The Nursing Voice - June 2021

The Nursing Voice June 2021 Page 1 

The Official Publication of the Illinois Nurses Foundation 

Quarterly publication direct mailed to approximately 4,500 RNs and 

electronically via email to 90,000+ RNs in Illinois. 

VOLUME 9 | NUMBER 1 | JUNE 2021 

Student Nurse Political Action Day 2021: 

Connect, Grow, Energize—Shape the Future 

The 23rd annual Student Nurse Political Action Day 

(SNPAD) was held on April 13, 2021. Each year, SNPAD 

brings together nursing students from across the state 

for a day of learning, networking, and advocacy, and 

this year was no exception. In the face of the COVID-19 

pandemic, this year's SNPAD was re-imagined as a one-ofa-kind, 

virtual experience that brought nursing educators 

and students together from across Illinois to discuss, 

learn, and connect – at no cost to participants. Over 1000 

nursing students from 46 schools attended (see list). 

The event opened with a Coffee Keynote with Jennifer 

Grooms, CEO of RekMed. Jennifer's inspirational session 

focused on her transformation from someone who 

had a crippling fear of blood into a nurse entrepreneur. 

Throughout the rest of the morning, nurse leaders 

presented various topics, including advocacy, health 

policy, and getting involved with nursing associations, 

including ANA-Illinois and the Student Nurse Association 

of Illinois (SNAI). Speakers included Glenda Morris Burnett 

PhD, MUPP, RN – Rush University College of Nursing, 

Gloria E. Barrera MSN, RN, PEL-CSN, Sue Clark, President 

– Capitol Edge Consulting, and Elizabeth Aquino, PhD, RN 

– President, ANA-Illinois. 

After lunch, Buck Davis provided the keynote address. 

Buck's powerful presentation engaged participants in 

a meaningful discussion on diversity, how to manage 

unconscious bias, how to be a positive and inclusive 

team member, and how to gain skills on how to address 

inappropriate comments in the workplace. The address 

segued into the final presentation and discussion of the 

day, which focused on diversity, equity, and inclusion 

within the nursing profession. 

The event closed with the selection of the SNPAD 

Scholarship Recipient. For the first time, ANA-Illinois 

selected one student attendee for a $500 scholarship. 

This year's recipient was Loyola University Chicago 

student Chase Wade. 

Thank you to all nurses who made the first virtual 

SNPAD an overwhelming success. Whether the topic 

was entrepreneurship, public health, or diversity 

and inclusion, many attendees contributed insightful 

comments on these topics. They helped to bring 

awareness to some of the major issues in nursing. 

A big "thank you" to all of our sponsors for their 

financial contributions. 

List of colleges participating in SNPAD 2021: 

● Aurora University 

● Blessing-Rieman College of Nursing and Health 

Science 

● CAAN Academy of Nursing 

● Carl Sandburg College 

● Chamberlain University College of Nursing 

● Chicago State University 

● City Colleges of Chicago - Malcolm X College 

● College of Lake County 

● College of Staten Island 

● Danville Area Community College 

● DePaul University School of Nursing 

● Elmhurst University 

● Governors State University 

● Graham Hospital School of Nursing 

● IECC - Frontier Community College 

● Illinois College 

● Illinois State University - Mennonite College of 

Nursing 

● Illinois Wesleyan School of Nursing 

● Joliet Junior College 

● Kennedy-King College 

● Lewis & Clark Community College 

● Lewis University 

● Loyola University - Marcella Neihoff School of 

Nursing 

● McKendree University 

● Millikin University 

● Molly College 

● Northern Illinois University School of Nursing 

● Oakton Community College 

● Olivet Nazarene University School of Nursing 

● Purdue Northwest University College of Nursing 

● Rasmussen University 

● Resurrection University 

● Rush University College of Nursing 

● Saint Xavier University School of Nursing 

● Sauk Valley Community College 

● Southern Illinois University Edwardsville 

● Southwestern Illinois College of Nursing 

● Spoon River College 

● St. John’s College of Nursing 

● Trinity Christian College 

● University of Illinois Chicago, College of Nursing - 

Springfield, Chicago, and Champaign Campuses 

● University of Phoenix 

● Walden University 

● Western Governors University 

● Western Illinois University School of Nursing 

Congratulations to Illinois State University – 

Mennonite College of Nursing who had the most 

attendees with 155! The program is featured on page 3. 

Student Nurse Political Action Day...continued on page 6 

Index 

current resident or 

Non-Profit Org. 

U.S. Postage Paid 

Princeton, MN 

Permit No. 14 

INF President’s Message.............. 2 

ANA-Illinois President's Message. . . . . . .3 

Ethics in Action...................... 4 

Providing Competent, Supportive Care 

for People who are Transgender....... 7 

INF Stories From Within .............. 8 

Practice Corner...................... 9 

Continuing Education Offering ....... 10 

Detection and Treatment of Delirium 

in Long-Term Care Settings ...........12 

IACN Looks Forward .................13 

Philippine Nurses Association of 

Illinois in Action..................... 14 

33rd Annual National Black Nurse's 

Day Celebration .................... 18 

Increasing Patient Engagement 

through EHR Portal Adoption ........ 20 

Identifying Self-Care Practices in 

Heart Failure Patients. .............. 22

Page 2 June 2021 The Nursing Voice 

INF PRESIDENT'S MESSAGE 

The Nursing 

Voice 

A Thank-You to Nurses! 

