Wyoming Nurse - December 2020

December 2020, January, February 2021
Vol. 33 • No. 4
WYOMING
NURSE
The
Official Publication
of The Wyoming
Nurses Association
Quarterly publication distributed
to approximately 10,000
RNs and LPNs in Wyoming.
President’s Message
4
2020 WNA Nursing Summit &
Convention Recap
8
Loneliness and Social Isolation
Cause Emotional Pain in the
Elderly
Hello members! I am thrilled
to be the Wyoming Nurses
Association President for the
next two years. I have been
a member since I moved to
Wyoming more than ten years
ago. I have seen so much
growth in our organization. It
pleases me to say that we are
currently sitting at our highest
membership ever, 510 members
strong! This was, and remains
to be, part of our strategic plan.
It is more important now than
ever that nurses feel supported
Marianne
Madariaga, MSN,
RN
in their chosen career. In keeping with our mission,
we continue to serve as the voice of nursing on
important issues and policies that impact our nursing
communities, especially in these trying times. We are
strong advocates for the promotion of healthcare of
Wyoming.
Our very first virtual Summit and Convention in
September was quite a success. We had 76 attendees
and 80 registered. Members reported being pleased
with the knowledge gained from Dr. Mark Dowell
(Rocky Mountain Infectious Disease), Jaquelin Wells
(Wyoming Public Health) and Dee Gilson (Incident
Commander of Sheridan Hospital) in what we have
learned, and continue to learn, about COVID-19.
Masking has proven to decrease the spread of the
virus, so please keep encouraging its use. Just like the
rest of the world, especially nurses, I want this virus
wiped out as soon as possible!
We have continued our monthly Zoom meetings on
Networks of Support. Since the last newsletter we have
hosted school nurses and long-term care. The next
one will be for Nurse Educators on Sunday, November
15, at 4 pm and, “What will 2021 Bring” on Monday,
December 14th at 6 pm. Just get on our website
www.wyonurse.org to find the link under “Upcoming
Events.”
I was the moderator for the long-term care meeting
and my biggest take-away was how concerned we
nurses are for our residents and the nurses who care
for them. We have never had to deal with such chronic
loneliness to this degree and I hope we never will
have to again. As Jeanine Niemoller stated, “People
do die of loneliness, not just COVID.” I encourage our
regions to reach out to your local long-term care and
assisted living facilities to share hope and thank them
for all they do. Residents and staff could use a positive
message and it will brighten their long days.
I wish you all a very happy holiday, full of love,
health, hope and promise in the New Year!
“If you don’t have a smile, I’ll give you one of mine.”
In Loving Memory of Leah Bryan, Casper College
Music Major
10-11
Membership Information
current resident or
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371

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Page 2 • Wyoming Nurse December 2020, January, February 2021
Executive Director’s Message
"Start each day with a
positive thought and a grateful
heart." Roy T. Bennett
None of us could have ever
predicted the extensiveness and
breadth of this year being the
Year of the Nurse. More so than
ever before, my heart swells
with pride as our members and
nurses across the country went
Tobi Lyon, MBA
above and beyond to respond
to the needs of Wyoming citizens throughout this
historic pandemic. Our nurses stood masked, shoulder
to shoulder on the front lines, meeting every possible
need for both COVID and non-COVID patients. Our
nurses stood masked, shoulder to shoulder, to support
our nursing students who will be our legacy and future.
Our nurses stood masked, shoulder to shoulder through
civil and cultural unrest times – united and committed
to using our voices to speak up for what is right and
advance the nursing profession. There were so many
tears along the way…and fears that have not gone
away…and still, nurses stand strong.
It's that time of year where people often reflect
on gratitude and what brings joy into our lives.
Although it's nice to count your blessings during the
holidays, being grateful throughout the entire year
has tremendous benefits on your quality of life. On
December 23, 2019, I wrote that in 2020 I would make
gratitude my theme for the year; little did I know that
having gratitude be part of my daily routine be so
significant to my journey to handle all that 2020 was
going to toss our way.
As 2020 comes to an end, gratitude may be one
of the most overlooked means to a fulfilled life that
we all have access to every day. I would remind all
our Wyoming nurses to take some time and focus on
gratitude and it benefits as you are dealing with more
than you ever thought you would have to during this
pandemic:
• Gratitude opens the door to more relationships.
• Gratitude improves physical health.
• Gratitude improves psychological health.
• Gratitude enhances empathy and reduces
aggression.
• Grateful people sleep better.
• Gratitude improves self-esteem.
• Gratitude increases mental strength.
We have gone through so much together this year
as a profession and as a country. As I reflect on what
we've been through and this "new normal," I am so
thankful for each one of our valued WNA members
and all Wyoming nurses, and so inspired by your
perseverance and resiliency. The entire WNA team is
here to support you; we continue to stand by you and
will be there with our members as we push forward
into the new year - masked, shoulder to shoulder,
and at the ready. The WNA Board met virtually in
November for a strategic session and identified
ways to continue to serve our members during the
pandemic and into 2021. We will continue our work
on supporting nurses' mental health by growing our
networks of virtual support programs and partnering
to promote wellness in our Wyoming communities.
The Board is also committed to growing, developing,
and diversifying our membership through promoting
the professional nurse's influence by working with
our regional leadership to educate our members and
establish partnerships within the community. The WNA
Board and staff look forward to continuing to serve our
members in 2021 and beyond.
The “WYOMING NURSE” is the official
publication of the Wyoming Nurses’ Association,
a constituent member of the American Nurses
Association, published quarterly every March,
June, September, and December.
