antibodies in Patients with 

Neuroblastoma. Pediatric Blood Cancer, 62(2), 

224-228. doi:10.1002/pbc.25280 

2. Bartholomew, J., Washington, T., Bergeron, 

S., Nielson, D., Saggio, J., & Quirk, L. (2017). 

Dinutuximab: A Novel Immunotherapy in the 

Treatment of Pediatric Patients With High- 

Risk Neuroblastoma. Retrieved February 14, 

2018, from http://journals.sagepub.com/doi/ 

pdf/10.1177/1043454216659448 

3. Dhillon, S. (2015). Dinutuximab: First Global 

Approval. Drugs, 75(1), 923-927. 

4. Erbe, A. K., Wang, W., Reville, P. K., Carmichael, 

L., Kim, K., Mendonca, E. A., . . . Sondel, P. 

M. (2017, June 12). HLA-Bw4-I-80 Isoform 

Differentially Influences Clinical Outcome As 

Compared to HLA-Bw4-T-80 and HLA-A-Bw4 

Isoforms in Rituximab or Dinutuximab-Based 

Cancer Immunotherapy. Retrieved February 

21, 2018, from https://www.ncbi.nlm.nih.gov/ 

pubmed/28659916 

5. J. B., Washington, T., Bergeron, S., Nielson, D., 

Saggio, J., & Quirk, L. (2017). Dinutuximab: A 

Novel 

6. Immunotherapy in the Treatment of Pediatric 

Patients With High-Risk Neuroblastoma. 

7. Pediatric Oncology Nursing, 34(1), 5-12. 

Retrieved January 08, 2018 

8. Marachelian, A., Desai, A., Balis, F., 

Katzenstein, H., Qayed, M., Armstrong, 

M., . . . Smith, M. L. (2016). Comparative 

pharmacokinetics, safety, and tolerability of 

two sources of ch14.18 in pediatric patients with 

high-risk neuroblastoma following myeloablative 

therapy. Cancer Chemother Pharmacol, 77, 405- 

412. doi:10.1007/s00280-015-2955-9 

9. McGinty, L., Kolesar, J., (2017). Dinutuximab for 

maintenance therapy in pediatric neuroblastoma. 

American Society of Health-System Pharmacists, 

74(8), 563- 567. doi10.2146/ajhp160228 

10. Plossel, C., Pan, A., Maples, K. T., & Lowe, D. K., 

(2016). Dinutuximab: An anti-GD2 monoclonal 

antibody for high-risk neuroblastoma. 

Annals of Pharacotherapy, 50(5), 416-422. doi 

10.1177/1060028016632013 

11. Secola, R., Marachelian, A., Cohn, S. L., 

Toy, B., Neville, K., Granger, M., . . . Martin, 

G. (2017, January 6). The Role of Nursing 

Professionals in the Management of Patients 

With High-Risk Neuroblastoma Receiving 

Dinutuximab Therapy. Retrieved February 5, 

2018, from http://journals.sagepub.com/doi/ 

pdf/10.1177/1043454216680595 

12. Tran, H. C., Wan, Z., Shear, M. A., Sun, J., 

Jackson, J. R., Malvar, J., … Seeger, R. C. (2017) 

TGFBR1 blockade with galunisertib enhances 

anti-neuroblastoma activity of the anti-GD2 

antibody Dinutuximab with natural killer 

cells. Clinical Cancer Research, 23(3), 804-813. 

doi10.1158/1078-0432.CCR-16-1743 

13. Whittle, Sarah B. (2017). Overview and recent 

advances in the treatment of neuroblastoma. 

Expert Review of Anticancer Therapy, 17(4), 369- 

386. 

14. Zenarruzabeitia, O., Vitallé, J., Astigarraga, 

I., & Borrego, F., (2016). Natural killer cells 

to the attack: Combination therapy against 

neuroblastoma. Clinical Cancer Research, 23(3), 

615-617. doi 10.1158/1078-0432.CCR-16-2478 

15. Zulmarie Perez Horta, J. L. (2016). Anti-GD2 

mAbs and next-generation mAb-based agents 

for cancer therapy. Immunotherapy, 8(9), 

1097–1117. 

Appraised by: Courtney Amb, RN; Helen 

Schuster RN; & DeeAnna Wynalda (Schmakel) RN 

Mayville State University RN-to-BSN student 


Are elementary aged children, who are 

considered obese, at an increased risk for obesity as 

an adult compared to children who are not obese? 