We have made it to Summer 

2021, and the pandemic 

continues. Little did we know a 

year ago, we would still be living 

in the pandemic. How long this 

will last, no one knows for sure. 

The vaccines have certainly 

helped slow down the spread of 

the Covid-19 virus, but we are 

still here socially distancing and 

trying to stay safe. 

2020 was the year of the 

Nurse, but it was not just a 

celebratory year for nursing, but 

Cheryl Anema 

PhD, RN 

a year that displayed the NEED for nurses. Nurses showed 

the world how they were our front-line workers of the 

pandemic. To continue the celebration, the World Health 

Organization (WHO) and the American Nurses Association 

(ANA) joined to extend the Year of the Nurse and Midwife 

into 2021. Nursing is more visible and recognized because of 

the continued dedication and compassionate care provided 

to patients and the community during this pandemic. 

I am proud to be a nurse, even if not working at the 

bedside. I graduated from nursing school over 40 years ago 

and remember the feeling of first passing the NCLEX and 

legally becoming an RN. I was excited and proud to join 

the profession. Now, I look back over these many years of 

nursing and see that nursing is still serving its community 

and leads healthcare to fight against this virus. I am not 

saying we are doing it alone; we are not. Nurses are part of 

a team of professionals and essential workers. 

Nurses are a universal gift to all. The dedicated work 

that they do and the kindness they deliver daily should 

serve as a reminder of the fundamental humanity inside 

us all. Becoming a nurse is one of the most selfless acts a 

person can undertake. 

The sacrifice that nurses, and other healthcare 

providers, make daily cannot fully be understood. Even 

before COVID-19, nurses gave up family holidays, social 

events, and weekends. Now? They are on the front line 

of the Virus War! Whatever you believe, nurses "have" 

risked their lives and continue to go to work and care for 

the needs of their patients. Every nurse out there who is 

working in the field, preparing others to work in the field, 

or have retired and support nursing today through their 

words and support, need to be proud they are a nurse! 

The IL Nurses Foundation (INF) continues to celebrate 

nursing through the 40 Under 40 Emerging Nurse Leader 

program and the Nurse of the Year Program. Additionally, 

the INF developed a COVID Publishing Taskforce. Over the 

past year, calls for nurses and patients' stories to share 

their pandemic experience with the INF were made. This 

taskforce compiled and edited the submissions into a 

book – Stories From Within: Nurses-Patients-Families- 

Health Care Workers Share Their Pandemic Experience. 

The book was released a few weeks before Nurses Week 

2021. The book is an excellent reflection on nursing care 

through the pandemic and the sacrifices that nurses 

and other healthcare workers made to care for the 

patients and families impacted by the pandemic. This 

book is available for purchase on Amazon.com, with all 

profits going to the INF. I hope you decide to buy a book 

for yourself and a few others for gifts to fellow nurses, 

nursing students, and anyone impacted by this pandemic. 

THANKS to each nurse for all they have, are, and will be 

doing to bring health and comfort to people throughout 

the state and worldwide, especially through this pandemic. 

To support the IL Nurses Foundation's work, please 

go to https://www.illinoisnurses.foundation/ and 

click on "Ways to Give." Every donation promotes INF 

collaboration with community partners to promote the 

health of the public, support nurses through charitable 

research, and enhance educational initiatives. 

NOW HIRING 

RN Health Center Administrator 

Positions available in Chicago Heights, 

Chicago, and Hazel Crest, IL. 

Apply online 

https://www.auntmarthas.org/careers/ 

Please direct any inquiries to Kmoreno@auntmarthas.org 

INF Board of Directors 

Officers 

Cheryl Anema PhD, RN ..........................President 

Brandon Hauer MSN, RN ....................Vice President 

Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN ..Secretary 

Karen Egenes EdD, RN ...........................Treasurer 

Directors 

Maureen Shekleton PhD, RN, DPNAP, FAAN 

Alma Labunski PhD, MS, RN 

Linda Olson PhD, RN, NEA-BC 

Amanda Buechel, BSN, RN, CCRN 

Lauren Wojtkowski BSN, RN, CEN 

ANA-Illinois Board Rep 

Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN 

Susana Gonzalez MHA, MSN, RN, CNML 

ANA-Illinois Board of Directors 

Officers 

Elizabeth Aquino, PhD, RN .......................President 

Monique Reed, PhD, MS, RN ..................Vice President 

Jeannine Haberman DNP MBA, RN, CNE ...........Treasurer 

Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN ....Secretary 

Directors 

Holly Farley, EdD, MS, RN 

Susana Gonzalez, MHA, MSN, RN, CNML 

Nicole Lewis, DNP, APRN, FNP-BC 

Dorothy Kane MSN, RN 

Zeh Wellington, DNP (c), MSN, RN, NE-BC 

Editorial Committee 

Editor Emeritus 

Alma Labunski, PhD, MS, RN 

Chief Editor 

Lisa Anderson-Shaw, DrPH, MA, MSN 

Members 

Cheryl Anema PhD, RN 

Deborah S. Adelman, PhD, RN, NE-BC 

Linda Anders, MBA, MSN, RN 

Kathryn Booth, MSN, RN, CNL 

Nancy Brent, RN, MS, JD 

Irene McCarron, MSN, RN, NPD-BC 

Linda Olson, PhD, RN, NEA-BC 

Lanette Stuckey, PhD, MSN, RN, CNE, CMSRN, CNEcl, NEA-BC 

Executive Director 

Susan Y. Swart, EdD, MS, RN, CAE 

ANA-Illinois/Illinois Nurses Foundation 

Article Submission 

• Electronic submissions only as a word document attachment 

using current APA guidelines. 

