Nevada RN - May 2019

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May 2019 • Volume 28 • Number 2

www.nvnurses.org

Nevada

RNFORMATION

Inside

articles

2 Be Part of an Awesome Team

3 Research & EBP Corner

4 NV Nurses Called to Advocacy

5 What a Great Time to be a Nurse

Practitioner

5 Check it Out!

6 NNA Environmental Health

Committee

7 Nevada Nursing Student

Association

8 Cassi Gonzales - A Special Catalyst

for Health

9 Veterans Corner

10 Antibiotic Stewardship

11 Bicycle Safety

12 Nurses in the News

13 What the Mirror Doesn’t Tell You

14 Safe Infant Sleep Practices

regular features

15 Nevada Nurses Foundation

THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION

The Nevada Nurses Association is a constituent member of the American Nurses Association

Quarterly publication direct mailed to approximately 42,000 Registered Nurses and Licensed Practical Nurses in Nevada

The President’s Message

Dear Colleagues,

Mary D. Bondmass, PhD, RN, CNE

President, Nevada Nurses Association (2018-2020)

According to the American

Nursing Association (ANA),

advocacy is a pillar of nursing.

Nurses instinctively advocate for

our patients, in our workplaces,

and our communities; but

legislative and political

advocacy is no less critical to

advancing the profession and

patient care.

On February 26, 2019, the Nevada Nurses

Association (NNA) sponsored Nurses Day at the

Legislature (NDAL) wherein 80 nurses and nursing

students met in Carson City. Discussions on advocacy

and issues affecting nurses as well as health and health

care were the topics of the day. As the day concluded,

I reflected on the concept of advocacy, and I would like

to share some thoughts.

Merriam-Webster defines advocacy as the act or

process of supporting a cause or proposal. Wikipedia,

one of the least scholarly, but most often cited sources

around, proposes that Advocacy is an activity by an

individual or group which aims to influence decisions

within political, economic, and social systems and

institutions. Neither definition mentions the word

patients, but most nursing texts adapt these and other

generic descriptions to our profession such that nurses

advocate for health, health care and individuals who

are unable or cannot advocate for themselves.

No doubt we all learned about advocacy in our

Nursing Fundamentals course; for some of us that

may have been quite a while ago, while others, not so

much. While advocating is probably something we all

do daily, regardless of our practice setting, it may be

helpful to take a few minutes or so to reflect on the

concept and its importance. Often, we get caught up

in the daily tasks that we must accomplish, that I fear

we do not always consider just how vital nurses’ role as

an advocate is. I wonder what a world without nursing

advocacy would be like. Who would, as Merriam-

Webster defines, would act to support causes; who,

as Wikipedia defines, would influence decisions within

political, economic, and social systems and institutions

relating to health and health care? Fortunately, we

don’t have to wonder about a world without nursing

advocacy because as the ANA indicates, it is a pillar of

our profession of which we can all be proud.

If you would like to become more involved with

NNA’s advocacy activities at the State level, I strongly

suggest you visit our webpage at https://nvnurses.org

and browse the content. If you are more interested

in national advocacy issues, view the ANA’s webpage

at https://www.nursingworld.org/practice-policy/

advocacy/

Colleagues, no matter your level of interest or

involvement, I ask you to take a moment to reflect

upon advocacy as a common thread of our profession

as we go about our daily lives in the workforce and

collectively work to improve health and health care for

the citizens of our state.

Respectfully yours,

Mary Bondmass, PhD, RN, CNE

President, Nevada Nurses Association

Happy Nurses Week!

May 6-12, 2019

current resident or

Presort Standard

US Postage

PAID

Permit #14

Princeton, MN

55371

Mark Your Calendars

• Saturday, June 1, 2019 – Crowns & Tiaras Big Hat

High Tea – Governor’s Mansion

• Saturday, September 14, 2019 – Convention 2019:

Inclusivity in Nursing – Las Vegas

• Saturday, September 14, 2019 - NNA Annual Meeting – Las Vegas

• Saturday, October 12, 2019 – Shining Stars of Nursing in Nevada

Las Vegas


Page 2 • Nevada RNformation May, June, July 2019

NNA Mission Statement

Have you visited the NNA Job Board recently? The Nevada Nurses Association promotes professional nursing practice through

continuing education, community service, nursing leadership, and legislative

activities to advocate for improved health and high quality health care for citizens of

Nevada.

Visit our website www.nvnurses.org and click on the Job Board tab to

view many available Nevada nursing jobs. If you want to receive email

notice when a new job is added, join our Job Board mailing list! Just

send your email address by text message:

Text NNAJOBBOARD to 22828 to get started

or email nnajobs@nvnurses.org.

If you have a job to advertise, contact Ian at

nnajobs@nvnurses.org. Our rates are reasonable and

money raised helps to benefit Nevada nursing.

BE PART OF AN AWESOME TEAM!

Do you enjoy learning from your colleagues? Would

you like to be a part of an action-oriented team that

contributes to Nevada nurses? If yes, consider running

for one of NNA’s open offices. The following positions

are now open for candidates:

• State level- seeking candidates for Secretary (2-yr

term) and one director (3-yr term)

• Northern Nevada – District 1: seeking candidates

for President, Vice President and one director (all

2-year terms)

• Southern Nevada – District 3: seeking candidates for Treasurer (2-yr

term)

• ANA Membership Assembly in Washington DC: seeking candidates for

one Representative and two alternates (1-yr terms). Candidates should

actively participate in at least one NNA committee. Tentative date for

the Assembly is June 17-June 19, 2020. Expenses are covered.

• Nominations Committee: seeking three candidates (1-yr term)

NNA State Board of Directors

Mary D. Bondmass, PhD, RN, CNE Mary.bondmass@unlv.edu ..............President

Nicki Aaker, MSN, MPH, RN, CNOR, PHCNS-BC naaker@aol.com .......Vice President

Rochelle Walsh, DNP, RN, PCCN rochelleh@unr.edu ......................Secretary

Glenn Hagerstrom, PhD, APRN, FNP-BC, CNE ghagersrom@unr.edu .........Treasurer

Peggy Lee, BSN, RN Lee.peggy4423@gmail.com ..................Director at Large

Amie Ruckman, MSN, RN amieruckman@gmail.com ...............Director at Large

Christa Secord, MSN, FNP-BC cjsecord@gmail.com ................Director at Large

Darlene Bujold, BSN, RN darlene.cbrn@gmail.com ...............President, District 1

Ruth Politi, PhD, RN healthccr@icloud.com ....................President, District 3

Donna Miller, RN Donna.Miller@airmed.com ......................Legislative Chair

Editorial Board

Managing Editor, Linda Bowman, RN, lbowman@nvnurses.org

Mary D. Bondmass, PhD, RN, CNE

Eliza J. Fountain, RN, BSN

Wallace J. Henkelman, Ed.D, MSN, RN

Tracey Long PhD, RN, MS, CDE, CNE, CCRN

Mary Baker Mackenzie, MSN, RN

John Malek, PhD, MSN, FNP-C

Print Editor, Kathy Ryan, MSN, RN-BC

Lisa Pacheco, MSN, RN

Betty Razor, RN, BSN, CWOCN

Denise Rowe, MSN, RN, FNP-C

Val Wedler, MSN, RN

Bernadette Longo, PhD, RN, FAAN

Visit NNA’s website for nominating form and full description of officers.

Question? Email Linda Bowman at lbowman@nvnurses.org. Nominations

close May 15, 2019.

Are you interested in submitting an article for publication in RNFormation?

Please send it in a Word document to us at lbowman@nvnurses.org. Our

Editorial Board will review the article and notify you whether it has been

accepted for publication.

If you wish to contact the author of an article published in RNFormation,

please email us and we will be happy to forward your comments.

www.nvnurses.org

Published by:

Arthur L. Davis

Publishing Agency, Inc.

SAVE THE DATE!!!

Convention 2019: Inclusivity in Nursing

September 14, 2019

7:30 a.m. – 5:30 p.m.

Clinical Simulation Center of Las Vegas

Shadow Lane Campus – Bldg. B

1001 Shadow Lane

Las Vegas, NV

The Nevada Nurses Association (NNA) along with the Nevada Nurses

Foundation (NNF) and the Nevada Nursing Student Association (NVNSA)

are planning a collaborative convention. The theme for the convention is

Inclusivity in Nursing and will feature nationally known keynote speakers,

breakout sessions, and poster presentations. Continuing Education hours

will be awarded. Abstract submission and registration information will be

available on the NNA website in early May 2019. More information will also

be available in the June/July RNFormation.


May, June, July 2019 Nevada RNformation • Page 3

Research & EBP Corner

Development of Patient Enrichment Program for Patients with

Psychiatric Behaviors in Acute Care

Submitted by Mary Bondmass, Ph.D., RN, CNE

This feature will present abstracts of research and

evidence-based practice (EBP) completed or spearheaded

by nurses or student nurses in Nevada. The

focus is on new evidence (i.e., research) or on the

translation of evidence (i.e., EBP) in Practice, Education

or Research. Submissions are welcome and will be

reviewed by the RNF editorial board for publication;

send your abstract submission in a similar format used

below to mary.bondmass@unlv.edu.

Danielle C. Craperi DNP, CNML, CNL

University of Nevada Reno

Background:

Acute care settings can have

a treatment gap for patients

that exhibit behaviors of a

psychiatric/mental health illness

(PMHI) that have a length of

stay (LOS) greater than 15

days. There may not be proper

knowledge for the clinicians

and/or programs to care for

patients in this population.

Often these patients have

had their acute condition

cared for, they are medically cleared and are awaiting

placement to an outside facility. Barriers to discharge

include needing guardianship, pending approval from

a payer source, or have filled out an application for

health insurance and are waiting for acceptance. The

extended LOS that this population can experience

puts them at a higher risk to experience conflict event.

Conflict events include acts of aggression, verbal abuse,

dependency issues, self-harm, noncompliance with

medication regime, HAI, falls, and elopements. This

population may have a diagnosis of a mental health

illness or they may have medical condition that causes

the patient to exhibit behaviors of a mental illness.

Purpose:

The purpose of this Doctor of Nursing Practice

(DNP) final project was to develop a Patient Enrichment

Program (PEP) to decrease the LOS and number

of conflict events experienced by this population.

Another purpose of this project was to increase the

nurse’s knowledge on how to care for patients that

exhibit PMHI. This population may have a diagnosis

of a mental health illness or they may have medical

condition that causes the patient to exhibit behaviors of

a mental illness.

Intervention:

The PEP provided education for nurses, a daily

routine and therapeutic activities for the patients.

Some therapeutic activities included, daily walks, music

therapy, art therapy, social skills, and pet therapy to

mention a few.

Results:

After three months of implementation of PEP there

was a statistically significant decrease in the number

of conflict events seen in this population. Pre and post

nurse evaluations of the education provided regarding

the care of psychiatric patients showed that nurses

gained knowledge and found that information to be

beneficial. LOS increase due to more patients that fit

criteria being transferred to unit.