Articles: 

Li, S., Chen, W., Sun, D., Fernandez, C., Li, J., Kelly, 

T., He, J., Krousel-Wood, M., & Whelton, P. (2015). 

Variability and rapid increase in body mass index 

during childhood are associated with adult obesity. 

International Journal of Epidemiology. 1943-1950. 

doi:10.1093/ije/dyv202. 

Mead E, Brown T, Rees K, Azevedo LB, Whittaker 

V, Jones D, Olajide J, Mainardi GM, Corpeleijn 

E, O'Malley C, Beardsmore E, Al-Khudairy L, 

Baur L, Metzendorf MI, Demaio A, Ells LJ. Diet, 

physical activity and behavioral interventions 

for the treatment of overweight or obese children 

from the age of 6 to 11 years. Cochrane Database 

of Systematic Reviews, 2017, Issue 6. Art. No.: 

CD012651. DOI: 10.1002/14651858.CD012651 

Moore, E. S., Wilke, W. L., & Desrochers, D. M. (2017). 

All in the family? Parental roles in the epidemic of 

childhood obesity. Journal of Consumer Research, 

43(5), 824- 859. doi:10.1093/jcr/ucw059 

Shah, D., & Maiya, A. (2017). Prevalence of childhood 

obesity in Anand District. Indian Journal of 

Physiotherapy & Occupational Therapy, 11(3), 21- 

26. doi:10.5958/0973-5674.2017.00066. 


Our team has researched 12 different articles 

on how obesity in children affects adulthood 

obesity. These studies go into detail on the affect 

obesity can have throughout a child’s life. These 

studies provide evidence that there is a need for 

intervention early in childhood to help prevent 

this worldwide epidemic. These studies provide 

information that family is a key component in 

helping prevent obesity. 

The first article in our reference list studies 

how obesity is a major public health challenge due 

to its high prevalence, its importance as a major 

risk factor for many chronic diseases and the 

magnitude of its association with mortality. The 

challenge of successfully reversing obesity once 

established and maintaining weight loss over the 

long term is well known. Prevention of obesity 

would have a significant impact in addressing 

our current worldwide obesity epidemic and the 

associated growing chronic disease burden. To 

achieve this goal, it is important to identify risk 

factors in early life for obesity (Li, et al. 2015). 

Mean BMI during childhood was the strongest 

predictor of adult obesity measures, consistent 

with previous observations. Importantly, there 

was an independent association between rate of 

change in BMI during childhood with adult obesity 

measures, which extends previous observations 

that rapid growth during infancy is a risk factor 

for adult obesity. Taken together, available 

evidence suggests that rapid increase in BMI in 

the first two decades of life is a potent risk factor 

for adult obesity (Li, et al. 2015). 

The second article reviews different 

interventions that children can do to overcome 

childhood obesity in children ages 6 to 11. One 

main intervention is to limit energy intake and 

increase energy expenditure. This article goes 

through the different comorbidities that can 

go along with obesity and also ways to battle 

childhood obesity for parents. This study shows 

that diet and exercise can have a small change 

on body mass index for short time periods, but 

obesity is a relapsing condition without continued 

interventions. One limitation in this study that 

Hiring RNs & LPNs 

$8,000 SIGN ON BONUS POSSIBLE 

We hire new graduates and offer tuition reimbursement 

For more information, call 701-845-8222 or 

visit our website at www.sheyennecarecenter.com. 

Applications can also be picked up at 

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Visit our new Facebook page @ www.facebook.com/sheyennecarecenter 

it only covers six months follow up, and further 

research can be done with follow ups after six 

months (Mead, et al., 2017). 

This third article by Moore, et al. (2017), 

describes the potential factors for childhood 

obesity. It goes over the different factors and 

framework for obesity. Childhood obesity is a huge 

problem within the United States. This study 

shows why it is so prevalent in the United States. 

This study goes into great detail of how the family 

network has a huge role in childhood obesity. This 

study has shown the importance of having equal 

diet and exercise within childhood. The framework 

for childhood obesity comes from the family 

with diet, exercise, genetics, and family health 

knowledge. Parents need to have good knowledge 

on healthy diets and exercises for children (Moore, 

et al., 2017). 