• Email: info@ilnursesfoundation.com 

• Subject Line: Nursing Voice Submission: Name of the article 

• Must include the name of the author and a title. 

• INF reserves the right to pull or edit any article / news 

submission for space and availability and/or deadlines 

• If requested, notification will be given to authors once the 

final draft of the Nursing Voice has been submitted. 

• INF does not accept monetary payment for articles. 

Article submissions, deadline information and all other 

inquiries regarding the Nursing Voice please email: 

info@ilnursesfoundation.com 

Article Submission Dates (submissions by end of the business day) 

January 15th, April 15th, July 15th, October 15th 

Advertising: for advertising rates and information please contact 

Arthur L. Davis Publishing Agency, Inc., P.O. Box 216, Cedar Falls, 

Iowa 50613 (800-626-4081), sales@aldpub.com. ANA-Illinois and 

the Arthur L. Davis Publishing Agency, Inc. reserve the right to 

reject any advertisement. Responsibility for errors in advertising 

is limited to corrections in the next issue or refund of price of 

advertisement. 

Acceptance of advertising does not imply endorsement or 

approval by the ANA-Illinois and Illinois Nurses Foundation 

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. ANA-Illinois and the Arthur L. Davis Publishing Agency, 

Inc. shall not be held liable for any consequences resulting from 

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

this publication express the opinions of the authors; they do not 

necessarily reflect views of the staff, board, or membership of 

ANA-Illinois or those of the national or local associations.


ANA-ILLINOIS PRESIDENT'S MESSAGE 

Dear Illinois Nurse Colleagues, 

I hope you are well and 

finding effective ways to 

continue to cope with the 

ongoing COVID-19 pandemic. 

I have seen many of you 

volunteering your time at 

COVID-19 vaccine clinics to 

protect us all against the virus. 

And many have shared their 

vaccine photos and experiences 

that have helped instill 

confidence in others to get their Liz Aquino, PhD, RN 

vaccine when it's their time. 

Nurses are the perfect ambassadors to enhance vaccine 

confidence. Thank you for all of those efforts and the 

ongoing work to get us through this pandemic. 

As we continue to think about ways to integrate selfcare 

into daily routines, ANA-Illinois received grant 

funding to launch a program called "RNconnect2 Well- 

Being." It's a text-messaging program that supports 

the emotional and mental well-being of nurses and 

nursing students in Illinois by sending text messages with 

reminders and resources on building resilience, self-care, 

gratitude, and much more. You can opt-in to participate 

by texting RNconnectIL to 60298. 

On behalf of ANA-Illinois's Board of Directors, I would 

like to thank all of you who participated in Student Nurse 

Political Action Day (1000 registrants from 46 different 

colleges/schools of nursing) and Nurses Day at the Capitol 

(75 attendees). Both events were a huge success and 

an excellent opportunity to listen, learn and support 

one another as we advance the nursing profession. The 

Expert Panel on Diversity, Equity, and Inclusion also has 

a series of quarterly webinars; the next session is on July 

28th, "Microaggressions, Unconscious Bias and Structural 

Racism" please go to the ANA-Illinois website Expert 

Panel page to register. 

Are you looking for more ways to get actively 

involved? We have new member engagement 

opportunities, including serving on the expert panel on 

nursing education and community service task force. 

There is also an open call for nominations to serve on the 

Board of Directors or as an ANA Membership Assembly 

Representative. Please go to www.ana-illinois.org to learn 

more. 

Let's continue to work together to celebrate and 

elevate one another and the nursing profession. 

Sincerely, 

Elizabeth Aquino, PhD, RN 

President, ANA-Illinois 

@LatinaPhDRN 

The world needs nurse leaders. 

We ask, why not you? 

Founded over 100 years ago, Illinois State University’s 

Mennonite College of Nursing is renowned for providing 

students with quality educational experiences that leave 

them better for their investment. Employers across 

Illinois seek out our graduates, including Memorial Health 

System, Advocate-Aurora Health, OSF, and Carle. 

We are an Advocate-Aurora Health Preferred 

Education Provider, which means you qualify for more 

in tuition reimbursement if you choose one of our 

programs. We have Dual Enrollment and Pathways 

partnerships with 16 community colleges statewide, and 

our RN to BSN program is ranked #3 in Illinois and #14 in 

the entire United States by US News & World Report. 

We believe that nurses have a unique lens and need 

to be at the decision-making table, helping to guide the 

future of health care. Currently, only 13% of nurses in 

the US hold a master’s degree; only 1% have a doctorate. 