WNA Executive Director
Tobi Lyon
301 Thelma Drive #200, Casper, WY 82609
Phone: 307-462-2600
Email: tobilyon@wyonurse.org
For advertising rates and information, please
contact Arthur L. Davis Publishing Agency,
Inc., PO Box 216, Cedar Falls, Iowa 50613,
(800) 626-4081, sales@aldpub.com. WNA
and the Arthur L. Davis Publishing Agency, Inc.
reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited
to corrections in the next issue or refund the
price of advertisement.
Acceptance of advertising does not
imply endorsement or approval by the
Wyoming Nurses Association of products
advertised, the advertisers, or the claims
made. Rejection of an advertisement does
not imply a product offered for advertising is
without merit, or that the manufacturer lacks
integrity, or that this association disapproves
of the product or its use. WNA and the
Arthur L. Davis Publishing Agency, Inc. shall
not be held liable for any consequences
resulting from the purchase or use of an
advertiser’s product. Articles appearing in
this publication express the opinions of the
authors; they do not necessarily reflect views
of the staff, board, or membership of WNA
or those of the national or local associations.
www.wpapro.org
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December 2020, January, February 2021 Wyoming Nurse • Page 3
Legislative
Update
All the Legislative
committees have met several
times over the summer
and fall. Interim committee
meetings allow for priority
topics to be addressed and
to develop legislation that
will be considered when
the Legislative Session
convenes next year. Due to
the pandemic, all meetings
have been done via Zoom.
Though safer, there have been
challenges with this type of
platform.
The Wyoming Nurses
Toni Decklever,
MA, RN
Association primarily watches the business of the
Labor Health and Social Services (LHSS) committee.
Other committees have worked on issues that have
garnered WNA’s attention. For instance, the Revenue
Committee is meeting mid-November and the topic of
tobacco taxes is on the agenda. WNA has always been
in support of raising the taxes on tobacco products
because the research is overwhelming that high prices
keep youth from starting to use tobacco.
One of the items on LHSS’s agenda in the October
meeting was to consider the revised APRN compact.
Wyoming is one of three states that passed legislation
a few years ago to become part of the APRN compact.
However, the compact would not go into effect until
at least ten states joined. The number of states stayed
at three, so the National Council of State Boards of
Nursing (NCSBN) revised the language to hopefully
appease more states.
The revised language required a year of practice
after APRN graduation before an application for a
multi-state license could be considered. This change did
not receive the support of Wyoming APRN’s and WNA.
Many APRN’s testified in opposition to joining the new
compact based on this change. The committee did not
consider moving this legislation forward, so there was
no change to current practice. An APRN must obtain a
license in each state they are practicing.
As to be expected, COVID-19 concerns, strategies
and budgetary challenges are the primary topics of
discussion for all the committees. Mental Health Care
has always been a concern, but the pandemic has
made it even more so. The budget shortfall is a major
problem for many programs and will become worse
with a second round of cuts coming. Though the
Revenue committee continues to look at ways to bring
money into our state, increasing taxes for the citizens
of Wyoming is not the way they want to proceed.
The recent election changed the makeup of the
Wyoming Senate and House that increased the number
of Republicans to 28 in the Senate and 53 in the
House. That leaves 2 Democrat seats in the Senate and
7 in the House. Though many legislators did not have
an opponent, several incumbents were defeated, so
there will be some new faces in the 2021 Legislature.
The 2021 Legislative Session is supposed to begin on
January 12, 2021 and is the 40-day General session. It
is anticipated the budget will be discussed at length.
Now is a good time to connect with your legislators
– especially if they have been newly elected. Email,
facetime, Zoom, etc. – there are lots of ways we can
connect without meeting in person at an event or
facility. It is vitally necessary to contact legislators
and make them aware of issues that are important
to nurses and the nursing profession. Your voice truly
makes a difference!
Toni Decklever, MA, RN is the WNA Lobbyist and
can be reached at tonisrn@gmail.com.
Care Center Director of Nursing
Must have a Wyoming Nursing license
Benefits start the month following your start date:
Health insurance | Life insurance | Retirement with
Employer Match | And a Great Paid Time Off Package!
To apply visit us at www.pvhc.org or call 307-754-1135
777 Ave H, Powell WY 82435 EOE

Page 4 • Wyoming Nurse December 2020, January, February 2021
WNA 2020 VIRTUAL NURSING
SUMMIT & CONVENTION
Thank you to all who attended the WNA 2020
Virtual Nurses Summit and Convention on September
25! While this wasn't how we had imagined how we
would celebrate the Year of the Nurse, we had 75
attendees who attended virtually this year!
Our panel discussion, "Public Health Lessons
Learned: Wyoming's Preparation and Response to
COVID" with Mark Dowell, MD; Jacqueline Wells
MSN, BSN, ASN; and Dee Gilson BSN, RN, CNOR
was a very insightful conversation. Tena Brown
provided an engaging and inspirational keynote
presentation. WNA President Marianne Madariaga
closed the virtual event with our WNA Annual
Nursing Awards Ceremony and the Year of the
Nurse tribute video, which can be seen on our
Facebook page.
Attendees of the event can access the recorded
sessions via the conference app. On-demand
versions of the two sessions are now available on
our website at wyonurse.org.
Come make a difference and
Join our Family.
We are hiring!
RNs, LPNs, CNAs
Contact our HR Director
for more information:
hrdirector@northfieldvilla.com
Make A Difference.