Dr. Craperi presented her project at the American

Nursing Conference

December 6 – 7, 2018 in Las Vegas, NV

To see the table containing more information for this article

please view the online version of Nevada RNformation at nursingALD.com.

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in all 50 states, and filter by location and credentials.

Browse our online database

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Find events

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Your always-on resource for

nursing jobs, research, and events.


Page 4 • Nevada RNformation May, June, July 2019

By Darlene Bujold, RN,

MSN, MSHI

On February 26th, 2019

nurses from throughout Nevada

came together in the halls

of the state's Legislature to

represent our proud profession

and to discover what bills are

significant to our patients and

our practices. The theme for the

day was "Advocacy the Power of Nursing."

The agenda for the day was pre-empted by our

state’s “Washoe Zephyrs” which made their presence

known, bringing wind speeds up to 84 mph and

toppling semis. Highways were closed, airlines flights

canceled, delayed or rerouted. Neither our keynote

speaker, Terry Kerns, PhD, RN who was to speak to our

role as advocates in relation to the opioid crisis nor the

NNA state president Mary Bondmass, PhD, RN, CNE

were able to make it from Las Vegas. In addition, the

Senate and Assembly floor sessions, where several

nurses were slated to sit with their legislators, were

canceled. Despite these deterrents, the event was very

well attended by nurses who braved the winds and

showed up to the table to learn and advocate.

Nicola Aaker, MSN, MPH, RN the NNA state Vice

President took up the torch to welcome this proud

group to the day.

Darlene Bujold RN, BSN, MSHI- District 1 President

NNA was honored to act as MC for the day and sang

the National Anthem to the group.

A round table panel of distinguished nurse leaders

shared their experiences of legislative advocacy, how

they found their voices and advocated for legislative

action. This panel consisted of:

David Tyrell, BSN, RN, Past President NNA – Provided

an impassioned call to nursing legislative advocacy and

facilitated rousing discussion.

Nicola Aaker, Director of Carson City Health and

Human Services - Shared her knowledge of pending

bills aimed at increasing Nevada’s public health funding

rate which is currently ranked as second to last in the

nation! Nicki was able to provide us with timely and

crucial pending legislation from the Interim Committee

on Health Care and the Regional Behavioral Health

Policy Boards.

Cathy Dinaur MSN, RN, Executive Director of the NV

State Board of Nursing – Spoke to the importance of

understanding the state laws that govern our practice

and promoted the re-submission of NV Nursing

Compact legislation.

Lisa Thomas PhD, RN, CNE, FAAN – Associate

Professor UNR Orvis School of Nursing – Spoke as a

subject expert to legislative policy.

Bernadette Longo PhD, RN, APHN-BC, CNL, FAAN –

Past NNA State Secretary, ANA Clean Air Ambassador,

Nominations Committee Chair NNA – Presented a

NV Nurses Called to Advocacy

heartfelt and encouraging plea, that “Each of us

are experts” in our own unique fields and how our

personal stories can resonate with our representatives

for the change we wish to see enacted.

Donna Miller RN/EMS-RN, CMTE – Told her story

of how a process dysfunction that she recognized as

needing to be fixed propelled her to the halls of the

legislature to change statutes for the better. She had

no clue how to go about this but she moved forward

regardless and “figured it out” as she went. She

also relates how relationships, made possible by her

involvement with the NNA were invaluable in meeting

this goal.

Jessica Ferrato and Paige Barnes (Crowley & Ferrato

Public Affairs) - Representative Lobbyists for the NNA

– Presented pending current legislation and updates

on clean-up of past bills. Policy highlights included:

APRN Signing Authority (SB134 and AB147) and Public

Health Funding (AB97). The discussion also included:

Assemblyman Sprinkle working to consider various

means to provide access to insurance for a variety of

underserved populations; and consideration of a cleanup

bill to resolve providers concerns with prescription

drug abuse.

Melissa Washabaugh, BSN, RN - Spoke to the role

of nurses in advocating for the rural areas of Nevada,

advocating for the Nevada Nursing Compact. She

also discussed how nurses can be instrumental in the

prevention of the rise in current national and state

suicide rates.

Anna Anders, MSN, RN, CENP, Chief Nursing Officer

& Vice President at Carson Tahoe Hospital, Inc.- Was

able to add lively discussion by sharing her personal

and professional experiences with such timely items

such as Mental Health legislation, doctor provider

shortages and the advantages of Nevada becoming a

Nursing Compact state.

Norman Wright, MS, BSN, RN provided an

interesting presentation on “Antimicrobial Resistance

Organisms” and how this is a serious health threat.

He explained the importance of communication as it

relates to vaccination history and antibiotic stewardship

and urged all nurses be a part of antibiotic stewardship.

While the topics and the speakers were extremely

interesting and provided oversight of what was on

the horizon for the 80th Legislative session, it was the

personal stories that many speakers shared on how as

nurses, they were able to find their voices and make a

difference.

Thank you to Vania Carter, MSN, APRN, FNP-BC with

NAPNA for coordinating the pre-event dinner on February

25, 2019. Many went through closed roads and flight delays

to attend.

Nurses Day at the Legislature could not have been

successful without the help of some incredible volunteers.

A huge thank you to Pat Fries and Becky Gebhardt for

their help with registration. Dave Tyrell and Donna Miller

jumped in at the last minute when we received information

at 8:00 pm on the night before that the key note speaker

was unable to attend due to cancellation of flights. Dave

and Donna came up with a great plan to save the day. A

big thank you to the presenters who were asked to sit on

a panel 10 minutes before the panel began. This speaks

volumes to the leadership qualities that NNA members

possess. Had these individuals not jumped in at the last

minute, NDAL might not have happened.

Becky Gebhardt and Pat Fries registering nurses

Nevada Nurses Association hopes that “Nurses

Day at the Legislature 2019” was a memorable event

for those who braved the uncooperating weather and

attended. Those who couldn’t attend were missed.

NNA is already looking forward to planning the next

NDAL event in 2021. Many photographs were taken,

however, due to the time constraints of meeting the

deadline of this publication, photos were not available.

Photos will be included in the 2019 NNA Yearbook

which will be sent out in July. NDAL handouts can be

found on NNA’s website under the Legislative section.

And finally, thank you to NDAL’s generous sponsors

Nevada Nursing Foundation, Nevada Advanced

Practice Nurses Association, Carson Tahoe, University

of Nevada, Reno Orvis – School of Nursing and

University of Las Vegas – School of Nursing.

Heidi Johnston and Karen Bearer near the

Nevada Nurses Foundation sponsor table.

Another huge THANK YOU goes out to Harvey

Dunbar from Grifols and Kane Furey from Respitech

who sponsored the pre-event dinner on Monday,

February 25, 2019.


May, June, July 2019 Nevada RNformation • Page 5

What a Great Time to be a Nurse

Practitioner!

Submitted by Susan S. VanBeuge, DNP, APRN, FNP-BC, FAANP

Check It Out!

Some Kind of Wonderful

By Kathy Ryan

Nurse practitioners or advanced practice registered

nurses (APRN) are one of the hottest professions in the

current US job market. According to the US News and

World Report, nurse practitioners rank #5 in Best Health

Care Jobs. With the median salary listed as $103,880 and

an unemployment rate of 1.1%, job security and the ability

to earn a living is achievable (US News, 2018).

Advanced practice nurses have different roles and

populations of foci they may be trained and practice.

The four roles include nurse practitioner, nurse midwife,

nurse anesthetist, and clinical nurse specialist. Population

of foci include family/individual across the lifespan, adult

gerontology, women’s health/gender related, neonatal, pediatrics, and psych/

mental health (NCSBN, 2008). Additional opportunities for APRNs are in specialty

areas such as oncology, nephrology, palliative care, orthopedics, and critical care.

Educational credentials and licensure of the individual advanced practice nurse will

define their scope of practice.

It is a great time to be an advanced practice nurse. There are more than

240,000 APRNs in the United States with just over 2,000 of these licensee’s in

Nevada. APRNs can be found practicing in hospital settings, primary care, specialty

care, outpatient clinics, rural health, palliative care, and higher education.

In Nevada, modernization of laws and regulations governing APRN practice

have changed positively in time since this role was created. The first Nevada nurse

practitioners were established in 1973 and formally granted a “Certificate of

Recognition” in 1979. From the time of initial recognition to current 2019 practice,

46 years after the profession was recognized, APRNs in the state have made great

strides to provide safe, professional, and compassionate patient care. A milestone

reached in 2013 changed practice as APRNs achieved full practice authority.

One of 23 states in the US, Nevada leads the way in providing care to patients

throughout the state. Since gaining full practice authority, the number of APRNs

have more than doubled in five years.

Given the positive practice environment, opportunities are abundant for

APRNs in Nevada and across the US. In Nevada, opportunities for employment,

consulting, building a practice, and providing direct patient care are available. The

winners in this environment are our patients. APRNs provide safe, comprehensive,

and compassionate care across the lifespan in the roles they are trained. Most

APRNs are trained in primary care and offer these services in the care of patients

in acute, chronic, and tertiary care. Training includes treating patients in a

holistic patient-centered model of care to encourage health promotion, provide

education, and evidence-based care.

It’s a good time to be an APRN in Nevada and across the US. Opportunities for

employment, service to others, and an ability to practice independently create an

excellent work environment for our profession.

References:

National Council State Boards of Nursing (2008). Consensus Model for APRN Regulation:

Licensure, Accreditation, Certification, and Education. Downloaded from https://

www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

U.S. News and World Report (2018). 2018 Best Jobs Report. Downloaded from https://

money.usnews.com/careers/best-jobs/nurse-practitioner

In the United States, most of us are blessed with an abundance of health care

opportunities. Many of us have a doctor for this, a doctor for that, a nutritionist for

this, a physical therapist for that, and high tech specialty services are just a referral

away. But for those less fortunate, health care practitioners and facilities, and the

healing and hope they provide, may be scarce or even absent altogether.

Enter “Some kind of wonderful:” Church Family Missions

In the 1980’s, Bill and Liz Gieg traveled from South Lake Tahoe, California, to

Central America. Liz recalled the world they discovered “was full of dirt streets…

deserted cars…and signs I couldn’t understand. Tons of looped wire hung from

telephone poles…bunches of wire ran from pole to pole to bring electricity to each

cement house…garbage [was] scattered everywhere.” Bill and Liz learned first-hand

of the crushing poverty and overwhelming need of those Guatemalan residents, and

their lives were forever changed.

Returning year after year to Central America, Liz carried a first aid kit “stocked

with more than the ordinary first aid items. In one situation I was able to supply

medicine and treatment to a diabetic man with ulcerated feet.” After serving on

a health care team to Bonete, Liz began to organize health care teams through

Church Family Missions, and that service opportunity continues today. To date, over

300 volunteers have traveled to El Salvador, Guatemala, Honduras, and Nicaragua,

and thousands have received loving health care.

In April 2019, Church Family Missions will travel once again to Guatemala (April

29 – May 10). These days the health care teams include doctors, nurse practitioners,

nurses, dentists, and volunteers providing services based on their education and

gifts. Chiropractors, massage therapists, occupational and physical therapists: all are

welcome and their essential treatments are so very much appreciated. Regarding

volunteering: if you’re willing, you’re able!