In the final study, overweight and obese 

children were seen in 23.8% in urban schools 

and 14.2% in rural schools. A study also reported 

obesity to be 4.5% in low income schools and 22% 

in mid-income schools. The study also showed 

prevalence of overweight higher than obesity, 

14.5% in boys, 12.8% in girls, and obesity being 

6.3% in both boys and girls. In conclusion, this 

study found a higher frequency of overweight 

and obesity in urban areas and boys as 

compared to girls and children from rural areas 

(Shah & Maiya, 2017). 

Bottom line: 

In conclusion, all of these studies have shown 

that there is significant evidence that obesity as a 

child is a risk factor for obesity in adulthood. This 

is a worldwide public health concern and there are 

a number of interventions that can be done to help 

decrease the risk of obesity. Risk factors need to be 

identified and interventions implemented to help 

decrease obesity. The key to these interventions is 

to start them early, start in childhood and inform 

families of benefits of these interventions. The 

framework for childhood obesity comes from the 

family with diet, exercise, genetics, and family 

health knowledge (Moore, et al., 2017.) 


Evidence-based education is really needed 

when it comes to obesity. Nurses can provide 

education regarding proper diets for children 

and use MyPlate examples illustrating portion 

sizes on each food group. Exercise plans are also 

important. Children should be in activities that 

are age appropriate. Screen time is another very 

important area to provide education. Nurses 

should also give out general information so that 

parents can understand weight regulation and the 

obesity development from childhood to adulthood. 

Spirit Lake Tribe Health Center 

Fort Totten, North Dakota is 

looking for nurses and nurse 

practitioners. 

Competitive salary and benefits 

Health, dental, vision, life insurance, 401 K 

and educational assistance. 

Sign on bonus • Staff of 75 

Contact: 

Human Resources 

Phone: 701-766-1215 

Fax: 701-766-1272 

HR email: 

slthr@spiritlakenation.com 

spiritlakenation.com


Appraised by: Kelsey Schlenk, RN & 

Christina Waddle, RN 



For hospitalized patients, can focused nursing 

assessments affect the occurrence of catheterassociated 

urinary tract infections (CAUTI) in 

comparison to routine nursing assessments? 

Articles: 

Dy, Sitha, Major-Joyness, B., Pegues, D., & Bradway, 

C. (2016). A nurse-driven protocol for removal 

of indwelling urinary catheters across a multihospital 

academic healthcare system. Urologic 

Nursing, 36(5), 243-249. doi: 10.7257/1053- 

816X.2016.36.5.243 

Giles, M., Watts, W., O’Brien, A., Berenger, S., Paul, 

M., McNeil, K., & Bantawa, K. (2015). Does our 

bundle stack up! Innovative nurse-led changes 

for preventing catheter-associated urinary tract 

infection (CAUTI). Healthcare Infection, 20, 62-71. 

Lam, T.B., Omar, M.I., Fisher, E., Gillies, K. & 

MacLennan, S. (2014). Types of indwelling 

urethral catheters for short-term catheterization 

in hospitalized adults. Cochrane Database of 

Systematic Reviews, 9, 1-95. doi:10.1002/14651858. 

cd004013.pub4 

Thomas, K. L. (2016). Reduction of catheter-associated 

urinary tract infections through the use of 

an evidence-based nursing algorithm and the 

implementation of shift nursing rounds. Journal of 

Wound, Ostomy & Continence Nursing, 43(2), 183- 

187. doi:10.1097/WON.0000000000000206 

Underwood, Lindsay. (2015). The effect of implementing 

a comprehensive unit-based safety program on 

urinary catheter use. Urologic Nursing, 35(6), 271- 

278. doi: 10.7257/1053 


We analyzed a total of eight articles that were 

narrowed down to five for our research. In the 

article addressed by Thomas (2016), a project 

was completed in a 536-bed teaching hospital 

in the United States. This consisted of five 

hospitals, two medical centers, and three urgent 

care centers. This Level II trauma center that 

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CAUTI Infections 

participated in the study contained a medical, 

cardiac, neuroscience and surgical intensive care 

unit. For this study, they used all patients that 

were admitted to a cardiac ICU and its step-down 

unit that required indwelling urinary catheters. 

This study was done over a three-month period 

in 2013 that recorded the occurrence of CAUTI, 

the rates of indwelling urinary catheters and 

the length that indwelling urinary catheters are 

in place prior to the implementation of nursing 

interventions specifically focused on indwelling 

urinary catheters. Wick’s Check-Plan-Do- 

Check-Act (CPDCA) model of continuous quality 

improvement was used during the project. Nurse 

driven protocols for the assessment and removal 

of indwelling catheters were implemented and 

nursing rounds for indwelling catheters were done 

every eight hours. The results from a nine-month 

period after implementation showed fewer CAUTIs 

(p=.009) and lower CAUTI rates (p=.005). The 

mean compliance for nurses performing indwelling 

catheter rounds three times per day was 91%. 