Make a difference in the lives of our patients.
Make a difference in your life.
RNs | LPNs
Full time, on all shifts
To apply online:
https://lifecarecareers.hcshiring.com
To apply in person or send resume:
We look forward to hearing from you!
www.northfieldretirement.net
EOE/M/F/V/D
1990 W. Loucks St., Sheridan, WY 82801
307.673.1079 Fax • www.LCCA.com

December 2020, January, February 2021 Wyoming Nurse • Page 5
2021 WNA Nurses Day at the Legislature
Harnessing the Power of Wyoming Nurses
Friday, January 29, 2021
The year 2020 was named the Year of the Nurse,
and what a year to truly learn the value of nurses as
these frontline heroes played a vital role in the fight
against COVID-19. Voted one of the most trusted
professions for 18 years in a row, nurses have kept
us safe, educated and have kept going when no one
else would. There is real power in that kind of selfsacrifice
and determination to help others. It is time
to harness that power. At the 2021, Nurses Day at
the Legislature, Wyoming nurses and future nurses
will come together to talk and learn about where
we’ve been and the power we have for the future.
Please join us for this special virtual event, Friday,
January 29, 2021.
DEMOGRAPHICS OF THOSE WHO ATTEND
The purpose of this conference is to educate and
empower Wyoming nurses on the power of the voice
of nursing and to support nurses in all stages of their
careers.
CONFERENCE OBJECTIVES:
1. Identify ways and the importance to engage
professionally at the state or local level
to impact issues that affect nursing and
healthcare.
2. Recognize the impact nurses can have on
policy.
3. Understand the legislative process.
EDUCATION EXHIBITOR & SPONSORSHIP
OPPORTUNITIES
WNA invites interested vendors to share product
expertise with us during the conference. For more
information on these opportunities, check out our
website at wyonurses.org or contact the WNA office
by email at nurse@wyonurse.org or call, (307) 462-
2600.
CONTINUING EDUCATION CREDITS
This activity has been submitted to the Ohio
Nurses Association for approval to award contact
hours.
AGENDA
Friday, January 29, 2021
8 am- 10 am Attend Health and Human
Services
Meeting
Visit Virtual Exhibit Hall
10 am– 11 am Welcome and Opening
Presentation
11 am – 11:15 Break
11:15 am - Noon Breakout Sessions
Noon – 12:30 pm Lunch Break
Visit Virtual Exhibit Hall
12:30 pm -1:15 pm Breakout Sessions
1:15 pm -1:30 pm Break
1:30 pm – 3 pm Closing Keynote and
Closing Remarks
REGISTRATION FEES:
• WNA Member – $75
• Non-member – $100
• Student** – $25
• Learning Pod location (1 login to stream
sessions, no CE offered) – $1000
Visit nursingALD.com today!
Search job listings
in all 50 states, and filter by location and credentials.
Browse our online database of articles and content.
Find events for nursing professionals in your area.
Your always-on resource for nursing jobs, research, and events.
TO REGISTER:
Use the fast and secure online form at:
www.wyonurse.org.
You can access our group registration form at
www.wyonurse.org or email astarmer@wyonurse.
org.
*Registration fees include materials and contact
hours
**Student rate only applies to students working
on pre-licensure
***$25 administration processing fee will be
assessed for personal cancellations prior to January
22, 2021. No refunds will be provided for personal
cancellations after January 22, 2021. Please call the
office if you would like to discuss transferring your
paid registration.
Cheyenne Regional is looking for individuals
who want to make a difference in Wyoming.
Here, you’ll be part of a strong, stable
healthcare organization–one with big plans
and a clear direction for growth.
For information about job opportunities
with Cheyenne Regional, please visit:
cheyenneregional.org/careers.
INSPIRE GREAT HEALTH WITH US.
Holiday Greetings
from the Board & Staff
of the Wyoming Nurses Association

Page 6 • Wyoming Nurse December 2020, January, February 2021
Region News
Central Region Update
Abby Bremer, RN
Central Region President
As I thought about what to write for this quarter,
I wanted to know more about the experiences of our
Central Region members during the pandemic. We are
learning so much as new information comes out and
changes our practice daily which is requiring us to dig
deep and find ways to maintain our resilience. My hope
is that when you read this quarter’s message from a
peer, you will see we are all in this together and find
some inspiration from a fellow nurse.
Let me introduce Megan Mendoza, perioperative
RN at Platte County Memorial Hospital who also floats
to help in L&D, ED and MedSurg. To learn about her
experience, I asked Megan three questions:
What has the COVID-19 pandemic changed for you?
How are you and your teams coping with these
changes?
What is the most important thing we can share to
help one another through COVID-19?
Here is Megan’s response:
My understanding for how I can support my
community and coworkers has grown immensely as we
are all facing challenges personally and professionally.
COVID-19 has changed the way I carry out my
nursing practice through strengthening my infection
prevention awareness, patient education strategies and
collaboration with other departments. It has become
clear now more than ever, that effectively managing
our own physical and mental health is essential during
this pandemic, so we are able to provide safe and
quality care to our patients.
As COVID-19 brings a different level of stress to
the community, especially during flu season, my team
is faced with challenges of personal illness, influx
of patients and acuity levels and changes in policies
or procedures. In coping with these changes, I have
seen my team meet these struggles with flexibility
and tenacity while directly supporting one another
with compassion and grace. I think it is important to
understand that we are all in this together. When one
person is having a bad day, we must lift them up in
that moment because we may need the same support
from them later on.