A “typical” day unfolds like this: we walk to a breakfast location, and share the

ground we walk on with cats and chickens. The bus driver may require we walk up

the rocky slope where the road used to be – here’s hoping it doesn’t rain today! We

know we’re approaching our clinic location by all the donkeys and horses “parked”

along the shaded fences.

The crowds of people awaiting us may number between four and five hundred.

Sometimes health care representatives from the national government join us

to perform registration, screening, or immunization surveillance. Our patients

then progress from triage (vital sign and blood sugar measurement, and antiparasite

medication administration), to physical assessment with recommendations

for treatment and medication, to a variety of treatment stations, and finally to

pharmacy. In addition, there are usually several hundred who visit with the dentists.

Thankfully translators assist every step of the way.

Days can be demanding, just as the smoke, heat, and dust are demanding. But

more than once a woman shedding tears of gratitude has said to me “I know you

could take a vacation anywhere, but here you are, with me.” Our eyes locked, our

hands reached for one another… a perfect and magnificent joining of hearts and

souls…

If you’re looking for something new, some kind of wonderful, please check

out Church Family Missions. The rewards are endless and eternal, and the life you

change may be your own!

For more information please visit Church Family Missions at www.cfmministries.

org or email churchfamilymissions@charter.net

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Page 6 • Nevada RNformation May, June, July 2019

NNA Environmental Health Committee

What’s new about Pediatric Lead Poisoning?

Bernadette M. Longo,

PhD, RN, CNL, PHNA-BC,

FAAN

As nurses we know that

young children are most

vulnerable to the toxic effects

of lead and can suffer profound

and permanent adverse health

effects, particularly on the

development of the brain and

nervous system (WHO, 2018). Over the last 40 years in

the United States there has been a significant reduction

of lead in the environment due to the removal of

lead in gasoline and paint. Typical pediatric screening

asks about living in a home constructed before 1978

for a basis of exposure (thinking of paint sources as

contamination). However, homes and buildings built

between 1982 - 1988 are likely to have lead in pipes,

fixtures and solder resulting in the drinking water as

a source of exposure. In 2011, Congress passed the

Reduction of Lead in Drinking Water Act revising

the definition of lead free by lowering the maximum

lead content of plumbing products from 8% to

0.25% (EPA). In addition to environmental sources

of lead, starting in the 1990’s the FDA, the California

Department of Health Services, and independent

laboratories had identified that certain imported

candies contained hazardous levels of lead. Candies

with elevated lead levels appeared to primarily be

imported from Mexico, Malaysia, China and India. All

these efforts were making progress on reducing the

risk of exposure to children.

Suddenly, lead poisoning was again in the

forefront as the Flint (Michigan) water crisis resulted in

~140,000 individuals being exposed to lead and other

contaminants in their drinking water for 18 months.

Yet, each day in our country children continue to be

exposed to lead and suffer with the adverse effects.

According to Healthy People 2020, no safe blood lead

level has been identified for children. Nearly 500,000

U.S. children ages one to five have blood lead levels ≥ 5

micrograms per deciliter (µg/dL), which is currently the

reference level at which the Centers for Disease Control

recommends public health actions be taken. Even

blood lead exposure levels as low as 2 µg/dL can affect

a child’s cognitive function.

New Considerations on

Exposure to Lead

Exposure to lead occurs from two routes: (1)

inhalation of lead particles (dust, fumes), and (2)

ingestion of lead-contaminated dust/soil, water (leaded

plumbing), and food, materials or contaminated hands.

As you are already aware, young children explore

by touch and hand-to-mouth behaviors potentially

resulting in exposure to lead. Recently, attention has

been given to unexpected new sources of lead exposure

and provide an opportunity for nurses to revise their

screening criteria for which children should be tested.

Lead-contaminated Spices, Herbal Remedies, and

Ceremonial Powders

Recent studies found that spices in the homes of

lead-positive children had elevated lead concentrations

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and suggested that these contaminated products

might represent an important source of childhood

lead exposure (Angelon-Gaetz et al., 2018; Hore et

al., 2019). The potentially lead-contaminated spices

included: saffron supplement, turmeric, and paprika. A

study by Hore et al. (2019) found spices and spice mixes

commonly used in South Asian cuisine (curry & masala)

contained elevated lead levels. The researchers further

identified various other seasonings used in different

cuisines, such as bouillon cubes and powders, broth,

or soup spices, as well as hot pepper, chili powder, and

paprika. They concluded that spices purchased abroad

were more likely to have elevated lead concentrations

compared with similar spices purchased locally in the

United States (Hore et al., 2019). The countries included

Georgia, Bangladesh, Nepal, Pakistan, Morocco,

Mexico and Jamaica. In comparison, another study

by Angelon-Gaetz et al. (2018) found some leadcontaminated

products were purchased in the US.

Contamination of spices can occur at any point

along the supply chain due to intentional or inadvertent

addition of lead. Intentional adulteration includes

adding a lead-based coloring agent or adding

weight for products sold by weight. Unintentional

contamination can occur by growing the spice plant

in lead contaminated soils and enters the plant/spice

by contaminated water or dust. Lead can also be

introduced during the grinding process of the spice

from lead-based equipment.

Non-food items can also be sources of lead exposure

to children. These include ceremonial powders and

topical remedies such as kumkum, sindoor, surma,

Balguti Kesaria (an ayurvedic medicine) and turmeric

(Angelon-Gaetz et al., 2018). In 2017, the U.S. FDA

issued a warning about Balguti Kesaria when it

confirmed it contained lead in addition to arsenic, and

mercury. Although ceremonial powders are not food,

they might be accidentally ingested by children.

Marksmanship

Shooting for sport and competition requires

commitment to training, discipline and regular practice.

Competitive shooting, from high school teams to

the Olympics, requires shooting excellence in three

positions, including the prone position on the ground.

Training usually begins around 8 to 10 years old.

Exposure to lead is from both inhalation and ingestion

routes and can occur from a variety of shooting-related

activities. Many bullets are made of lead, which is

vaporized at the base of the bullet when it is released

at the muzzle of the gun. Lead is also involved in the

Neurotoxic Effects from

Lead Poisoning

• Executive functions: remaining on task

• Visual-spatial skills

• Speech & language deficits

• Fine & gross motor skills

• IQ

• Long term: academic performance &

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primer (lead styphnate) to start the combustion of the

gun powder, which propels the bullet down the barrel.

Powder and particles are shed by friction of the bullet

moving through the barrel during firing. The inhalation

exposure primarily occurs when the lead-containing

vapors of shooting blow back into the breathing

zone of the shooter, especially in the prone position.

Secondary exposure also occurs from the environment

of the firing range, especially indoor ranges with

poor ventilation. Lead can collect on finely-sized dust

particles and be inhaled. Ingestion of lead occurs from

handling the bullets, eating or drinking at the shooting

range, contaminated soils or floors, and contaminated

clothing and shoes of the marksman. Furthermore,

if dry sweeping is used for cleaning, this action can

resuspend lead-ladened particles. Goldman et al. (2017)

have been advocates to bring awareness and offer

personal protective and hygiene measures for shooters,

as well as environmental measures to reduce exposure

of lead at firing ranges.

Brain development is a fragile process of

myelinogenesis that continues until about age 25.

Lead exposure is believed to affect the health of

myelin coating on the neurons in the brain. Hence,

adolescents with lead exposure may be facing

associated long-term risks that present in adulthood.

These include a decrease in renal function, blood

pressure and cardiovascular effects, hematological

effects, essential tremor and cognitive effects overtime

(Goldman et al., 2017).

NURSING INTERVENTIONS

Provider engagement with patients and

community education are successful methods

to increase lead screening rates!

Spices and herbal remedies are a part of

many children’s diets and might be a source

of lead exposure. Therefore, communicate

the risks for lead contamination in spices,

especially those purchased abroad.

Identify children/adolescents involved in

marksmanship activities – add them to your

screening list!

Nevada’s Low Blood Lead

Testing Rate

Alarmingly, only 3% of Nevada's 217,000 children


May, June, July 2019 Nevada RNformation • Page 7

NNA Environmental Health Committee

Fumes from shooting contain lead, a newly

recognized source of exposure.

Spices and herbal remedies may contain lead.

Strategies to Improve Lead Testing

1) Audit your own clinical performance

& that of your team. Time pressures and

simple forgetfulness are common reasons

many children who should be tested are

falling through the cracks. The majority of lead

poisoned children do not exhibit any outward

symptoms of illness, or symptoms so vague as to

be mistaken for any number of minor childhood

illnesses. As nurses, we can do better!

2) Simplify the system to screen for lead. Make

sure screening questions for testing are in an

EMR or form used at annual exams for children.

Offer point-of-service testing by purchasing inclinic

capillary lead screening equipment and use

it.

3) Update your “at risk” profile for who

should be tested. Update according to

current guidelines (see NCLPPP resources).

Add marksmanship and families who may use

imported spices to the screening list. Also,

consider homes built before 1988, instead of

1978.

4) Follow-up & case manage lead-positive

children. Develop a system in your clinic to

track and reach out to these patients for longterm

health maintenance.

5) Offer Parent Education materials. Obtain

from free websites such as the NCLPPP & CDC.

Place in waiting rooms or a poster on the wall

in treatment rooms. Include in your educational

material packets given out at annual exams.

6) Partner with “The Nevada Childhood Lead

Poisoning Prevention Program” and your

local Nevada Health Department!

References & Resources

Angelon-Gaetz, K.A., Klaus, C., Chaudhry, E.A., & Bean,

D.K. (November 23, 2018). Lead in Spices, Herbal

Remedies, and Ceremonial Powders Sampled from

Home Investigations for Children with Elevated Blood

Lead Levels - North Carolina, 2011-2018. Morbidity and

Mortality Weekly Report, 67(46), 1290-1294.

Goldman, R. H., Woolf, A. D., & Karwowski, M. P. (2017).

Gun Marksmanship and Youth Lead Exposure:

A Practice-Oriented Approach to Prevention.

Clinical Pediatrics, 56(11), 1068–1071. https://doi.

org/10.1177/0009922817701177

Haboush-Deloye, A., Marquez, E., Marshall, M., &

Gerstenberger, S.L. (2019). Evaluation of the blood

lead screening component of the Southern Nevada

Childhood Lead Poisoning Prevention Program. Journal

of Public Health Management and Practice, 25,

S37-S43. doi: 10.1097/PHH.0000000000000882

Haboush-Deloye A, Marquez E, Gerstenberger S. (2017).

Determining childhood blood lead level screening

compliance among physicians. Journal of Community

Health, 42(4), 779-784.

Look on page 11 of RNFormation for answer!

Hore, P., Alex-Oni, K., Sedlar, S., Nagin, D.A. (2019).