Our programs prepare you to excel—at the bedside and 

beyond. 

Program offerings: 

• Traditional & Accelerated BSN 

• RN to BSN 

• BSN to DNP – Family Nurse Practitioner 

• BSN to DNP – Leadership & Management 

• Doctor of Nursing Practice 

• Ph.D. in Nursing 

• Certificate – School Nurse 

• Certificate – Psychiatric Mental Health Nurse 

Practitioner 

• Certificate – Family Nurse Practitioner 

Interested students can learn more at: https://bit. 

ly/3ns4Y8Y 

At MCN, we’re working hard to reshape health in our 

communities. We invite you to join us. 

Call for 

Submissions to 

The Nursing Voice 

The Nursing Voice editorial committee seeks 

article submissions and Continuing Education (CE) 

article submissions for our upcoming issues. We are 

also going to have themes for each issue starting 

with the September 2021 issue. If you have an article 

worthy of a CE, the INF staff can assist in applying for 

the CE. 

September 2021 Issue: Supporting the New 

Nurse: Current Challenges in Nursing Education and 

the New Nurse Graduate/Orientee 

(Clinical experiences, E-learning, Simulation, 

Preceptor & Educator challenges, ‘Code Red') 

December 2021 Issue: Inclusion and Diversity in 

Healthcare 

(Implicit bias, gender identification and nursing 

care, racial bias in healthcare, diversity in nursing 

employment/recruitment/education) 

March 2022 Issue: Public Health Issues and the 

Nursing Profession 

(2020 Equity, Access to health care, School nurses, 

Environmental issues and health care, Community 

Health) 

Article submission is not limited to the issue 

theme. 

The Nursing Voice submission guidelines can be 

reviewed at https://www.illinoisnurses.foundation/ 

programs/ (scroll down past scholarship and grant 

information) 

Questions about submissions can be sent to 

syswart@ana-illinois.org 

HYBRID/ONLINE


ETHICS IN ACTION 

Over the last 15 months, the 

COVID-19 pandemic affected 

nurses, other healthcare 

professionals, patients and 

families, and all people and 

countries worldwide. Death, 

illness, isolation, loss of jobs, 

depression, and financial 

problems are just a few of the 

negative effects associated with 

this global pandemic. 

The ethical issues faced 

by nurses affect patient and 

family safety and the safety of 

nurses, colleagues, and all those 

affiliated within health care 

organizations in unique ways. 

The nursing profession was hit 

very hard by the pandemic. In 

the early days of the pandemic, 

many first-line health workers 

did not have enough personal 

protective equipment (PPE) 

and were exposed to the virus. 

Many nurses became ill from 

this exposure. Over the past 

year, there have also been 

reports of anxiety, depression, 

and sleep problems among 

nurses and other health 

Lisa Anderson 

Shaw DrPH, MA, 

MSN 

Lina Olson PhD, 

RN, NEA-BC 

care workers associated with caring for patients with 

COVID-19. 

As the pandemic progressed, scientific knowledge 

and understanding about COVID-19 grew and changed, 

often creating confusion and frustration about the 

characteristics of the disease. There were subsequent 

implications for policy and practice with often confusing 

messaging from scientists and others about balancing 

safe practices in caring for patients and each other. For 

example, at the beginning of the pandemic, scientists 

said masks should not be worn by the public, and then 

later that they should. As knowledge and understanding 

about COVID-19 advanced, policy and practices related to 

the pandemic were altered. When looking for guidance 

from the Code of Ethics for Nurses with Interpretive 

Statements (ANA, 2015a), all nine provisions can be cited, 

especially Provision 1 (respect), Provision 2 (primary 

commitment to the patient), Provision 3 (safety), and 

provision 5 (nurse's duty to self). 

During these stressful times, healthcare institutions 

began to mobilize support services for nurses and 

healthcare staff. Healthcare institutions in the United 

States began developing resources to care for COVID-19 

patients and organize health and wellness resources 

for their clinical and supportive care staff, especially in 

cities with large medical centers (Anderson-Shaw, & Zar, 

2020). Some examples are system-wide mental health 

and wellness programs, daily huddles among nurses and 

other healthcare workers, and moral distress rounds and 

debriefing sessions. 

The ANA Code of Ethics for nurses, Provision 1 states, 

"The nurse practices with compassion and respect for the 

inherent dignity, worth, and unique attributes of every 

person" (American Nurses Association [ANA], 2015b). This 

statement is fundamental to nurses' relationships with 

their patients as well as co-workers. Stressful situations, 

especially when the stress is constant and ongoing, can 

negatively affect nurses' mental and physical health. 

Provision 1 is a reminder that no matter how stressful 

nurses' work may be, it is essential to continue showing 

compassion and respect to patients, co-workers, and 

ourselves. COVID-19 has had a real impact on nurses and 

relationships with others and subsequently on mental 

health. Provision 5 emphasizes duties to self and others 

as a component of moral respect, which extends both to 

oneself and others. Promoting the safety of ourselves, 

colleagues, patients and families, and nurses' own 

families have created ethical concerns during this time. 