I think checking in with each other regularly and
asking, “How can I help?” is important for gauging
where others are in managing their workload and
stress. Supporting personal boundaries and recognizing
when a team member needs a break shows that we
can do this together and no one will be left behind.
We can support one another by encouraging self-care
strategies like exercising, healthy eating, meditating,
getting enough sleep or seeking counseling to
maintain stability for our own health and wellbeing.
I want to thank Megan for her willingness to
share her perspective, I hope you find this message
encouraging and inspirational and I hope you take a
moment to check in with a peer to ask how they’re
doing and offer support, as Megan so adequately
pointed out, “We can do this together!”
Northeast Region News
Lacey Johnson, MSN, RN
Northeast Region President
Hello from the NE Region. We have three new
members and are excited to have them join. They are
Kristy Buckley and Laci Little from Sheridan and Radael
Peterson from Gillette, welcome!
We would like to welcome Tommie Ritterbusch
MSN, RN as the new NE Region Vice President.
Tommie is the Nurse Manager at Welch Cancer Center
in Sheridan. She has great experience in leadership
and is excited to be a part of the team. Please welcome
her!
With the current “new standard” in healthcare we
are all being challenged daily. The region is feeling the
same pressure and stressors as the rest of Wyoming.
There are a lot of moving parts and changes occurring
in our organizations. Increasing our PPE and building
COVID halls is happening weekly.
With our projection for an increase of COVID
patients both Campbell County Hospital, Buffalo
Hospital and Sheridan Memorial Hospital are prepping
daily and having discussions. All of healthcare in
Wyoming is seeing what the rest of the nation saw
in March and April. One of the biggest challenges
our communities are facing is our healthcare workers
becoming ill.
It is important to remember to keep ourselves and
our front line staff healthy. The current situation is
mentally exhausting when family cannot be present
during these difficult times. Sheridan Memorial has
worked closely with their HR department and Employee
Assistance Program to provide group debriefing
session so staff are able to talk as a group and express
the stressors. This has been found to be an effective
team activity to assist the staff in difficult times. We
highly encourage each individual nurse to know that
there are resources available. If you are a manager/
supervisor or above, make sure your staff has this
resource available.
We want to tell our co-professionals across the
state that we are thinking of you all during this time,
and pray that everyone stays safe and healthy.
Northwest Region News
Linette Johnson, MSN, RN
Northwest Region President
We hope everyone is fairing well through these
unusual times. A BIG Thank You to all our nurses
working in all capacities to benefit our communities!
We welcome our newest board member, Tina
King, Secretary, NW Region. Paula Kihn, former
Secretary, is now the NW Region Vice President.
Tina King is an RN at North Big Horn Hospital. She
lives in Buffalo, Wyoming with her husband, yet she
has strong connections to the Northwest region of
Wyoming. Tina has been a practicing RN for twentysix
years. She holds a Doctor of Nursing Practice
in Educational Leadership, an MSN and BSN from
Excelsior College.

December 2020, January, February 2021 Wyoming Nurse • Page 7
Northwest membership update as of
October 2020:
94 active members, 3 new members, 1 cancelled
member, 1 reinstated member - We thank you for
your continued membership; your dues help our
region fund scholarships!
WNA Virtual Summit - Takeaway:
At the WNA Virtual Summit in September Dr.
Dowel gave a compelling session on our COVID-19
situation in Wyoming – we will witness a rise in cases
before we see an improvement; he reminded all of us
– As we move into flu season, and with COVID cases
rising, please wear your mask and wash your hands!
Check out this great article regarding Misti
Asher, RN! Way to go, Misti!
https://www.powelltribune.com/stories/greatcatch-school-nurses-suspicions-help-save-studentslife,27502
Learn more about a healthcare partnership
happening in Fremont County:
NextGen Healthcare Partnership of Fremont County
(HPFC) is a grassroots initiative stemming from the
Next Generation Sector Partnerships (NGSP). The
HPFC includes four subcommittees: Mental Health,
Retention and Recruitment, Fremont County Health
Assessment and Telehealth. The Depot Foundation is
the HPFC fiscal sponsor. If interested in volunteering,
or if you want to learn more, please check out these
links:
Follow us on Facebook at https://www.
facebook.com/Healthcare-Partnership-of-Fremont-
County-108642353830423
Are you wondering what the HPFC is all about,
check out this four minute video: https://vimeo.com/3
16399062?fbclid=IwAR3mU7L7KtQeMN-Z3ZlgKzvDrfrFgh222my5RIQ5AQu5pPoZsZxuW7Gbjs
If you have any stories to share for upcoming
publications, please reach out to our newest board
member, Tina King, NW Region Secretary, at
tkingwy@gmail.com.
We continue to meet, communicate and
collaborate within the state and our region to meet
the needs of our nurses.
Opportunities for Engagement:
If you are interested in any of these opportunities
or if you would like more information, please email
christina.brewer@nwc.edu.
Scholarship Selection Committee - Review
Scholarship Applications/Select recipients/Announce
Awards
Liaisons/Representatives - To arrange and execute
Nurses’ Week Activities at local facilities to promote
WNA and recognize Wyoming nurses for their hard
work and dedication.
Nurse “experts” – Conduct mini-educational
sessions/discussions (15-30 minutes) at regional
meetings regarding topics of interest.
Scholarships!
The Northwest Region is thrilled to announce
the 2020 recipients for our three scholarships!
This year the region expanded eligibility criteria
to include applicants from across Wyoming. After
extending the application deadline, we received
qualified applicants in each category.