A spoonful of lead: A 10-Year look at spices as a

potential source of lead exposure. Journal of Public

Health Management and Practice, 25, S63-S70. doi:

10.1097/PHH.0000000000000876

The Nevada Childhood Lead Poisoning Prevention Program.

https://nvclppp.org/

EPA Drinking Water Contaminants – Standards and

Regulations & The Federal Lead and Copper Rule.

https://www.epa.gov/dwstandardsregulations

World Health Organization. (2018). Lead poisoning and

health. https://www.who.int/en/news-room/factsheets/detail/lead-poisoning-and-health

Household interventions for preventing domestic lead

exposure in children. Cochrane Systematic Review –

Intervention, 2016. https://www.cochranelibrary.com/

cdsr/doi/10.1002/14651858.CD006047.pub5/full

Bernadette M. Longo, Ph.D., RN, APHN-BC, CNL,

FAAN

Chair of NNA’s Environmental Health Committee

Emerita Professor at the Orvis School of Nursing,

University of Nevada Reno

By Camille Catelo

UNLV Student Nurse

Vice President, Nevada

Nursing Student

Association

The Nevada Nursing Student

Association (NVNSA) is the

first state student nurses’

association chapter for Nevada.

It was recently founded last April 2018 to allow all

nursing schools in Nevada to come together and

work towards common goals. NVNSA’s mission is to

bring together various student nurses’ associations

in Nevada to create a network that will ensure the

proper education of nursing students and result in the

highest quality professional healthcare. Its goals include

promoting community engagement through outreach

opportunities, becoming involved in the Nevada

legislature by advocating for bills that will affect the

future of nursing practice, the creation of scholarships

to advance nursing education, and provide leadership

opportunities for nursing students. Additionally,

NVNSA plans events to allow nursing students to

network, hone their leadership skills, and help them

transition from undergraduate nursing students to

professional nurses.

NVNSA helped organize the Future of Nursing in

Nevada (FONN) awards gala and the Shining Stars of

Nursing event in Nevada last October 6th, 2018. The

FONN awards gala is a fundraising event to support the

work of the Nevada Action Coalition (NAC) which is

the driving force for transforming health care through

Nevada Nursing Student Association

nursing in our state. The NAC’s goal is to improve

the health of Nevada residents, remove scope-ofpractice

barriers, prepare nurses to lead in the changes

to advance health, and expand opportunities for

nursing students by providing scholarships and grants.

This event aimed to honor nurses in Nevada and all

proceeds went to nursing scholarships and grants.

NVNSA is currently leading the Vegas Roots Project

which helps low-income Nevada residents eat fresh

fruit and vegetables while supporting family farmers

and growing economies. This volunteer opportunity

happens on the first day of every month, and interested

individuals can contact nevadansaofficial@gmail.com.

My name is Camille Catelo, and it has been a

wonderful experience to serve as the first Vice

President of NVNSA, I am delighted to have this

opportunity to invite you to our exciting event:

“Meet and Greet” with our board of directors and

first annual convention to elect our next officers.

The NVNSA 1st annual convention will be held on

Saturday, May 11, 2019, at 12pm-4 p.m. at the Nevada

System of Higher Education (NSHE) building located

at 4300 S. Maryland Parkway in Las Vegas. Please

join us if you want to learn about what we do, or

have interest on how to get involved with community

health events, breakthrough nursing events, and

leadership opportunities. RSVP by May 3, 2019 at

nevadansaofficial@gmail.com to assist with planning

this exciting event.

Additionally, we are also co-organizing the Nevada

Nurses Association convention on September 14th,

2019. Please plan to attend this event if you would

like to support NVNSA, the first state student nurses’

association chapter for Nevada. There will be keynote

speakers, poster presentations, opportunities to get

Continuing Education (CE) credits, and fundraising

silent auctions with raffles. There will be more

information available soon. We look forward to seeing

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Page 8 • Nevada RNformation May, June, July 2019

Cassi Gonzales - A Special Catalyst for Health

By Tracey Long PhD, RN, MS

Three years ago, Cassi Gonzales, RN and a few friends created a Healthy Athletes

program for Special Olympics in Nevada. Nevada was one of the few states that

didn't have a Healthy Athletes program in conjunction with the National Special

Olympics program. Their goal was to have a health fair twice a year in northern

and southern Nevada where special needs athletes could get physicals, meet with

healthcare professionals for education, referrals, and various services. The services

now offer screenings and education to the athletes to help promote a healthy

lifestyle. The five programs are:

• Health promotion: a nurse-run program that offers education on nutrition,

healthy living and exercise

• Med fest: offers physical exams for the athletes and provides referrals to

specialists as needed

• Fun fitness: physical therapists teach stretches, balance and exercises

• Strong minds: provides education on relaxation and stress control techniques

• Special smiles: provides dental screenings, referrals and education on oral

hygiene

All of the clinical directors volunteer their time and have been trained by Special

Olympics International on how to run their discipline. The growth in the programs

have grown exponentially. In addition to the biannual health fair, they have started

a fitness class where athletes can work with a fitness instructor weekly. Fitness

challenges throughout the year are offered for athletes who may not be able to

attend classes.

Gonzales humbly stated “When I first started volunteering for Special Olympics,

my first thoughts were “I’m going to make such a difference in the lives of these

athletes. I’m going to help them get healthier; I’m going to help educate them

and I’m going to improve the quality of life.” It didn’t take me long to realize that

while I was trying to change their lives, the athletes were changing mine. They have

taught me to always do my best, to always be positive and encouraging to others,

and to do my best to enjoy the moment that I’m in.” Bringing in new volunteers

and showing them just how rewarding volunteering with Special Olympics can be

is a special joy for Gonzales. They are always looking for new volunteers to serve as

program directors and volunteers in any capacity to help the athletes and programs in

Southern Nevada.

For more information about this program and to become a volunteer contact Cassi

Gonzales @ caasicgonzales@gmail.com or visit the website for Special Olympics of

Southern Nevada at https://www.sonv.org/

Dementia Word Search

Puzzle

BINGO

BLANKETS

CANDY

COMFORT

COMPASSION

DIGNITY

FAMILY

FEEL

HOLD

HUGS

LISTEN

MEMORIES

MUSIC

PLAY

RESPECT

SLEEP

SLOWER

SMILE

TEARS

TIME

TOUCH

WARMTH

ANSWERS on page 13


May, June, July 2019 Nevada RNformation • Page 9

VETERANS CORNER

Mental Health Services for Veterans with Post Traumatic Stress Disorder (PTSD)

Denise Rowe DNP, MSN, APRN, FNP, BC

Post traumatic stress disorder (PTSD) is a debilitating mental disorder with

a significant public health burden in the United States (US). 1-2 Veterans are at

heightened risk for PTSD due to military combat and exposure to other traumatic

events. 3 The prevalence of PTSD among US Veterans is estimated to vary between

5% and 32% compared to the annual prevalence of 3.5% among the general US

adult population. 4-9

The diagnostic criteria for PTSD includes an exposure to an actual or threatened

death, serious injury, or sexual violence through: direct experience, witnessing,

learning about traumatic events that occurred to others, or experiencing repeated

or extreme exposure to the unpleasant details of the traumatic events. 10 Several

weeks or months after the events, individuals may experience intrusive symptoms

(including flashbacks, nightmares and intrusive thoughts of the incident), avoidant

behaviors (such as avoiding situations, people, stimuli that remind them of the

traumatic event), negative mood including self-blame for the traumatic incident,

isolation and detachment), and alterations in arousal (including hypervigilance,

exaggerated startle response, poor sleep and concentration). 10 People with PTSD

can have other mental health problems - like depression, anxiety, alcohol and drug

abuse. Consequently, these individuals are at risk for harming themselves or others. 11

VA Southern Nevada Healthcare System provides a wide array of mental health

services to Veterans with PTSD. These services include psychotherapies, medications

and classes / support groups. Psychotherapies focus on techniques to address the

underlying symptoms from traumatic events and are proven to treat PTSD. 11

Psychotherapies

Psychotherapies are available to treat the symptoms of PTSD. Psychotherapies

include:

• Prolonged Exposure Therapy (PE) – PE exposes individuals to the traumatic

thoughts, feelings and situations they are avoiding while helping them to

manage their thoughts and feelings more effectively

• Cognitive Processing Therapy (CPT) - CPT teaches individuals how to identify

traumatic thoughts and feelings and utilize techniques to change them

• Eye Movement Desensitization and Reprocessing (EMDR) – EMDR utilizes a

specific sound or movement to trigger traumatic memories and work through

the process of eliminating the associated negative thoughts, emotions, and

feelings

Medications

In addition to psychotherapy, a variety of medications are available to treat PTSD.

While they are not the only pharmacotherapy available, SSRIs (selective serotonin

reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are

types of antidepressant medications commonly used in treating depression and

anxiety associated with PTSD. 11 SSRI and SNRI control neurotransmitters (serotonin

and norepinephrine) in the brain to relieve the symptoms of depression and anxiety

by elevating mood and promoting a sense of well-being. Four SSRIs/SNRIs that are

recommended for PTSD include Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine

(Prozac) and Venlafaxine (Effexor).

Support Groups

VA Southern Nevada Healthcare System offers many support groups and classes

to veterans with PTSD.

Classes / Groups

(ACT Orientation) Introduction to

Acceptance and Commitment Therapy

ACT for Depression and Anxiety

ACT for PTSD

Mantra Repetition for Veterans:

Meditation Techniques for Veterans

with PTSD

Pathways to Recovery Group

PTSD support Group

HU Meditation and Guided Imagery for

Healing and Peaceful Energy

Anger Management Group

Managing Your Anger

Anger Management Series for Women

Veterans

Women’s Mind Body Group

Winning Against Depression

Tai Chi & Chi Gung Class

Yoga for PTSD-Mind Body Group

Therapy

Bass Guitar Group

Classes / Groups

PTSD Phase I – Combat PTSD Group

PTSD Phase I – Non-Combat Group

PTSD Phase I – Military Sexual Trauma

PTSD Phase II – Military Sexual Trauma

Evidenced Based Therapy preparation

Imagery Rehearsal Therapy for

Nightmares

Cognitive Behavioral Therapy for

Insomnia

Vet to Vet Peer Support Group

Recharge Group for Improving Sleep

Pathways to Recovery – Women’s Peer

Support Group

Post Traumatic Growth Group

Brief Cognitive Behavioral Therapy for

Depression

Mindfulness Based Stress Reduction

Group

PTSD Stress Management Group

Acoustic Guitar Group

Veterans may schedule appointment for classes/groups at VA Southern Nevada

Healthcare System by contacting:

• VA Medical Center PTSD Program: 702-791-9062

• Veterans Recovery Center: 702-791-9060

• Women’s Health Center: 702-791-9176

• Northwest Clinic Mental Health: 702-791-9020

• Northeast Clinic Mental Health: 702-791-9050

• Southwest Clinic Mental Health: 702-791-9040

• Southeast Clinic Mental Health: 702-791-9030

• VA Medical Center Call Center: 702-791-9024

References:

1. Alonso J, Petukhova M, Vilagut G, et al. Days out of role due to common physical

and mental conditions: results from the WHO World Mental Health surveys. Mol

Psychiatry. 2011;16 (12):1234 –1246 . doi:10.1038/mp. 2010.101 PubMed

2. Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders:

an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr

Soc.2009;18(1):23–33. doi:10.1017/S1121189X00001421 PubMed

3. Wisco BE, Marx BP, Wolf EJ, et al. Posttraumatic stress disorder in the US veteran

population: results from the National Health and Resilience in Veterans Study. J Clin

Psychiatry. 2014;75(12):1338 –13 46 .

4. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health

services, and attrition from military service after returning from deployment to Iraq or

Afghanistan. JAMA. 2006;295(9):1023–1032. doi:10.1001/jama. 295.9.1023-1032.

5. Kulka RA, Schlenger WE, Fairbank JA, et al. Trauma and the Vietnam war generation:

Report of findings from the National Vietnam Veterans Readjustment Study. Vol 18:

Brunner/Mazel New York; 1990.

6. Dohrenwend BP, Turner JB, Turse NA, et al. The psychological risks of Vietnam for US

veterans: a revisit with new data and methods. Science. 2006;313(5789):979–982.

doi:10.1126/science.1128944 PubMed

7 Kok BC, Herrell RK, Thomas JL, et al. Posttraumatic stress disorder associated with

combat service in Iraq or Afghanistan: reconciling prevalence differences between

studies. J Nerv Ment Dis. 2012;200(5):444–450.

8. Kessler RC, Berglund P, Delmer O, Jin R, Merikangas KR, Walters EE. Lifetime

prevalence and age-of-onset distributions of DSM-IV disorders in the National

Comorbidity Survey Replication. Archives of General Psychiatry. 2005; 62(6):593–602.

[PubMed: 15939837]

9. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, Severity,

and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey

Replication. Arch Gen Psychiatry. 2005; 62:617–627. [PubMed: 15939839

10. Diagnostic and Statistical Manual of Mental Disorders. (DSM-5®). Arlington, VA:

American Psychiatric Association; 2013.

11. US Department of Veterans Affairs. Understanding PTSD and PTSD treatment. https://

www.ptsd.va.gov/publications/print/understandingptsd_booklet.pdf. Accessed

November 14, 2018.

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Page 10 • Nevada RNformation May, June, July 2019

Antibiotic Stewardship

Many nurses who read

RNformation are not members

of the Nevada Nurses

Association (NNA) or the

nationwide American Nurses

Association (ANA) and, before I

continue, the question at hand

is:

“What is your responsibility

to prevent antimicrobial

resistance?”

ANA’s periodical, The American Nurse, published

the article: “Strengthening nurses’ role in antibiotic

stewardship” in October 2017. It begins; “The recent

worldwide outbreak of Candida auris, a multidrugresistant

fungus, underscores the criticality of

robust institutional and community-based antibiotic

stewardship programs. Improving antibiotic use is a

patient safety issue.” The article focuses on what nurses

can do to halt antimicrobial resistance. 1

The January 2019 edition of The American Nurse

updated the ANA’s 2017 concerns and the cover photo/

text defines Candida auris as an emerging threat.

The accompanying article: “Nurses’ response to an

emerging threat” emphasizes the potential dangers

of multidrug-resistant (MDR) Candida auris as a new

world-wide peril. 2

Also, in January 2019 Lei Chen, Ph.D. Sr.

Epidemiologist at the Washoe County Health District

sent out a bulletin instructing: “If your healthcare

facility is located in Washoe County, should you have

any suspected case of Candida auris, please call us

immediately at 775-328-2447.”

A Nurse’s Responsibility

By Norman Wright, RN, BSN, MS

History

Anyone who has followed this column since 2016

knows the problem of Antimicrobial Resistance (AR) is

more extensive than the recent concerns with Candida

auris, which is fungal not bacterial. Fungal Candida

auris alarms go way beyond MRSA, VRE or other

familiar MDR pathogens. Likewise, MDR organisms

(meaning resistant to just three classes of antimicrobial

agents) are now overshadowed by Carbapenemresistant

Enterobacteriaceae (CRE) that can be PDRO

(Pan Drug Resistant) meaning resistant to all classes of

antibiotics.

Recognizing AR is an ever-expanding global threat

you may ask yourself - “What can one nurse do to

avoid AR?” After all, you are a single person in a vast

network of health care providers and, unless you are an

APN, you cannot write an antibiotic order. You may feel

powerless, so why try? Which brings us to one of the

basic mandates of nursing – do no harm.

The May, 2016 edition of ANA’s The American Nurse

includes the article “Antibiotic stewardship for staff

nurses” 3 which, under the heading of: “Role of the

staff nurse” highlights these five actions:

1. Ensure pertinent information about antibiotics is

available at the point of care

2. Question the antibiotic administration route

3. Reassess antibiotic therapy in two to three days

4. Review antibiotic therapy when your patient

develops a new C. difficile infection

5. Reconcile antibiotics during all patient-care

transitions

To rephrase, the first action is: Obtain and

communicate accurate information about your patient’s

symptoms to the prescriber. I recommend using SBAR.

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The second step, you must re-evaluate and question

the prescribers’ initial antibiotic order, then three review

subsequent C&S reports to determine if the antibiotic/

antifungal is appropriate, or needed at all. Number 4

asks you to determine if an allergic reaction, or C-diff,

develops. Finally, if the C&S report shows an antibiotic

is not needed, or the bacteria is resistant, you must

communicate this information to the prescriber and get

the initial order changed.

Let’s get real

Reality is some prescribers do not want to be

questioned and any nurse who questions them gets

bullied. When confronted by this type of behavior you

have a decision to make, do you say, “I am sorry I will

never question your order again,” or do you stand up

and continue questioning?

If you adhere to the premise of “Do No Harm” it

is your responsibility to continue questioning, which

admittedly may be difficult. Depending on the politics

of the institution you work at, raising concerns have

been known to place a nurse’s job in jeopardy. But this

is a topic for another day.

Back to basics

Each time you neglect to perform proper hand

hygiene you potentially cause harm. Likewise, if you

observe someone failing to use proper transmissionbased

precautions (isolation), it does not matter if they

are a nurse, visitor, RT, PT, CNA, or a physician, call them

out because they place your patient at risk for infection.

Preventing an infection achieves two goals. Your

patient was not harmed, and, if there is no infection

there is no need to order an antibiotic.

Be observant, explore your environment and find

items harboring germs. For example, let’s look at

privacy curtains. The American Journal of Infection

Prevention published a study on how quickly a bedside

curtain gets contaminated. The study found that 14

days after freshly laundered hospital curtains were

hung five of eight curtains were contaminated with

MRSA. 4

Now ask yourself - during patient care, did you ever

realize the curtain was not providing enough privacy

and you quickly close it with your soiled gloved hand?

If yes you just contaminated the curtain. Later, before

tending to the patient in the next bed you wash your

hands, put new gloves on and again close the curtain!

You have just contaminated your clean gloves with

pathogens from the patient you previously cared for!!!

Cross-contamination happens that quickly. Explore

your environment for other similar scenarios to resolve.

For additional information on preventing

antimicrobial resistance go to www.nvasp.net – The

website of the Nevada Antimicrobial Stewardship

Program. We must preserve the power of antibiotics

for future generations.

Become involved and join the American Nurses

Association, which enrolls you in Nevada Nurses

Association. These organizations provide resources that

will promote your nursing career, and antimicrobial

stewardship.

Citations:

1) https://www.americannursetoday.com/nurse-roleantibiotic-stewardship/

2) https://www.americannursetoday.com/candida-aurisemerging-threat/

3) https://www.americannursetoday.com/antibioticstewardship-staff-nurses/

4) https://www.ajicjournal.org/article/S0196-

6553(18)30155-X/fulltext

PERSHING GENERAL HOSPITAL

Lovelock, NV

Career Opportunities for Nurses

FULL TIME / PART TIME POSITIONS-

ED/ACUTE RN & LTC RN/LPN

Per Diem RNs needed in the ER/Acute – must have

experience. RNs or LPNs needed in Long Term Care.

Application and information for all opportunities

available: www.pershinghospital.org

855 6th St., Lovelock NV 89419 • 775-273-2621 x202

EOE/Drug & Alcohol Free Workplace


May, June, July 2019 Nevada RNformation • Page 11

Bicycle Safety

CDC RECOMMENDS HELMETS

The CDC recommends the use of a properly fitted

helmet, when riding a bicycle, for all ages, to prevent

head and brain injury in case of a crash (2017). Helmets

not only protect against head and brain (TBI) injuries,

which are the leading cause of morbidity and mortality,

but other facial, ocular and dental injuries as well.

Those wearing helmets during a wreck were found to

have a 51% lower risk of TBI, 31% lower risk of facial

fracture and 27% decrease in facial contusions and

lacerations (Joseph et al. 2017).

Lisa McKinney, BSN, RN

Cycling can be a fun form of recreation, exercise and

transportation for the whole family to enjoy. However,

cycling is not without risks. There were 840 bicyclists

killed, in the United States, in 2016, (National Highway

Traffic Safety Administration, NHTSA). Seven of these

fatalities were in Nevada and accounted for 1.8%

of total traffic fatalities (NHTSA, 2018). The Nevada

Department of Transportation shows 58% of these

accidents were in the roadway, 13% on sidewalks

and another 13% in intersections (2017). The majority

of bicycle related deaths and one-third of non-fatal

injuries are related to traumatic brain injuries (TBIs). TBIs

tripled when injuries happened to riders not wearing

helmets. In 2012, over 80,000 bicycle related head

injuries were treated in emergency departments across

the US. Helmets have been shown to decrease the risk

of severe head and brain injury by 63-88% (Graves et

al. 2014).

AGE & GENDER RELATED STATISTICS

While one might think children are the ones to

most benefit from helmet use, children accounted for

only 7% of bicyclists killed in traffic collisions in 2016.

In this same time frame, men accounted for 84% of

bicycle fatalities. The largest group of men were 50

to 54 years old and 12% were 55 to 59. Men’s bicycle

fatalities were 5.6 times higher than women’s (NHTSA,

2018). A study conducted between 1997-2013 reported

3.8 million bicycle injuries not ending in death. These

numbers are thought to be just an estimate as only a

fraction of accidents causing injuries are ever reported.

The costs to society related to these statistics include

medical costs, loss of work as well as life or quality of

life. This study found the cost of non-fatal injuries to

be $209 billion and fatalities $28 billion (Science Daily,

2017). Joseph et al. (2017) found that over $2 billion US

healthcare dollars are spent on TBI’s annually.

BE SAFE

• Wear a Proper Fit Helmet

• Wear Light Reflective Clothing

• Be Aware of Your Surroundings

• Know the Law (NRS 484B.760-783)

Bicyclists have the same rights and

responsibilities as other drivers.

HELMET SAFETY & FIT

For helmets to be effective in protection, they must

be a Consumer Product Safety Commission (CPSC)

approved helmet. The CPSC is the standard required

by law, in the United States, for bicycle helmets. This

standard was put in place by the government in 1994

and covers all helmets produced for the US, since 1999

(Bicycle Helmets, 2017).