(Thomas, 2016). 

In our next study, The Cochran Incontinence 

Group's Specialized Trials Register was examined. 

All randomized control trials (RTC) and quasi- 

RTCs comparing different types of indwelling 

catheters in patients that were catheterized for 

less than 14 days were used as the search criteria 

and 26 trials met the criteria. Studies showed 

that antiseptic-coated catheters may reduce 

the number of bacteria in the urine but did not 

reduce the presence of UTIs. Other studies did 

show that catheters coated with antimicrobials 

significantly reduce the number of bacteria in the 

urine and can reduce the incidence of patients 

developing a CAUTI. Overall, the type of catheter 

is not as important to reduce in incidence of 

CAUTIs as reducing the number of unnecessary 

catheterizations and their prompt removal (Lam, 

Omar, Fisher, Gillies, & MacLennan, 2014). 

Nursing practice and assessment play a great 

role in the occurrence of CAUTIs within hospital 

patients. The Bladder Bundle is a protocol that 

can be used as a CAUTI prevention technique. 

With implementation of this bundle, nurses would 

increase their use of bladder scans, use catheter 

removal prompts, provide efficient catheter 

care, and use urinals and bedside commodes. 

Hospitals that implemented the Bladder Bundle 

saw a significant decrease in CAUTI rates. 

Removal prompts would make nurses and 

physicians aware of catheter duration and need 

for catheter removal. With prompts of catheter 

removal and use of alternative methods there was 

a decrease in catheter utilization, catheter days, 

and CAUTI rates (Dy, Major-Joyness, Pegues, & 

Bradway, 2016). 

Bottom line: 

Since urinary tract infections are a common 

hospital-acquired infection and many are caused 

by indwelling urinary catheters, nurses can 

be an important resource in the reduction of 

the occurrence of CAUTIs (Lam, Omar, Fisher, 

Gillies, & MacLennan, 2014). These infections 

have a significant impact on patient morbidity 

and an estimated 1 in 1,000 deaths per urinary 

catheterized patients are contributed to a CAUTI 

(Giles et al., 2015). Studies have shown that focused 

nursing assessments can reduce the occurrence of 

CAUTI in hospitalized patients. These assessments 

include identifying the need for an indwelling 

urinary catheter, prompt removal of the catheter, 

providing efficient catheter cares and choosing 

the correct type of catheter. Even though studies 

have shown a decreased risk of CAUTI with the 

implementation of focused nursing assessments, 

more research is needed to validate these results. 


Proper catheter cares and insertion techniques 

are important during a nursing assessment to 

prevent CAUTI infections. Having appropriate 

training, supplies, and performing routine 

catheter cares can help prevent the occurrence 

of these CAUTI infections. Insertion techniques 

effect the number of bacteria present and sterile 

technique must be followed to minimize the 

number of bacteria present upon insertion of 

an indwelling urinary catheter. We can educate 

our nurses about proper sterile technique and 

this can be practiced through staff education 

materials and hands on training. Catheters 

must also keep a closed drainage system to keep 

bacteria out of the urethra and bladder. Every 

time the system is opened, we are increasing the 

access point of bacteria to enter the bladder which 

then increases the risk of patients developing a 

CAUTI. Foley catheter drainage bags should only 

be emptied as needed and cleansed after each 

use (Underwood, 2015). Catheters should also 

be secured to the patient’s leg using an adhesive 

or Velcro securement device. If the catheter is 

not secured properly, it can piston back and 

forth which can then introduce bacteria on the 

outside of the catheter into the urethra which 

can then migrate to the bladder using capillary 

action. These implications for nursing practice 

can easily be implemented for the patient with an 

indwelling urinary catheter and help to reduce 

the risk of CAUTI occurrence. Nurses also need 

to be aware of the catheter duration and need for 

Foley catheters. This should be assessed regularly 

and often as the need for catheter can change 

with patient status. Nurses can be a part of this 

intervention and remind providers about the 

length of time a Foley has been placed. 