Pre-licensure scholarship ($500.00) - Sharron
Hodges
Continuing education scholarship ($250.00) -
Raedel Kellogg
Membership scholarship (1-year WNA/ANA
membership) – Heidi Christensen
education setting said, “We are testing the faculty
once a week and students twice a week. We also use
an app for everyone to self-report symptoms. The
students must share the results of the app with the
facility prior to attending class or clinical.” They are
also using hybrid classes to minimize exposure. The
app has been an invaluable tool. It helps self-screen
participants before they report to class or work and
helps save time with screeners. As someone enters a
facility, usually just a temp is taken and one is able to
show they have a green screen, star or check mark is
given at the end of a clear screening on the app.
A few respondents stated they do not feel safe
in their facility. This is mainly due to non-nursing or
non-medical staff not following the recommended
protocols and guidelines. Stay strong, keep leading
and teaching what is needed. Keep being an example
of what to do and hopefully others will follow. If you
need PPE, please reach out to your WNA board. You
are all awesome! Our state is so fortunate to have our
great nurses!
As we approach the Holiday Season remember to
practice self-care. Here are a few tips to try:
1. Take a few moments every day to meditate or
take a quick 10-minute walk or read a book.
2. Get 8 hours of sleep a night.
3. Just say NO. Simply say “I can’t. I’m sorry.” You
do not need to over stretch yourself.
4. Choose one person whose company you enjoy
and who lifts you up and plan a date with them.
5. Do something creative, even if it is not Pinterest
worthy. Draw, paint, try an adult coloring book.
6. Have a movie night. Hallmark has lots of Holiday
Movies.
7. Treat yourself to a manicure, a pedicure, a facial
or a massage.
8. Turn off your phone for a few hours.
I hope you are now inspired to make some time for
you during this Holiday Season! You can really reduce
your stress level by taking breaks and practicing selfcare.
A less stressed you equals you being a better,
more efficient nurse and person.
Thank you for all you do to serve the people in our
region! I look forward to seeing you on our ZOOM in
December.
Southwest Region News
Carla Lee, MS, RN, CNE
Southwest Region President
Southwest Region would like to welcome Patty
O’Lexy as our newest member of the board. Thank
you Patty, for your willingness to serve as our Region
Secretary. Patty comes with a wealth of experience
in patient care. She has worked in Medical-Surgical
nursing, Cardiopulmonary Services, Hospice, Care
Transition and currently works in the Education
Department for MHSC. Patty has not only served
on several boards throughout her career, she is kind
and dedicated to both her patients and the field of
nursing.
We are also pleased to have Heidi Frandsen
continue her service as Vice President. A special
thanks goes to Deanne Garner for serving as
Secretary for the past two years. Deanne, we are
grateful for your time and energy.
We would also like to welcome the newest
members to the Southwest Region: Janet Goulette,
Brittany Jones, Alisa Orr, Chastity Joyner, Jaden
Romango and Clarissa Roosa. We are so happy to
have you!
In these unprecedented times, we will continue to
support the membership while remaining cognizant
that nurses are overwhelmed, overworked and
fatigued. As we approach the holiday season, we
would like to encourage nurses to find ways to
experience joy. Nurses are surrounded each day by
negativity and conflict and it is our sincere hope that
you are all able to find at least one thing each day to
be grateful for, or that brings you happiness. Whether
that is a heated seat in your car on a cold morning,
a delicious cup of coffee or a smile from a patient or
loved one, please look for the simple yet wonderful
things that are in your life. May the holiday season
give us all an opportunity to reflect on our blessings.
Wyoming
Department of Health
State-wide Smoke-
Free Strategy
Wyoming Department of Health is looking
to bring a group together to represent their
county/region on a state-wide smoke-free
strategy. This will begin with a series of
interactive webinars as part of TA we were
awarded through the National Association
of Chronic Disease Directors. This will be an
opportunity to connect with other states
without a statewide smoke-free policy.
The goal is to use this webinar series to
springboard a Wyoming specific meeting
where we can discuss a concerted effort in this
area.
If you are interested in participating, please
contact Hannah Johnson at the Wyoming
Department of Health at hannah.eck@wyo.gov
Southeast Region Update
Shawn Wyse, RN
Southeast Region President
Happy November everyone! Thank you to all of you
that participated in our region feedback survey. The
survey gives us a great direction to move towards. We
will hold a ZOOM meeting on December 15th, 2020.
We will send out more information via email as the
date gets closer.
COVID-19 is on the rise in our state. We are
all working hard to keep ourselves, and those we
serve, healthy. Most of our survey respondents said
they work in a hospital or long-term care facility, in
education or in corrections. Most feel safe in their
positions at their facilities. The most popular way
Southeast Region Nurses are responding to COVID-
19’s impact is they are being careful, wearing
masks and social distancing. One respondent in the

Page 8 • Wyoming Nurse December 2020, January, February 2021
Loneliness and Social Isolation
Cause Emotional Pain in the Elderly
Karra Harrington and Martin J. Sliwinski
** This article was published in The Conversation, a free on-line newsletter.
“We believe in the free flow of information. Republish our articles for free, online
or in print, under a Creative Commons license.” Read the newsletter at www.
theconversation.com
Maintaining high quality relationships may be a key for protecting brain health
from the negative impacts of loneliness. The loneliness of social isolation can
affect your brain.