Respect for human dignity is at the heart of nursing care, 

especially in times of stress that can manifest itself in 

various ways, including symptoms of anxiety, depression, 

sadness, and helplessness. 

Numerous studies have been conducted over the past 

year, both nationally and internationally, that focused 

on the impact of the pandemic on nurses. These have 

highlighted the resulting emotional and mental health 

issues. Strategies to protect and promote nurses' mental 

health benefits, the individual nurse, and the profession. 

The American Nurses Association and other professional 

nursing associations have identified resources such 

as the ANA Healthy Nurse Healthy Nation program 

(healthynursehealthynation.org), the ANA COVID-19 

Resource Center (ANA Nursing World.org), which includes 

ANA's COVID-19 Self-Care Package for Nurses. Self-care 

strategies include education, building resilience with 

mindfulness and meditation, and seeking professional 

help through therapy. During this time, nurses have often 

reminded themselves that "I am ok" and "I will be ok," 

and it is also ok to seek resources that improve mental 

and emotional health. 

Further information will be forthcoming in future 

columns. 

Please send clinical ethics questions to The Nursing 

Voice for discussion in upcoming issues. 

References 

Anderson-Shaw, L.K., & Zar, F.A. (2020). COVID-19, moral 

conflict, distress, and dying alone. Journal of Bioethical 

Inquiry, 17(4), 777–782. https://doi.org/10.1007/s11673-020- 

10040-9 

American Nurses Association (2015a). Code of ethics for 

nurses with interpretive statements. Silver Spring, MD: 

Nursesbooks.org Retrieved from https://www.nursingworld. 

org/practice-policy/nursing-excellence/ethics/code-ofethics-for-nurses/coe-view-only/ 

American Nurses Association (2015b). Code of ethics for nurses 

with interpretive statements. Silver Spring, MD: Nursebooks. 

org.


Student Nurse Political Action Day...continued from page 1


Providing Competent, Supportive Care for People 

Who Are Transgender 

F. Patrick Robinson, PhD, RN, ACRN, CNE, FAAN 

Sherry L Roper, PhD, RN 

The idea that gender is binary (male or female) and 

determined at birth predominates Western cultures. 

However, research evidence and lived experiences 

suggest that gender exists on a spectrum with many 

options. Some people identify as a gender different 

from their gender determined at birth (Deutsch, 2016). 

Our traditional understanding of gender, based on 

chromosomes and primary (genitalia) and secondary sex 

characteristics, is often called biological sex or gender (or 

sex) assigned at birth. Gender identity, on the other hand, 

is the innermost concept of self as male, female, a blend 

of both, or neither (Lambda Legal, 2016.). 

The majority of people are cisgender, which occurs 

when gender assigned at birth and gender identity are 

the same. However, the best available data suggest that 

approximately 1.4 million adults do not self-identify 

with their gender assignments (e.g., someone assigned 

female at birth but identifies as male) (Flores et al., 2016). 

Transgender is an umbrella term for this population. A 

visibly growing segment of the U.S. population does not 

identify with the binary notion of gender. Nonbinary is a 

collective term for this population, but individuals may 

use terms such as genderqueer, gender fluid, or gender 

non-conforming. 

There is no standard or correct way to be (or be seen 

as) transgender. Some people who are transgender 

choose gender-affirming hormone therapy to achieve 

masculinizing or feminizing effects; others do not. Surgery 

that revises genitals to conform to gender identity is a 

critical part of the transition for many people who are 

transgender (Deutsch et al., 2019). Others do not feel 

that genital surgery is a necessary part of transition but 

may opt for non-genital surgeries to produce desired 

characteristics, including breast augmentation or removal 

and body contouring procedures. In other words, the 

importance of therapy related to the quality of life varies 

by individual. Also, some people who are transgender 

may want these services but do not have access to them 

because they are (a) unavailable in the community; (b) 

not covered by insurance (even if the individual has 

insurance, and many do not), and (c) too expensive. 

Remember: there is no one way to "be" transgender 

or cisgender. People choose to express their gender 

identities in personally satisfying ways, which may or 

may not match social expectations of what it means to 

look and behave as a male or female. Some transgender 

women choose not to wear makeup or dresses, and 

some cisgender men choose to wear their hair long and 

earrings. 

Health Disparities in People Who are Transgender 

Negative attitudes and discrimination toward the 

transgender community create inequalities that prevent 

the delivery of competent healthcare and elevate the 

risk for various health problems (Grant et al., 2011). In 

comparison to their cisgender counterparts, people who 

are transgender experience higher incidences of cancer, 

mental health challenges, and other health problems 

(Department of Health & Human Services, n.d.). For 

instance, transgender women, compared to all other 

populations, are at the highest risk of injury from violence 

and death by homicide. People who are transgender are 

also more likely to smoke, drink alcohol, use drugs, and 

engage in risk behaviors (Institute of Medicine, 2011). 

Furthermore, discrimination and social stigma increase 

poverty and homelessness in people who are transgender 

(Safer et al., 2017). The inability to afford basic living 

needs may lead to employment in underground 

economies, such as survival sex work or the illegal drug 

trade, which place the person who is transgender at 

an even higher risk for violence, drug use, and sexually 

transmitted infections (Deutsch, 2016). 