To access electronic copies of the 

North Dakota Nurse, please visit 

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ANA News Update 

The Nursing Now Campaign Launches 

Reprinted from American Nurse Today, 

Volume 13, Number 5 

Investing in nurses to achieve 

global health. 

Health should be a recognized universal 

right. Having an equitable health system should 

be a universal standard. And having highly 

skilled nurses recognized for their expertise in 

providing care and leading efforts to transform 

a nation’s health and health system should be a 

universal practice. 

U.S. nurses are not alone in our quest to be 

a prominent voice at all tables in determining 

how to best shape and deliver healthcare. Just 

a few months ago, a three-year, global campaign 

was publicly launched called Nursing Now 

under the auspices of the Burdett Trust for 

Nursing in collaboration with the International 

Council of Nurses (ICN) and the World Health 

Organization (WHO). More than 30 countries, 

including the United Kingdom, Switzerland, 

South Africa, and the United States, were 

represented at launch-day activities held around 

the world. Catherine, Duchess of Cambridge, 

served as the official patron. 

The Nursing Now campaign is focused on 

improving health globally by raising the profile 

and status of nurses worldwide. The agenda 

is ambitious, but it’s critically important and 

can be accomplished with real investment 

in nursing and ongoing support. Nurses and 

midwives make up the largest segment of the 

health workforce worldwide, and they can have 

a great impact on the health and well-being of 

individuals and communities because of their 

expertise and extensive reach through their 

varied roles and settings. 

That said, we’re facing a global shortfall of 

nine million nurses and midwives projected 

by 2030. The WHO Triple Impact report, 

whose findings helped initiate the campaign, 

also noted that although there is “enormous 

innovation and creativity in nursing,” nurses 

“are too often undervalued and their contribution 

underestimated.” 

To achieve its vision, the campaign has 

developed goals that are similar to those outlined 

in the U.S.–focused Institute of Medicine 

report, The Future of Nursing: Leading Change, 

Advancing Health. Both the campaign and the 

report address advancing nurses’ education 

and professional development, including 

leadership skill-building and their ability to 

effectively function in rapidly evolving healthcare 

environments. The campaign and report also call 

for increasing nurses’ influence on health policy 

and engaging nurses in leadership roles at all 

levels. And both serve as clarion calls for investing 

in the nursing workforce and viewing nurses as 

the key to solving many healthcare-related issues. 

Lord Nigel Crisp, former chief executive of 

the National Health Service in England, and cochair 

of the international board leading Nursing 

Now, recently met with the ICN Executive 

Committee. In discussing ICN’s action plans for 

the campaign, Crisp reinforced the importance 

of engaging the world’s nursing leaders to make 

an indelible impact on global health, saying, 

“I believe that strengthening nursing is one of 

the single biggest things we can do to improve 

health globally. Nurses, wherever they are, are 

the health professionals closest to the community 

and are invaluable in 

promoting health and 

preventing diseases as 

well as providing care 

and treatment.” 

As the U.S. 

representative from the American Nurses 

Association to ICN and its first vice-president, 

I have the privilege of talking with nurses from 

many of the 130-plus member countries. I’ve 

learned that no matter our country of origin, 

nurses share the ability to identify patient and 

population needs; implement effective, and 

sometimes very creative, interventions; and 

understand that health promotion and preventive 

measures are critical to raising the health of 

patients, communities, and nations. Many of us 

also share similar struggles, although to varying 

degrees: staffing shortages, workplace and societal 

violence, emerging infectious diseases, and 

barriers to practicing to our full education and 

expertise. Addressing these, too, will help achieve 

the impact we want on global health. 

The Nursing Now campaign will run to the 

end of 2020, which coincides with the 200th 

anniversary of Florence Nightingale’s birth and 

a worldwide celebration of nurses. I encourage 

all nurses to learn more about the campaign 

at nursingnow.org and to support each other in 

leading the way to helping people achieve health. 

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN 

President, American Nurses Association 

ANA Enterprise Appoints Dr. Loressa Cole as 

New Chief Executive Officer 

Silver Spring, MD 

— The ANA Enterprise 

announced the appointment 

of Dr. Loressa Cole as its new 

Chief Executive Officer (CEO). 

She assumed this role on May 

7, 2018. 

In this role, Cole, DNP, 

MBA, RN, FACHE, NEA- 

BC, will provide strategic leadership and have 

responsibility for the operating activities of the 

Enterprise including management of staff and 

implementation of programs for the American 

Nurses Association (ANA), American Nurses 

Credentialing Center (ANCC), and American 

Nurses Foundation. 