Physical pain is unpleasant, yet it’s vital for survival because it’s a warning that
your body is in danger. Pain tells you to take your hand off a hot burner or to see
a doctor about discomfort in your chest. Pain reminds us all that we need to take
care of ourselves.
Feeling lonely is the social equivalent to feeling physical pain. It even triggers
the same pathways in the brain that are involved in processing emotional
responses to physical pain.
Just like feeling physical pain, feeling lonely and disconnected from others is
also a signal that we need to take care of ourselves by seeking the safety and
comfort of companionship. But what happens when we are unable to find
companionship and the loneliness persists?
As scholars at the Center for Healthy Aging at Penn State, we study the impact
of stress on the aging body and brain, including how it can worsen cognitive
decline and risk for dementia. The social isolation older adults are experiencing
now amid the coronavirus pandemic is raising new mental health risks, but there
are things people can do to protect themselves.
The health consequences of loneliness
The COVID-19 pandemic has put many older adults’ social lives on hold, leaving
them at greater risk for loneliness. They know they face a higher risk of developing
severe symptoms from COVID-19, so many are staying home. Restaurant closures
and limits on visitors to assisted living centers have made it harder to see family
and friends.
But even prior to the pandemic, public health experts were concerned about
the prevalence and health impacts of loneliness in the U.S. Loneliness affects
between 19% and 43% of adults ages 60 and older, and many adults ages 50
and over are at risk of poor health from prolonged loneliness.
Research has shown that prolonged loneliness is associated with increased risk
for premature death, similar to smoking, alcohol consumption and obesity. Other
health consequences are also associated with loneliness, including elevated risk for
heart disease and stroke, and it is associated with increased physician visits and
emergency room visits.
Loneliness can affect brain health and mental sharpness
Older adults who are socially isolated or feel lonely also tend to perform worse
on tests of thinking abilities, especially when required to process information
rapidly.
Moreover, those who feel lonely show more rapid decline in performance on
these same tests over several years of follow-up testing.
It is thought that loneliness may contribute to cognitive decline through
multiple pathways, including physical inactivity, symptoms of depression, poor
sleep and increased blood pressure and inflammation.
Loneliness has also been found to increase the risk of developing dementia by
as much as 20%. In fact, loneliness has an influence similar to other more wellestablished
dementia risk factors such as diabetes, hypertension, physical inactivity
and hearing loss.
Although the underlying neural mechanisms are not fully understood, loneliness
has been linked with the two key brain changes that occur in Alzheimer’s disease:
the buildup of beta-amyloid and tau proteins in the brain. Other indicators
of psychological distress, such as repetitive negative thinking, have also be
linked with the buildup of beta-amyloid and tau in the brain. Theories suggest
that loneliness and other psychological stressors act to chronically trigger the
biological stress response, which in turn appears to increase beta-amyloid and tau
accumulation in the brain.
How loneliness can contribute to disease
The evidence suggests that prolonged feelings of loneliness are detrimental to
health. So, how do those feelings get converted into disease?
Feeling lonely and socially isolated can contribute to unhealthy behaviors such
as getting too little exercise, drinking too much alcohol and smoking.
Loneliness is also an important social stressor that can activate the body’s stress
responses. When prolonged, that response can lead to increased inflammation
and reduced immunity, particularly in older adults. Inflammation is the body’s
response to fight off infection or heal an injury, but when it continues unchecked
it can have a harmful impact on health. Stress hormones play an important role
in making sure that inflammation doesn’t get out of control. But, under chronic
stress, the body becomes less sensitive to the effects of the stress hormones,
leading to increased inflammation and eventually disease.
In healthy older people, loneliness is related to a stress hormone pattern similar
to that of people who are under chronic stress. This altered pattern in the stress
response explained why people who were lonelier had poorer attention, reasoning
and memory ability.
Social activity can buffer against the decline
Maintaining high quality relationships may be a key for protecting brain health
from the negative impacts of loneliness.
Older adults who feel more satisfied in their relationships have a 23% lower risk
of dementia, while those who feel their relationships are supportive have a 55%
lower risk of dementia, compared to those who feel dissatisfied or unsupported in
their relationships.
Maintaining social activity also buffers against decline in thinking abilities, even
for those who live alone or who have signs of beta-amyloid accumulation in their
brain. One reason for these benefits to brain health is that maintaining strong
social ties and cultivating satisfying relationships may help people to cope better
with stress; people who feel better able to cope with difficulties or bounce back
after a stressful event show less buildup of tau protein in their brains.
This is good news because, with the importance of social distancing for
controlling the COVID-19 pandemic, how people manage their feelings and
relationships is likely more important for brain health than the fact that they are
spending time physically apart.
Strategies for coping with loneliness
Loneliness is a common and normal human experience. An important first step
is to recognize this and accept that what you are feeling is part of being human.
Rather than focusing on what’s not possible at the moment, try to refocus
your attention on what you can do to stay connected and make a plan to take
action. This could include planning to reach out to friends or family, or trying new
activities at home that you normally wouldn’t have time for, such as online classes
or book clubs.
During times of high stress, self-care is essential. Following recommendations
to maintain regular exercise and sleep routines, healthy eating and continuing to
engage in enjoyable activities will help to manage stress and maintain mental and
physical health.
Karra Harrington is a Postdoctoral Research Fellow, Clinical Psychologist, at
Pennsylvania State University.
Martin J. Sliwinski is the Professor of Human Development and Family Studies,
Director of the Center for Healthy Aging, at Pennsylvania State University.