The CPSC helmet must be properly fit and adjusted.

If the helmet is not properly adjusted it is unstable and

may wobble or rotate. Helmets are made with adjustable

straps, many with an adjustment at the nape of the neck

as well as under the chin affecting stability. Poor stability

compromises the efficacy of the helmet on impact. In one

particular study, children and adolescents were found to

more often wear helmets incorrectly. The correct size,

adjustments, angle or tilt and width of the helmet worn,

was found to be detrimental in its effectiveness. The

helmet should be adjusted to take out the instability, with

straps fastened securely under the jaw.

It is worth seeking fit guidance from a bicycle

technician, in one of the many sports or bicycle shops

in the area. Sufficient helmet fitting was found in less

than half of retail stores (Thai, McIntosh & Pang, 2015).

NURSES GET INVOLVED

Nurses may get involved in one of the many school

bicycle programs or create bicycle safety programs

where they do not exist. Nurses have a wide range

of outreach to educate patients, families and schools

within our communities. For example, one trauma

center was instrumental in developing a program to

keep kids healthy and safe in their community. The

program consists of bicycle safety books, DVD’s,

video games, classroom educational programs as

well as organizing an interactive bicycle safety rodeo.

The safety program provided patients presenting to

the emergency department after crashing, safety

awards for wearing helmets. The positive recognition

reinforces safe behavior (Elwell, Kulp & McCue, 2014).

Nurses may provide printable education brochures

available at Nevada’s Source for Bicycling Information,

BicycleNevada.com (n.d.):

Kids Bicycling Guide

https://www.nevadadot.com/home/

showdocument?id=3684

Kids Bicycling Guide in Spanish

https://www.nevadadot.com/home/

showdocument?id=3686

A Guide to Frequently Asked Questions

https://www.nevadadot.com/home/

showdocument?id=3682

A Guide to Frequently Asked Questions

https://www.nevadadot.com/home/

showdocument?id=3692

Grab your helmet, friends and family and get out

there and ride Nevada!

Reference

Bicycle Helmet Standards. (2017). Retrieved from https://

helmets.org/standard.htm#CPSC

BicycleNevada.com (n.d.). Nevada’s Source for Bicycling

Information. Retrieved from https://www.nevadadot.

com/mobility/bicycle

Centers for Disease Control and Prevention. (2017).

Bicycle safety. Retrieved from https://www.cdc.gov/

motorvehiclesafety/bicycle/index.html

Elwell, S., Kulp, H. & McCue, J. (2014). Creating a

comprehensive bicycle safety program. Journal of

Trauma Nursing, 21(6), 309-313.

Graves, J., Pless, B., Moore, L., Nathens, A., Hunte, G., &

Rivara,F. (2014). Public bicycle share programs and

head injuries. American Journal of Public Health,

104(8), 106-111.

Joseph, B., Azim, A., Haider, A., Kulvatunyou, N., O’Keefe,

T. Hassan, A., Gries. L. Tran, E., Latifi, R. & Rhee, P.

(2017). Bicycle helmets work when it matters the most.

The American Journal of Surgery, 213(2), 413-417.

National Highway Traffic Safety Administration. (2018).

Bicyclists and other cyclists (DOT HS 812 507).

Retrieved from https://crashstats.nhtsa.dot.gov

Nevada Department of Transportation. (2016). Public safety.

Retrieved from https://www.nhtsa.gov/sites/nhtsa.dot.

gov/files/documents/nevada_fy2017_ar.pdf

Science Daily. (2017). Soaring medical costs from bicycle

accidents. Retrieved from https:www.sciencedaily.com/

releases/2017/06/170601082236.htm

Thai, K., McIntosh, A. & Pang, T. (2015). Bicycle helmet size,

adjustment and stability. Traffic Injury Prevention,16,

268-275.

NNA EHC Answers

puzzle on page 7


Page 12 • Nevada RNformation May, June, July 2019

Nurses in the News

Tracey Long PhD, RN, MS, MSN, CDE, CNE, CCRN

Nevada Nurses in the News

Joyce Malaskovitz has been named the new CNO for

Desert Springs Hospital in Las Vegas, Nevada. She brings

to the position a long legacy of leadership with the

Diabetes Treatment Center at the hospital, which due to

her leadership is the only accredited diabetes education

program in Nevada. Her leadership in the Valley Health

system will continue to promote the hospital’s accredited

programs of CHF, Diabetes, Bariatrics, and Stroke care,

which she also created. Desert Springs Hospital sent five

members from the emergency department to Alabama

this past summer for disaster training. Participants

included (pictured) Travis Legrand, RN, ER manager,

David Barrett, RN Clinical Supervisor, Brooke Backer, RN

Joanne McCready, RN, and John Kay, EMT-P. After the

Las Vegas October 1 shooting, emergency department

personnel have received advanced training in triage tools

to hazmat suit decontamination. “Personally, this was

one of the most memorable educational experience I’ve

had in my 13-year nursing career,” Backer stated.

National Nurses in the News

Leading articles of nurses in the news nationwide

have featured stories of male nurses sexually assaulting

patients in nursing homes. One disabled patient in

a vegetative state in an Arizona nursing home facility

gave birth, to the surprise of the nursing staff who

were unaware she was pregnant as they responded

to her labor. The father of the baby was confirmed

by DNA tests to be a male nurse who worked with

her. The Arizona Governor has called for severe

investigation of such conduct. This issues a strong call

to all nurses nationwide to honor the legal and ethical

duty to honorably respect those entrusted to our care.

New York nurses won a hallmark legislation to

be eligible for retirement benefits in a $20.8 million

settlement. Male dominated professions described as

“physically taxing,” such as plumbers and construction

workers entitled them to early retirement after working

K’ima:w Medical Center (an ambulatory, rural clinic), an entity of the

Hoopa Valley Tribe, is seeking applicants for the following positions:

Director of Nurses DON, FT/Regular ($83,688-108,678 per yr

DOE) – 8-hr shifts, M-F; no weekends; signing bonus available; loan

repayment available. Responsible for setting the standards for clinical

nursing care; providing care; and, supervises the Nursing Department.

Minimum Requirements: RN Licensure; driver license; Bachelor degree

preferred; two years supervisory experience preferred.

Open until filled.

Registered Nurse Care Manager, FT/Regular ($69,264-90,043 per yr

DOE) – 8-hr shifts, M-F; no weekends; signing bonus available; loan

repayment available. Acts as patient care coordinator for outpatient

clinical services and participates in patient and family education.

Minimum Requirements: RN Licensure; driver license; Bachelor degree

preferred; 1-2 years case management experience preferred.

Open until filled.

For an application, job description, and additional information, contact:

K’ima:w Medical Center, Human Resources,

PO Box 1288, Hoopa, CA, 95546

or call 530-625-4261, ext. 211 or 226,

or email: hr.kmc@kimaw.org

for a job description and application.

Resume and CV are not accepted without

a signed application.

Nurses in Albany, NY demonstrating this past

summer to pass a minimum staffing law, which

passed. Source: Mike Groll/Associated Press

25 years by age 50. Nurses lobbied to be qualified

equally as a profession for benefits and won triumphantly

recognizing the very physical demands of nursing.

National nurse shortages still estimate thousands of

nurses are still needed in all areas of nursing as the baby

boomer generation ages and requires medical attention

and more patients have access to health care due to the

Affordable Care Act. Community and mental health

are put at risk due to the shortage. An estimated 92%

of emergency rooms report patient overcrowding and

often hold patients in hallways on gurneys waiting for

available rooms. Additionally, efforts are being made in

multiple states to recruit more minority nursing students

to better serve the nation’s growing diverse populations.

Scholarships and grants are available through various

organizations and nurses are encouraged to promote

the nursing profession to the younger generation.

Celebrating Nurses in Nevada

David Barrett and Arlene Blanco were nominated

by Desert Springs Hospital as exemplary in their fields

and worthy of celebration. Getting to know these

nurses will give you a sense of pride in nursing as our

colleagues demonstrate excellence in their corners of

our nursing world.

David Barrett: ER Charge Nurse

What is your background in nursing?

I began as a CNA, then LPN, RN and now BSN RN

for the past eight years. It’s been a long journey and I

have learned so much.

How do you maintain positivity while working in the

challenging setting of an ER?

I think if you remember that most people make the

best decision at the time with the information they

have, helps you not to judge, but just to help them

when the decisions produce negative outcomes.

How do you help your ER team to be effective and

positive?

I will always remember my ER charge nurse mentor

who had significant things stolen from his home the

day before. He would have been justified coming

to work angry, but he came to work and moved on

positively through the work day, because people

needed him to be at his best. That really impacted me.

Join Our Team!

The Clark County School District located in

Las Vegas, Nevada is currently hiring School Nurses.

Interested candidates should visit our website

www.teach.vegas or call us at 702-799-5427 to learn more.

In CCSD, more than 320,000 students are served in a unique

combination of urban and rural schools. We are searching

the globe for individuals who have extraordinary passion,

the keen ability to connect with students, and a relentless

drive to achieve life-changing results.

#1 for Kids

School Nurse Positions Available

What are you doing now that energizes you in

nursing? (At this question, he physically got excited and

his demeanor was full of energetic passion)

I started a non-profit called $5 for Change and our

goal is to give back essentials of housing and food

to our homeless youth in Southern Nevada. We have

coordinated community food and clothing drives with

many volunteers who served Noah’s animal house,

the Ronald McDonald House, Three Square, Whitney

Elementary School, Shade Tree, Well Care clinic and

hospital children’s drives for several years. If everyone

in Las Vegas donated just $5/month that could support

the funding to help end youth homelessness in our city.

We’re offering them a hand-up not a hand-out.

To learn more how you can volunteer or donate go

to: https://fivedollarsforchange.com/

Arlene Blanco: In-patient wound care coordinator

Why did you want to become a nurse?

I want to make a difference in people's lives. I

was inspired by the nurses that took care of my

grandmother when she was hospitalized. I admired

how they touched my grandma's life, and how those

nurses look fulfilled in what they're doing - serving sick

people.

What is your current nursing position?

In-Patient Wound Care Coordinator. I went To

Emory University in Atlanta, Georgia for my Wound,

Ostomy, Continence Nursing Program. I specialized in

Wound care and I'm board certified in Wound Care

and a member of the WOCN Society.

What do you love about nursing?

It allows me to enjoy the rewards of serving people

while growing professionally and personally.

If you could improve the nursing profession what

would you do?

My message is for nurses to uphold their profession

and increase their awareness of their significant part in

the health care team.

What is your advice to new nurses?

Don't give up easily. The first few months may be

overwhelming but give yourself time to adjust to your

new role. Respect the knowledge and long years of

experience of the experienced nurses. Be a team player

and always establish rapport with your patients and

families and other health care team members.

What is your advice to experienced nurses of how to

stay in love with nursing?

Always go back to the time how enthusiastic they

were to become nurses. Never forget that they were

once a new nurse, so be supportive with the new

nurses. You can also learn from them. Keep yourself

abreast in the new trends of nursing by attending

conferences, trainings and classes. It is helpful in

updating and improving your knowledge and skills.