People who are transgender are more likely to rely 

on public health insurance or be uninsured than the 

general population. Even those insured report coverage 

gaps caused by low-cost coverage that does not include 

standard services for preventative, behavioral health, or 

gender-affirming therapies, including hormones (Deutsch 

et al., 2019). Lack of access to comprehensive health 

care leads some people who are transgender to seek 

hormones from the community and social networks 

without clinical support and monitoring, putting them at 

additional risk for adverse reactions and complications. 

Researchers suggest that healthcare providers' 

inability to deliver supportive and competent care serves 

as a powerful mechanism underlying health disparities 

(Fenway Institute, 2016). The experiences of people who 

are transgender are often not included in healthcare 

provider diversity and inclusiveness training. While 

transgender-related content in health professions basic 

education programs would effectively improve provider 

knowledge, skills, and attitudes, transgender health has 

not been prioritized in nursing education. The result is 

a nursing workforce inadequately prepared to care for 

people who are transgender (McDowell & Bower, 2016). 

Nursing Care of People Who Are Transgender 

Competent, supportive transgender care requires 

nurses to recognize potential biases and understand 

gender that may differ from their current beliefs and 

social norms. Honest reflection on these feelings is an 

essential step in providing competent transgender care. 

Using a lens of cultural humility, where cisgender nurses 

acknowledge that they do not adequately know about 

being transgender while also being open to learning, is 

helpful. In this spirit, open, transparent inquiry on the 

part of nurses when they do not know something (When 

I speak to your children, what name should I use to refer 

to you?) or how to proceed with care (I need to place a 

catheter into your bladder, and I know you have had 

gender-affirming surgery. Do you want to give me any 

special instructions?) can build trust. 

While gender-affirming care such as hormones, 

androgen-blocking agents, and surgeries require 

specialist care management, nurses will encounter 

transgender patients in all healthcare areas. Assessing 

the history and current status of gender-affirming 

therapies is critical to inform safe care. For example, 

hormone-induced changes in muscle and bone mass, 

along with menstruation or amenorrhea, can alter 

gender-defined reference ranges for laboratory tests such 

as hemoglobin/hematocrit, alkaline phosphatase, and 

creatinine (Deutsch, 2016). Nurses should consider the 

gender assigned at birth (especially if it is the only gender 

information to which the lab has access) and genderaffirming 

therapy-induced physiological changes to make 

valid inferences about lab values. Nurses should also 

ensure that a complete history of the use of hormones 

and androgen blockers (including those obtained from 

non-licensed providers) is taken. Nurses should work 

with other providers to ensure that hormone therapy 

does not stop with hospitalization unless contraindicated 

by current pathology or prescribed medications. Abrupt 

cessation of hormone therapy can have a significant and 

negative impact on emotional and physiological health. 

Systems-Level Policies, Processes, and Advocacy 

Professional nurses can play a crucial role by 

advocating for policies and processes that promote 

safe, effective, and supportive care for people who are 

transgender. Misgendering a patient (making an incorrect 

assumption about gender identity) can cause emotional 

distress and erode patient-provider trust. Unfortunately, 

electronic health records (EHR) often do not support 

competent care for people who are transgender. For 

instance, healthcare providers should use a 2-step 

gender identification process (Deutsch, 2016). However, 

many do not, and EHR systems rarely provide prompts 

for the processor space for easy documentation and 

access to information derived from the process. Asking 

about a patient's current gender identity can result in 

several responses. The EHR should make checkboxes 

for a reasonable number of those responses, including 

male, female, transgender male, transgender female, 

and nonbinary. A fill-in-the-blank is needed for other 

identifies. The gender assigned at birth also requires 

options beyond male or female; people born with 

external genitalia, gonads, or both that do not conform to 

what is typically male or female (intersex) may have been 

identified incorrectly at birth. The EHR should provide an 

intersex option to this question. Some people who are 

transgender are uncomfortable revealing gender assigned 

at birth, so decline-to-state should be another option. 

Note that this process should be the standard for all 

patients, not just those assumed to be transgender. 

People who are transgender may use names other 

than their legal names (Lambda Legal, 2016). Navigating 

a legal name change is complicated and costly. Some 

people who are transgender do not have the resources 

for a legal name change; for others, it may not be safe, 

given current social or legal circumstances. Using a 

patient's chosen name and pronouns is critical to patientcentered 

care. The EHR should prominently document 

the patient's chosen name and pronouns, which should 

also be used outside the EHR, including for appointments 

and prescriptions. Patients should only have to provide 

the information once, decreasing the need to correct 

providers and improving patient-provider relationships. 

EHRs should also contain an organ inventory, perhaps 

as part of surgical history, as providers will need to 

know about the presence or absence of reproductive 

and gonadal organs to inform clinical decision-making. 

This information must be clear, unambiguous, and easily 

accessible in the EHR to inform care and prevent medical 

and surgical errors. 

Nurses should work within governance processes to 

ensure that all institutional policies support transgender 

patients, staff, and visitors. Nondiscrimination statements 

should include gender identity. Policies about restrooms 

and staff changing rooms (usually labeled in genderbinary 

terms) should state that a person's gender identity 

rightly determines the room to be used and that that 

right should not require any proof (e.g., health provider 

confirmation) related to gender or gender identity. 