Seeing Through the Mask
L. Charles Martinez, RN
Reprinted with permission from Arizona Nurse
August 2020 issue
A couple of years ago a group of nurses embarked
on what was at the time called the attunement
challenge. The challenge was for the nurses to take
practical steps to be more “in tune” with their patients.
The challenge was broken into 12 different approaches
that were to span a year. The first and springboard into
the challenge was to “see patients as people.” It goes
without saying that patients are people, right? The
problem lies in the busyness (or business, if preferred)
of health care and that patients can sometimes be
looked at as a diagnosis, an assignment, or sadly, just
a pain.
That brings us to 2020 and COVID-19, people with
whom we have no relation or understanding of who
they are, are shrouded behind veils or masks. What
we are missing are the faces, the smiles, the laughter,
and hidden expressions that sometimes give us clues
into what people are really going through. What we
all must remember is that under the mask is a living,
breathing, laughing, crying individual with something
to offer the world. It is so easy to overlook a complete
stranger, even more so when you don’t see their face.
Today we can choose to see through the mask and
see the person as we see ourselves. An individual with
needs, wants, and concerns who is uncertain, anxious,
and if we are not afraid to admit it, a little scared at
what the future holds. As we see through the mask
and deeper into the soul of the person we see that
there is a spirit within each of us to overcome, have
meaningful relationships, share life, and live life to the
fullest.
So today, I challenge each and every one of us to see
past the mask and see our future as one of hope and
of deeper understanding of those around us.
At first sight we see that today we are not who we
used to be. Today holds us between where we were
and where we want to be. What we must remember
is that today, not tomorrow, is what we have and the
rest is not guaranteed. So today I choose to see you
through your mask as a person, body, soul and spirit...
forever thankful for this day, that together we can live
it. -LCM

December 2020, January, February 2021 Wyoming Nurse • Page 9
Integrative Care: What is it and What Does it
Mean for Nursing?
Mary E. Burman
Most adults are more
likely to seek help in a
primary care setting than
a mental health setting
(National Institute of Mental
Health [NIMH], 2017).
Consequently, about half
of mental health care for
common disorders such as
depression and anxiety, is
provided in primary care
settings. However, those
with mental conditions
who receive care in a primary care setting are
less likely to receive effective care. For example,
“75 percent of adult patients with depression see
primary care providers, but only half are accurately
diagnosed. When a referral is made to a mental
health provider, only about half of patients follow
through with making an appointment. As a result,
many behavioral health problems go undetected,
undertreated and/or untreated” (NIMH, 2017, para.
6).
To address these unmet needs, nurses and others
are advocating for a model of care that integrates
behavioral health and primary care. Integrative care
(also referred to as collaborative care or integrated
behavioral health care) is defined as:
The care a patient experiences as a result of
a team of primary care and behavioral health
clinicians, working together with patients and
families, using a systematic and cost-effective
approach to provide patient-centered care for
a defined population. This care may address
mental health and substance abuse conditions,
health behaviors (including their contribution to
chronic medical illnesses), life stressors and crises,
stress-related physical symptoms, and ineffective
patterns of health care utilization (Agency for
Healthcare Research and Quality, n. d.).
Integration of care can occur along a continuum
from coordinated care with an emphasis on
communication between mental health and
primary care, to co-located care in which physical
proximity is emphasized, to integrated care in
which primary care and behavioral health redesign
and transform care through full collaboration (see
https://www.thenationalcouncil.org/wp-content/
uploads/2020/01/CIHS_Framework_Final_charts.
pdf?daf=375ateTbd56). Not all settings will be able
to attain the higher level of integration; however,
any integration is important. To help organizations
decide when and how to integrate care, a variety
of on-line resources are available (see https://www.
thenationalcouncil.org/integrated-health-coe/
resources/).
Core components of integrated care models
include the following: 1) team-driven, 2) population
focused, 3) measurement-guided, and 4) evidence
based. In integrated care models, nurses are critical
members of the integrated team. At minimum,
integrative care teams generally have a primary
care provider (e.g., a family nurse practitioner), a
psychiatric mental health provider (e.g., psychiatric
mental health nurse practitioner), behavioral health
provider (e.g., therapist), and a case manager (e.g.,
registered nurse). It is important that the team, in
addition to providing care to individuals, also address
population factors that influence the health of their
community. Integrated care models should have
clearly articulated and measurable outcomes that are
evaluated on a regular basis. Finally, care is grounded
in the best available evidence.
Want to know more? Participate in the University
of Wyoming Integrative Care ECHO learning
network. The network is open to anybody, including
nurses, nurse practitioners, physicians, therapists
and social workers, and can be easily accessed
through your smartphone, tablet or computer. The
sessions are generally twice a month on Thursdays
over the noon hour. The sessions have an overview
and update on a topic relevant to integrative care,
e.g., treatment of insomnia, use of antipsychotics in
primary care. A discussion of a real patient challenge
is offered by one of the participants with experts
and other network members providing input and
addressing questions. Go to: http://www.uwyo.
edu/wind/echo/mental-health/index.html for further
information.
Nurses are well-positioned to take the lead on
integrated care and to address critical unmet needs
for mental health and primary care in our rural state!
Mary E. Burman is a professor emeritus at the
University of Wyoming. She was on the faculty for 28
years, serving as Dean of the Fay W. Whitney School of
Nursing for 11 of those years. She continues to be active
in health care serving on the Boards of Directors for
Ivinson Memorial Hospital, Downtown Clinic and Delta
Dental of Wyoming.