Share with us an uplifting story about how you

made a difference for good in a patient's life.

There's actually a lot of them. I took care of a

non-English speaking patient who had a dehisced

abdominal surgical wound. I've been managing the

wound vacs for several months, so I established a good

relationship with her and her family. The wound was

healing slowly as she had other comorbidities and a

nutritional deficit. I remember the first time I met her,

she was extremely terrified. I was able to lessen her

fears and she and her family trusted me. She always

thanked me every time I change her vac dressing and

that kindness from her touched me.


May, June, July 2019 Nevada RNformation • Page 13

Tracey Long, PhD, RN, MS, MSN, CDE, CNE,

CHUC, CCRN

“I hate my body.” “Where did all these ugly gray

hairs and wrinkles come from?” “How could anyone

find me attractive when I look like this?” “My body is

such a burden.”

If you’re like 97% of the American population, you’ve

probably said something like this to yourself. According

to a repeat survey done by Glamour magazine 30

years ago and updated in 2014, 54% of women are

unhappy with their body and 80% claim the mirror

makes them feel bad about themselves. Even men admit

to body image angst; from 1997 to 2001, the number

of men who had cosmetic surgery increased 256%.

Unhappiness about body image has been reported

among girls as young as age six. Clearly, we need to

evaluate the messages the mirror is sending to us.

Mirror, mirror, on the wall

Although many of us rely on mirror messages as the

absolute truth, we need to be aware of the inherent

distortions the mirror may hold. Ever since 8,000 B.C.,

when the mirror made its first appearance, people

have been evaluating their personal worth based on

their physical appearance. Two opposite attitudes exist:

Some people are fixated by their own faces, as shown

by an obsession with “selfies.” Others declare their

body hatred throughout the day as we often see on

social media. We have a love-hate relationship with the

mirror—but the mirror may not always tell the truth.

People with anorexia nervosa see a distorted view in

the mirror; some view themselves as fat even though

they’re dangerously thin. The mere act of focusing

on something, such as a nose or a mole, may make it

look larger in the mirror. Even your mood may affect

the way you see yourself. When you’re tired, angry, or

anxious, the mirror may reflect your emotions more

than your true physical image.

What the mirror tells you

Relying on the mirror to tell you “who is the fairest

of them all” may not give you the whole truth. Despite

potentially negative messages people get from the

mirror, it can provide helpful information. It can tell

you a lot about both the outside and the inside of

your body. Although we focus on our exterior image,

the mirror can provide information about the internal

health of your body.

Using your nursing assessment skills, take an objective

look at your skin and hair. The skin, the body’s largest

organ, can provide a lot of feedback on your sleep (or

lack thereof) and nutrition. Without adequate vitamin

intake or sun, your skin may be pale and flaccid; without

adequate essential fatty acids, it may be dull or dry.

Stress, overwork, and lack of purpose in your life may

reflect in the empty eyes that stare back at you.

What the mirror doesn’t tell you

Shakespeare’s Hamlet exclaimed, “What a

piece of work is man! How noble in reason, how

infinite in faculty! In form and moving how express

and admirable! In action how like an angel! In

apprehension how like a god!”

The mirror doesn’t tell you about the amazing functions

of your body systems, or that you and your body are the

most brilliant creations in the universe. For instance, your

endocrine system is an amazing creation of numerous

Dementia Word Search Answers

puzzle on page 8

What the Mirror Doesn’t Tell You

autonomic functions working through feedback loops of

chemicals to regulate many systems. It also balances your

energy levels through the thyroid gland. When is the last

time you thanked your adrenal glands for helping regulate

your blood pressure via cortisol and aldosterone?

Thanks to auto-regulation, your body can maintain

its temperature within the same general range even

when the environment around it changes constantly.

Breathing is controlled by tissues in your carotid arteries

that track carbon dioxide (CO2) concentration and send

messages to the brain’s respiratory center. Your body

breathes faster or slower to eliminate CO2 as needed,

all without your conscious awareness.

Your pancreas produces both insulin and glucagon,

which naturally oppose each other, but work in

harmony to balance blood glucose levels. These

levels affect the function of all three trillion cells in

your body. Your glucose level rises in the morning to

awaken you and give your cells energy to start the day

automatically. Somatostatin regulates the endocrine

system, balancing insulin and glucagon to work in

complete balance without your attention. When is the

last time you thanked your pancreas?

The mirror also doesn’t tell you how well your liver

detoxifies drugs and chemicals and maintains your

blood glucose level when you’re asleep. Nor does it

reveal that your immune system constantly monitors

and patrols your blood for foreign pathogens, which

it then kills through a complex chemical cascade. Does

the mirror tell you that your spleen has been working

hard to store white blood cells and recycle red blood

cells? When did you last thank your spleen?

What the mirror doesn’t tell you about your

magnificent self is far more interesting and exciting than

the cellulite you may glimpse in the mirror. It doesn’t

let on that your body has innate abilities, such as autoregulation,

self-defense, and self-healing. Your body has

the ability to detect injury and immediately goes into

repair. Your natural self-healing includes the inflammatory

process and movement of white blood cells to the site of

damage to destroy pathogens that may have caused or

entered the injury. Your body moves gracefully through

tissue repair and healing autonomically, usually. We

often treat our bodies so poorly and then expect them

to perform without our support. An example is giving

our bodies Styrofoam (such as poor food choices) and

expecting it to repair like steel.

The nursing reflection

Ironically, some nurses who care for sick patients

and help promote health and healing are unhealthy

themselves. Research shows that occupational stress,

poor coping behaviors, and lack of support create

anxiety and depression in nurses. The longitudinal

Nurses’ Health Study, which began in 1988, examines

relationships among hormone replacement therapy,

diet, exercise, and other lifestyle practices and chronic

illnesses. It found female nurses’ health was no better

than that of the general populace. Ideally, a nurse’s

health should reflect their education and knowledge

Ready for a change? Want to try

something different? Come to

beautiful rural Nevada.

RNs needed for:

Long-Term Care

Director of Nursing

49 bed attached to hospital

Acute ER

Supervisor

slmcnv.org

Contact Administration at

775-463-6401

All RNs, LPNs, and New Grads welcome to apply

of the human body. Unfortunately, knowledge alone

doesn’t create vibrant health. We should sing along

with the Disney character Mulan, who asks, “When

will my reflection show who I truly am?”

You’re invited to join the American Nurses

Association campaign for action improving nurses’

health and wellness. For more information please

visit http://www.healthynursehealthynation.org/ and

view the free webinar on the grand health challenge

for nurses at https://campaignforaction.org/webinar/

improving-nurses-health-wellness/

As nurses, we can do better to reflect the true inner

beauty of our bodies—and project that beauty in our

lifestyles. Balancing the mirror’s messages is the key.

What the mirror doesn’t tell you can inspire you to

honor your body. What it does tell you can motivate

you to care for yourself, so you can better model

healthy behaviors for patients.

Fixing the mirror’s reflection

In our society of quick fixes and limited warranties,

it’s easy—and often necessary—to replace just about

everything. Most material objects can be replaced

when they’re worn out.

The only thing that can’t be replaced is the human

body. We can misuse and abuse it or treat it with

loving care. Despite the amazing advances of medical

science (and plastic surgery), your body is still your

physical essence. Although it comes with a lifetime

warranty, its quality isn’t guaranteed; that’s up to you.

Our decisions can determine our destiny with health.

Saying you don’t have time for your health today may

leave you with no health for your tomorrow.

What does your mirror say to you? Will you listen?

AUTHOR BIO

Tracey Long is a Professor of nursing in Las Vegas,

Nevada for Chamberlain and Arizona College. As an

identical twin, she regards her twin sister as her better

reflection.

Selected references

Coditz GA, Manson JE, Hankinson SE. The Nurses’ Health

Study: 20-year contribution to the understanding of health

among women. J Women Health. 2009;6(1):49-62.

Dove® Campaign for Real Beauty. www.dove.us/Social-

Mission/campaign-for-real-beauty.aspx

Enoch JM. History of mirrors dating back 8000 years.

Optom Vis Sci. 2006;83(10):775-781.

Mark G, Smith AP. Occupational stress, job characteristics,

coping, and the mental health of nurses. Br J Health

Psychol. 2012;17(3):505-21.

Cleveland Clinic. Fostering a better self-image. Retrieve

from http://my.clevelandclinic.org/health/healthy_

living/hic_Stress_Management_and_Emotional_

Health/hic_Fostering_a_Positive_Self-Image

American Nurses Association health nurses campaign.

Retrieved from http://www.nursingworld.org/

healthynurse

Song, M. and Iovannucci, E. Nurses Health Study. JAMA

Retrieved from http://oncology.jamanetwork.com/

article.aspx?doi=10.1001/jamaoncol.2016.0843

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Page 14 • Nevada RNformation May, June, July 2019

Submitted by Rebecca Gebhardt, APRN FNE

Forensic Nurse Practitioner & DNP student

Washoe County Human Services Agency

As a nurse participating in the Infant Fatality Review

Board for Sudden Unexpected Infant Death (SUID), the

tragedy is close to my heart. The Washoe County Infant

Fatality Review has two sections including community

response to sentinel events and public health

improvements and the internal investigation of the

specific factors of the SUID; both contribute to defining

areas to affect positive change.

Nevada, not unlike the rest of the nation, has

experienced a tragic increase in infant mortality related

to unsafe sleep practices. In July 2018, the Clark County

Coroner’s office reported that, across all demographics,

"unsafe sleeping conditions kills a baby every two

weeks." The 2016 records confirm this sad reality

with 31 deaths due to modifiable risk factors. Washoe

County is not far behind averaging one per month in

2018. Providers that have experienced the tragedy of an

Safe Infant Sleep Practices

infant loss in their practice setting or personally could

not express how painful this is to a family. The pain is

compounded when modifiable risk factors, grounded in

good intention, led to the infant’s death (Mejia, 2018).

The Center for Disease Control and Prevention (CDC)

divides SUID into seven different categories including

sudden infant death syndrome (SIDS), accidental

suffocation, neglect or homicide, hypothermia and

hyperthermia, metabolic disorders, poisoning, and the

unknown or undetermined. Unlike the broad category

of SUID, SIDS became a diagnosis in 1969 and to

the present day, is recognized only as a diagnosis

of exclusion. The criteria for SIDS is that an infant is

less than one year of age, all of the modifiable risk

factors eliminated, thorough autopsy and genetic

testing yielding no other cause, and the clinical and

death scene is devoid of suspicion. Only then can

the diagnosis of SIDS be used. For those particular

cases, there may be potentially applied scientific

research relating to the serotonin levels in the medulla

oblongata or hippocampus associated temporal lobe

epilepsy (CDC, 2014).