Finally, clear guidelines concerning non-private room 

assignments should include assigning roommates based 

on gender identity rather than gender assigned at birth. 

Power to Make a Difference 

The ANA Code of Ethics obligates nurses to practice 

"compassion and respect for the inherent dignity, worth, 

and unique attributes of every person" (ANA, 2015, para 

1). While some nurses may intentionally discriminate 

against people who are transgender, it is more likely 

that a lack of knowledge and experience leads to nursing 

actions that result in suboptimal care. Nurses play critical 

roles in transgender care by (a) providing supportive, 

affirming care, (b) creating an inclusive environment, 

and (c) leading interprofessional teams toward genderaffirming 

care. Education and a commitment to 

understanding the lived experiences of people who are 

transgender is, therefore, essential for all nurses. 

References 

American Nurses Association. (2015). What is the nursing code 

of ethics? https://nurse.org/education/nursing-code-ofethics/ 

Department of Health and Human Services, Office of Disease 

Prevention and Health Promotion. (n.d.). Healthy people. 

Lesbian, gay, bisexual, and transgender health. https://www. 

healthypeople.gov/2020/topics-objectives/topic/lesbiangay-bisexual-and-transgender-health 

Deutsch, M.B. (2016). Guidelines for the primary and genderaffirming 

care of transgender and gender nonbinary people 

(2nd ed.). Center of Excellence for Transgender Health, 

University of California at San Francisco. https://transcare. 

ucsf.edu/sites/transcare.ucsf.edu/files/Transgender- 

PGACG-6-17-16.pdf 

Deutsch, M.B, Bowers, M.L., Radix, A., & Carmel, T.C. (2019). 

Transgender medical care in the United States: A historical 

perspective. In J.S. Schneider, V.M.B. Silenzio, & Erikson- 

Schroth, L. (Eds.). The GLMA Handbook on LGBT Health (1, 

83-131). Santa Barbara, CA: Praeger. 

Fenway Institute, National LGBT Health Education Center. 

(2016). Providing inclusive services and care for LGBT people. 

https://www.lgbtqiahealtheducation.org/publication/ 

learning-guide/ 

Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). 

How many adults identify as transgender in the United 

States? UCLA School of Law, William Institute. https:// 

williamsinstitute.law.ucla.edu/publications/trans-adultsunited-states/ 

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., 

& Keisling, M. (2011). Injustice at every turn: A report of the 

National Transgender Discrimination Survey. https://www. 

transequality.org/sites/default/files/docs/resources/NTDS_ 

Report.pdf 

Institute of Medicine. (2011). The health of lesbian, gay, 

bisexual, and transgender people: Building a foundation for 

better understanding. http://www.nationalacademies.org/ 

hmd/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual- 

and- 

Lambda Legal. (2016). Transgender rights toolkit. https://www. 

lambdalegal.org/issues/transgender-rights 

McDowell, A. & Bower, K. (2016). Transgender health care 

for nurses: An innovative approach to diversifying nursing 

curricula to address health inequalities. Journal of Nursing 

Education, 55(8), 476-479. DOI 10.3928/01484834- 

20160715-11 

Safer, J. D., Coleman, E., Feldman, J., Garofal, R., Hembree, W., 

Radix, A., & Sevelius, S. (2017). Barriers to health care for 

transgender individuals. Current Opinion in Endocrinology, 

Diabetes, and Obesity, 23(2), 168-171. DOI: 10.1097/ 

MED.0000000000000227 

Singh, S., & Durso, L. E. (2017). Widespread discrimination 

continues to shape LGBT people's lives in both subtle 

and significant ways. Center for American Progress. 

https://www.americanprogress.org/issues/lgbt/ 

news/2017/05/02/429529/widespread-discriminationcontinues-shape-lgbt-peoples-lives-subtle-significant-ways/


INF Stories From Within 

Submitted by Susan Hurley, RN, BSN, MPH 

Marketing co-director IANPC 

The Illinois Ambulatory Nurse Practice Consortium (IANPC) was established in 2013 

and is a local networking group of the American Academy of Ambulatory Nursing 

(AAACN). The IANPC mission is to promote leadership, collaboration, and innovation 

in the delivery of ambulatory care nursing through professional clinical practice, 

education, research, and health policy initiatives. 

Why Join IANPC? 

• Networking opportunities 

• Professional growth and development 

• Earn free CEs at events 

Become a Member Here 

IANPC membership is FREE to join, 

provides a connection to a national 

nursing organization, and offers 

opportunities to share best practices. 

Quarterly educational events are held 

that focus on members’ interests such 

as current clinical issues, self-care and 

quality improvement. IANPC welcomes 

anyone with a professional interest in 

Illinois ambulatory nursing. 

https://forms.gle/qocosxflkhzQsuM4Q6 

Want to learn more? The IANPC can be 

reached via email at ianpcnurses@gmail. 

com. Click on the link or use the QR code to become a member. 