Dr. Cole is an accomplished senior executive 

who brings more than 30 years of progressively 

higher leadership and management experience, 

most recently as Chief Officer and Executive Vice 

President of ANCC. ANCC promotes excellence 

in nursing and health care globally through 

credentialing programs, recognizes healthcare 

organizations that promote quality patient 

outcomes, and accredits healthcare organizations 

that provide and approve continuing nursing 

education. She has been with ANCC since 2016. 

Previously, Dr. Cole held Chief Nursing 

Officer and Chief Operating Officer positions 

within the Hospital Corporation of America’s 

(HCA) Capital Division. While Chief Nursing 

Officer at LewisGale Montgomery Hospital, 

she led the hospital to attain ANCC Magnet® 

recognition. Among her many accomplishments, 

she championed year-over-year improvement in 

employee engagement and reduction in nursing 

turnover, as well as implemented several specialty 

and Service Excellence programs that helped 

establish the regional health system as a Joint 

Commission Top Performer and earned Leapfrog 

“A” rating for hospital safety. 

“Dr. Cole is well prepared to lead and 

strengthen the evolving ANA Enterprise. She was 

selected from a field of outstanding candidates to 

fulfill this top leadership role for nursing,” said 

ANA President Pamela F. Cipriano, PhD, RN, 

NEA-BC, FAAN. “She brings proven leadership 

as a seasoned healthcare executive and as the 

current Executive Vice President of ANCC. She 

demonstrates the vision, creativity, passion for 

nursing, and strong business acumen to leverage 

the strengths of ANA’s entities to enhance and 

grow the Enterprise.” 

“I am very honored and excited to assume 

this prestigious position. The American Nurses 

Association is the professional association for 

all registered nurses, and a recognized leader 

in ensuring quality care for all Americans,” 

said Dr. Cole. “At 4 million and growing, 

America’s nurses outnumber all other healthcare 

professionals and serve an essential role 

to protect, promote, and improve health for all 

ages. I am humbled to lead the organization that 

for more than a century has nobly represented 

and served our nation’s nurses. I look forward to 

working with the dedicated staff and volunteers 

who contribute tirelessly to maintain and grow 

the exceptional programs and credentialing 

products offered by the ANA Enterprise.” 

Dr. Cole earned an associate degree in nursing 

from Bluefield State College in Bluefield, WV, 

a bachelor’s degree in nursing from Virginia 

Commonwealth University in Richmond, VA, a 

master’s of business administration from Averett 

University in Danville, VA, and a doctorate in 

nursing practice from Case Western Reserve 

University in Cleveland, OH. She is a member of 

ANA, Virginia Nurses Association, American 

Organization of Nurses Executives, and the 

American College of Healthcare Executives, where 

she holds Fellow status. Additionally, she currently 

serves on the Journal of Nursing Administration’s 

Editorial Board and the Joint Commission’s 

Nursing Advisory Council. A past President of 

the Virginia Nurses Association and the Virginia 

Partnership for Nursing, Dr. Cole has also served 

on multiple boards, including The Bradley Free 

Clinic of Roanoke (VA), The Free Clinic of the New 

River Valley, and the Daily Planet (Richmond, VA). 

The ANA Enterprise is the organizing platform of 

the American Nurses Association (ANA), the American 

Nurses Credentialing Center (ANCC), and the American 

Nurses Foundation. The ANA Enterprise leverages 

the combined strength of each to drive excellence 

in practice and ensure nurses’ voice and vision are 

recognized by policy leaders, industry influencers 

and employers. From professional development and 

advocacy, credentialing and grants, and products and 

services, the ANA Enterprise is the leading resource for 

nurses to arm themselves with the tools, information, 

and network they need to excel in their individual 

practices. In helping individual nurses succeed—across 

all practices and specialties, and at each stage of their 

careers—the ANA Enterprise is lighting the way for the 

entire profession to succeed.

Sitting Bull College – NOW HIRING 

• Director, Division of Nursing 

• Clinical Nursing Instructor (Part-time) 

• Clinical Nursing Laboratory Technician (Part-time) 

Please submit: Cover letter, resume, official transcripts, 3 current reference letters 

signed and dated (1 from immediate supervisor), certificate of Indian blood (if 

applicable), copy of Social Security Card & Valid driver’s license & SBC Background 

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The North Dakota Nurse - August 2018

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