References:
Agency for Healthcare Research and Quality (n.d.). What
Is Integrated Behavioral Health Care (IBHC)? https://
integrationacademy.ahrq.gov/products/behavioralhealth-measures-atlas/what-is-ibhc.
National Institute of Mental Health (2017, February).
Integrated Care. https://www.nimh.nih.gov/health/
topics/integrated-care/index.shtml

Page 10 • Wyoming Nurse December 2020, January, February 2021
Just a Rest
So I don't know about you, but life just seems to roll
along at Mach 5. It has been a year for sure. The discussion
and funny memes about 2020 really hit home for me.
I keep waiting for the next “issue” to arise and steal my
attention. I'm tired.
In all the years I have been in nursing and healthcare, I
have experienced many ups and downs. If you have been
in healthcare for a hot minute, you have too. There are the
days and months of issues which demand our time and
attention. We have deadlines, unrealistic expectations,
demanding bosses, and organizations fighting for survival.
There are days when “enough is enough”.
Does this sound like you today?
The recent events of leading and working through
a pandemic while still maintaining all of your other
responsibilities impacts EVERY aspect of your life. From
the job, to the family, to your personal health, life this
Dr. Dean L.
Prentice, Colonel
(Ret), USAF, NC,
DHA, MA, BSN,
NE-BC
year seems to be pulling you in every direction. And there is no seeming respite
in the near future. For me, who I like to consider a naturally positive person, being
this run down and trodden on can be overwhelming. A natural zapper of energy,
motivation, and faith in self.
As you have travailed your vocation, you too have probably come across times
like this. Where you begin to doubt your ability to continue at the level you
have been working. The time where you start to not enjoy coming into your job
because there are days you “just can't” one more time for that draining employee.
Where you stand outside a meeting room contemplating “why even bother going
in” before you go and dutifully take your seat. When the vocation and calling
becomes just a job.
Well colleagues, during this time, I keep reminding myself that sometimes,
more than I'll admit, I need to take a break. To Rest. It doesn't mean I'm not still
in the fight. It doesn't mean I don't care or engaged or that I'm quitting. It means
there are times in my professional life where I need time for…me. I need a rest to
get myself back in alignment. I need time to ensure I am recharging my mental,
physical, emotional and spiritual batteries.
This means remembering 3 things which make me a more grounded leader
and professional. The challenges of daily life can get you off balance and out
of alignment. And when that happens I am not always at my best. I need the
discipline to pursue my purpose so I can support my why.
The desired state is to remember the “why” I do what I do. Focus is needed
on this as my first step. This “why” should drive my purpose. Supporting my
“purpose” means the actions, behaviors and attitudes I have when I come into
my office each day will help me reach my “why”. And then the discipline to
move forward on accomplishing the goals needed to meet my purpose. It's funny
how these simple 3 steps can help me align my priorities and help me regain my
footing when I feel lost, without direction or desire. But first, just a rest.

December 2020, January, February 2021 Wyoming Nurse • Page 11
Call for Proposals for the 2021 ANA
Membership Assembly Is Now Open
Members are encouraged to engage in the
identification of strategic policy topics and the
submission of proposals for discussion by ANA's
governing body, the Membership Assembly, at the
2021 annual meeting in June.
Section 1 of the 2021 Membership Assembly
Policy Development Guide includes questions to
consider prior to submitting a proposal. In Appendix
A of the Guide, you'll find the ANA Enterprise 2020-
2023 Strategic Goals. The Guide also contains detailed
information on the submission and review of proposals,
including emergent proposals; Dialogue Forums;
and examples of approaches used by state nurses'
associations that have successfully engaged members in
ANA's policy work.
TO SUBMIT PROPOSALS FOR DISCUSSION –
Click here to access the online proposal form.
Also, during the 2021 Membership Assembly,
there will be a special focused session on COVID-19.
The goal of this session is to capture lessons learned
or innovative ideas/strategies that informed patient
care and all aspects of nursing's response to the
pandemic. This information will be used to inform the
Membership Assembly discussion and ANA's ongoing
engagement with responding to the current COVID-19
outbreak and future pandemic planning.
TO SUBMIT PROPOSALS FOR THE SPECIAL
FOCUSED SESSION ON COVID-19 DISCUSSION –
Click here to access the online proposal form for the
COVID-19 Special Session.
Completed proposals MUST BE submitted (by using
the online proposal forms) by 5:00pm ET on Monday,
February 1, 2021. Refer to Appendix D in the Guide
for key dates and direct questions to Cheryl Peterson,
Vice President, Nursing Programs, via email (practice@
ana.org).
Links to resources listed above:
• Membership Assembly Policy Development
Guide: https://www.nursingworld.org/~4acba5/
globalassets/docs/ana/guide-ma---policydevelopment-process---final.pdf
• ANA Enterprise 2020-2023 Strategic Goals:
https://www.nursingworld.org/ana/about-ana/
anae-strategic-plan-2020---2023/
• Click here to access the online proposal form.:
https://fs30.formsite.com/ANA_NursingWorld/
Dialogue-Forum-Topic/index.html
• Click here to access the online proposal form
for the COVID-19 Special Session.: https://fs30.
formsite.com/ANA_NursingWorld/klhbfyq1wi/
index.html
South Lincoln Hospital District
Kemmerer, Wyoming
OPERATING ROOM
REGISTERED NURSES
$7,500 Sign on Bonus
$5,000 Relocation Allowance
New graduates welcome to apply!
Will provide on the job training!
Apply Today:
www.southlincolnmedical.com