Unsafe sleep practice is often passed down

generationally or culturally misinformed by individuals

that don't know or understand the risk factors. Often

healthcare colleagues are among the misinformed

due to the age of their children or lack of knowledge

regarding the actual number of healthy infant

deaths related to SUID. The acronym SIDS has been

familiar for generations; unfortunately, there are

multiple inaccurate interpretations. Recently, the

National Association of Medical Examiners, American

Academy of Pediatrics, the American Academy

of Nurse Practitioners, and many other pediatric

healthcare stakeholders, have taken a closer look at

the differentiation and standardization of diagnosis

between accidental smothering or mechanical

suffocation and the thymic causes (Haynes et al., 2016).

This author plans a study that will examine suffocation

related to unsafe sleep practices as this number is on

the rise as the SIDS rate decreases. Common factors

and scene findings include prone or side position, soft

bedding, pillows of all shapes, water beds, couches, missfitting

mattresses, bed frame distance to the wall, larger

person rolling over onto the infant, and creating a wedge

with a body part. Anything that decreases or restricts

the oxygenated environment in or around the infant’s

face can play a role. There is also a risk of strangulation

between bed rails and pumper pads. Fortunately, there

is a hopeful movement in Nevada to create legislation

banning the sale of bumper pads.

Bairoliya and Fink (2018) identified that over 7,000

full-term infants died in the U.S .between 2010 and

2012. SUID was the leading cause of full-term infant

death. These authors concluded that lower maternal

education regarding unsafe sleep was associated with a

higher risk of dying from SUID and quoted "a substantial

proportion of these deaths are preventable" (p. 2).

This author has developed a survey to identify gaps

and bias of education delivery by role models such as

nurses and social workers. The identification of these

issues may help focus future efforts in Nevada on

the education of providers, adjusting the present inplace

systems, and shift collectively in awareness. The

information gathered may add to the body of knowledge

in classification and reporting; it may also improve trend

monitoring and lead to design interventions ending

healthy infant mortality related to unsafe sleep.

References

Center for Disease Control (2014). Sudden Infant Death.

https://www.cdc.gov/sids/data.htm

Bairoliya, N. & Fink, N. (2018). Causes of death and infant

mortality rates among full-term births in the United

States between 2010 and 2012: An observational

study. Journal of Pediatric Medicine 15(3) 1-14. https://

doi.org/10.1371/journal.pmed.1002531

Haynes, R., Folkerth, R., Paterson, D., Broadbelt, K.,

Zaharie, D., Hewlett, J., … Kinney, H. (2016). Serotonin

receptors in the medulla oblongata of the human fetus

and infant: The analytic approach of the international

safe passage study. Journal of Neuropathology &

Experimental Neurology 75(11) 1048-1057. https://doi.

org/10.1093/jnen/nlw080

Mejia, H. (2018, July 24). Clark County Coroner: Unsafe

sleeping conditions kill a baby nearly every 2

weeks. https://www.lasvegasnow.com/...coroner...

baby.../1320163673


May, June, July 2019 Nevada RNformation • Page 15

Nevada Nurses Foundation EST 2014

Hello Everyone!

The Nevada Nurses Foundation (NNF) is grateful for establishing a professional

and charitable presence in Nevada, collaborating with individuals, educational and

health care institutions, and community organizations as well as carrying out its

mission. With the federal recognition as a 501(c)(3) non-profit organization status

in October 2014, the NNF has since awarded $80,526.00 dollars to Nevada nurses,

certified nursing assistants, licensed practice nurses, and pre-nursing students.

Because of the generous and charitable donations from people like you, the NNF

will award over $100,000.00 in awards by the end of this year.

Maria D’Errico, APRN, RN, NNF Advisory Board member; Community Outreach

Coordinator and previous two-time scholarship recipient and Dave Tyrell, BSN, RN,

NNF Executive Board member, previous NNA President share ways to support the

Nevada Nurses Foundation (NNF). Through the generous support of our donors,

the NNF has granted scholarships to more than 80 nurses and nursing students

across the state. By becoming a scholarship donor you have an important role

in supporting the professional development of nurses and increasing access to

quality healthcare for Nevadans. You can also sponsor grants that support nursing

professional projects, and recognize the achievements of your nursing colleagues by

nominating them for one of the many awards that NNF offers.

If you are a previous NNF scholarship recipient there are many ways to show your

gratitude and foster a culture of giving back to the Foundation. You can volunteer to

serve on the NNF Advisory Board, where members collaborate on ways to advance

the mission and vision of the Foundation. You can also help to increase awareness

of the NNF by sharing our scholarship opportunities with nursing students, and

identifying potential community partners to support the Foundation. There is no

effort too small, and the NNF appreciates all of your support. Together we can work

to support the professional development of our nursing community so that we can

increase access to quality care for all Nevadans.

“The Nevada Nurses Foundation had a very productive year in 2018” asserts

Dr. Glenn Hagerstrom, NNF Chief Financial Officer. According to Dr. Hagerstrom,

the NNF received approximately $11,000 in donations specifically for scholarships

and $1,670 in other donations in 2018. Approximately $44,800 was earned from

fundraising events such as the Big Hat High Tea and the Shining Stars of Nursing

dinner. These amounts demonstrate that only 22% of our revenue for the year

came from donations whereas 78% of our revenue came from our own fundraising

efforts. The Foundation awarded a total of $18,908 in scholarships and grants in

2018, which represented 73% of the total expenses for the year. The remainder of

our expenses were for operational and fundraising event costs. With your support,

we look forward to another successful year in 2019.

Please consider attending the Crowns and Tiaras Big Hat High Tea on Saturday,

June 1st, 2019 at the Nevada Governor’s Mansion catered by Yerington’s The Bakery

Gallery. Entertainment by the University of Nevada, Reno Music Therapy Foundation

and pianist Landon Flournoy, BSN, RN. Tickets are on sale NOW for $50.00 per

ticket, $500 per table, and an additional $10.00 for gluten-free. Last year, we sold

out, so purchase your tickets ASAP. Doors open at 1:00 PM! Silent auction, raffle,

fun times with friends and family, delicious food, wonderful entertainment, and

supporting three Nevada Foundations!

The Shining Stars of Nursing in Nevada will be held on Saturday, October

12th, 2019 at the exquisite Blind Center of Las Vegas, Nevada. If you would like

to participate in the planning of this one of a kind state-wide Nevada nursing

and student nursing awards and recognition event, please contact SSON@

NVNursesFoundation.org. The Shining Stars of Nursing in Nevada Student Nurse

Event, is a free student event held in the morning of October 12, 2019. Vendor and

Exhibitor opportunities are available to support student nurses in Nevada.

The NNF is the charitable and philanthropic arm of the Nevada Nurses

Association and our mission is to increase access of quality health care for Nevada

citizens by promoting the professional development of nurses through scholarships,

grants, and recognition. Please help us increase quality health care and visit us on

social media; like and follow us on Facebook, Twitter, Instagram, and LinkedIn.

When shopping on Amazon Smile, please select the Nevada Nurses Foundation

as your charitable organization and Amazon will make a donation to NNF on your

behalf.

On behalf of the Nevada Nurses Foundation, thank you for your support and

collaboration!

Thank you and have great days,

Sandy

Sandra M. Olguin, DNP, MSN, RN

President/Chief Executive Officer

Nevada Nurses Foundation

“Success has nothing to do with what you gain in life or accomplish

for yourself, it’s what you do for others.” ~ Danny Thomas


Development of Patient Enrichment Program (PEP) for Patients with

Psychiatric Behaviors in Acute Care

Danielle C. Craperi, DNP, RN, CNML, CNL

University of Nevada, Reno

Dr. Stephanie DeBoor/DNP Project Advisor

Introduction and Problem

Acute care settings often have a treatment gap for patients

that exhibit behaviors of a psychiatric/mental health illness

(PMHI). This treatment gap is related to lack of proper

knowledge and/or programs to care for patients with

PMHI. Due to limited community-based resources,

patients with PMHI have extended length of stay (LOS)

compared to those without a PMHI. 7.74% of hospitalized

patients will experience an undesirable event.

Increased LOS causes higher risk to experience conflict

event

Conflict events: Aggression, verbal abuse, dependency

issues, self-harm, noncompliance with medication regime,

HAI, Falls, elopements.

e

Project, Goals and Intervention

Project

Develop a Patient Enrichment Program (PEP) for acute care can

help bridge the gap. PEP will offer education for nurses, a daily

routine and therapeutic activities for the patients, since these

things have all shown to help with the care of this population.

The population includes adults that exhibit mental health

behaviors that are caused by a mental or medical illness.

Diagnosis's may include anything from bipolar or schizophrenia

to Huntington's or frontal lobe trauma

Tai Chi

Daily Walks

Movie Nights

Arts & Crafts

Pet Therapy

PEP Activities

Music Therapy

Art & Movement

Therapy

Chair Yoga

Meditation

Goals

Family style meals

Daily Routines

Floral arranging

Individual Music Therapy

Social Skills Activities

Results Continued

Month

Pre-Implementation Conflict Events

Number

of Events

with

Greater

Than 14

Days LOS

Number of

Events

Involving

Population

of Interest

Percentage of

Events

Involving

Population of

Interest

Jul-17 25 19 (19/25) 76%

Aug-17 24 16 (16/24) 66%

Pre-Implementation Types of Events

Month Number

of

Security

Events

Jul-17 17

Percentage

of Security

Events

(17/19)

89%

Other

Types

of

Events

2- Skin

breakdown

Percentage

of Other

Events

(2/19) 11%

Aug-17 8 (8/16) 50% 8- Falls (8/16) 50%

Post Implementation Conflict Events

Month

Number of

Events with

Greater

Than 14

Days Length

of Stay

Number of

Events

involving

population

of interest

Percentage

of Events

involving

population

of interest

Sep-17 18 15 (15/18) 83%

Oct-17 22 17 (17/22) 77%

Nov-17 18 15 (15/18) 83%

Month

Post Implementation Types of Events

Number

of

Security

Events

Sep-17 12

Oct-17 12

Nov-17 12

Percentage

of Security

Events

(12/15)

80%

(12/17)

71%

(12/18)

80%

Other

Types

of

Events

Percentage

of Other

Events

3-Falls (3/15) 20%

5-Falls (5/17) 29%

3-

Falls

(3/15) 20%

There was a statically significant decrease in the number of conflict

events after the implementation of PEP

Results

Month

Pre-Implementation LOS

Patients

Average LOS at

Time of Event

(Days)

Units Overall

Average LOS

(Days)

Jul-17 64 6.48

Aug-17 80 6.8

Month

Post-Implementation LOS

Average

Length of Stay

at Time of

Event (Days)

Units Overall

Average

Length of Stay

Sep-17 41 6.94

Oct-17 50 6.20

Nov-17 104 7.44

Pre and post nurse evaluations

showed that staff gained

knowledge from provided

education.

LOS increase due to more patients that fit criteria being

transferred to unit, from 8 to 15 patients. This occurred because

the PEP programs promotion throughout the hospital.

• PEP was presented to Nursing Leadership

• Fliers were distributed

• Formal and informal communication about PEP was

developed to many nurses, CNA’s, hospitalists and

psychiatrists.

References

To request references email Danielle Craperi at DCraperi@gmail.com

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