To access electronic copies of 

The Nursing Voice, please visit 

http://www.nursingALD.com/publications 

Illinois Nurses Foundation publishes book “Stories from 

Within,” detailing the experiences of nurses, healthcare 

providers, patients, and family members with COVID-19 

Editors: Anema, C., Egenes, K., Morley, C., & Swart, S. 

The Illinois Nurses Foundation (INF) is 

proud to present “Stories from Within,” a 

book detailing the experiences of nurses, 

healthcare providers, patients, and family 

members throughout the COVID-19 

pandemic. 

The book is available to the public 

and can be accessed at http://bit.ly/ 

Storiesfromwithin. 

Over the past year, nurses and nurse 

educators walked willingly into the 

COVID-19 pandemic biological storm. 

Their stories are many, their experiences 

varied, but what brings them all together 

is a commitment to ensuring people who 

face health challenges are cared for and 

comforted. “Stories from Within” serves as 

an important memoir of what the nursing 

profession was faced with and how, 

together, nurses supported each other, 

their families, and most importantly, their 

patients,” said Cheryl Anema, President 

of the INF. “Time after time, these 

nurses were terrified and exhausted yet 

determined and resilient. This book shares 

those stories." 

As a nurse practitioner, graduate nursing student, and mom, Jovonne Owens tells 

her story about the anxiety levels running high amongst her hospital colleagues. “We 

watched the news reports of growing COVID-19 numbers and deaths while struggling 

to obtain proper patient protective equipment to care for our patients. Things became 

tough when we began to see our hospital staff members lose their own lives as they 

battled on the front lines against this virus we were still learning about.” She recounts 

her fears for herself and her family during this time and the sacrifices she made to 

ensure the health and safety of all who crossed her path. 

This past year, nurses shouldered the clinical risk and unspoken acceptance of 

personal sacrifice necessary to beat back the COVID-19 pandemic. Nurses helped not only 

individuals who faced complications due to COVID-19 but also their families, who could 

not be at their family member’s bedside. One story told by a bedside registered nurse in a 

neonatal intensive care unit described the emotionally challenging heartbreak of a mother 

seeing her newborn infant being re-intubated and not having the support of her husband 

by her and their baby’s side due to COVID-19 hospital restrictions. “It was heartbreaking 

to see that all the father wanted was to be with his wife and hold his child,” the nurse 

said. Nurse educators rose to the challenge of providing advanced critical care education 

to nurses who never imagined themselves working during a pandemic—in many cases, 

making drastic changes to how they teach overnight. 

“Stories from Within” is an essential memoir of what the nursing profession faced 

and how, together, nurses and other healthcare providers supported each other, their 

families, and most importantly, their patients. 100% of the proceeds from the sale of 

this book will support the INF’s programs focused on nursing excellence. 

The INF’s mission is to collaborate with community partners in promoting the health of 

the public by supporting nurses through charitable research and educational initiatives. 

Facebook: https://www.facebook.com/IllinoisNursesFoundation 

Website: https://www.illinoisnurses.foundation/


PRACTICE CORNER 

Illinois Law & Nursing Practice 

QUESTION 

An RN sent in a concern 

that he is feeling sadder than 

usual since caring for patients 

during the Pandemic. He is 

also experiencing difficulty 

concentrating when at work 

and is concerned he may be 

depressed. He is apprehensive 

about seeking treatment if 

it will affect his license. He 

asks if his anxiety surrounding 

treatment and his license is well 

founded. 

Nancy J. Brent, 

MS, JD, RN 

ANSWER 

A qualified No. Experiencing mental suffering of any 

kind is not an issue under the Act and its Rules. It is an 

issue if it affects a nurse licensee’s safe and competent 

practice. 

The Illinois Nurse Practice Act and its Administrative 

Rules underscore the importance of good mental health 

for nurse licensees. In fact, in order to obtain a license 

as a professional registered nurse (RN), an advanced 

practice nurse (APRN), or a licensed practical nurse (LPN) 

in Illinois, the applicant must be “fit.” 

Although that term is not defined in the Act or rules, 

synonyms for the word include “healthy” and “well.” 

Once licensed, the Act and its Rules address 

“competent” practice. This term is also not specifically 

defined but synonyms include “capable,” “able,” and “fit.” 

Mental distress and the Act most clearly intersect in 

its section on Grounds for disciplinary action (225 ILCS 

65/70-5). 

If a nurse licensee is found to meet one or more of 

the 40 listed grounds, disciplinary action may be taken 

against the nurse, including, but not limited to, a refusal 

to renew the license, placing the nurse on probation, or 

suspending the license. 

All of the possible connections between mental 

distress and the grounds in this section are beyond the 

scope of this article. A number of those links can be 

highlighted, however. 

They include: 

“(4) A pattern of practice or other behavior which 

demonstrates incapacity or incompetency to 

practice under this Act. 

(14) Gross negligence in the practice of practical, 

professional, or advanced practice registered 

nursing. 

(19) Failure to establish and maintain records of 

patient care and treatment as required by law. 

(30) Physical illness, mental illness, or disability that 

results in the inability to practice the profession 

with reasonable judgment, skill, or safety.” 

The Administrative Rules (68 IL IAC Part 1300) also list 

possible connections between mental distress and its 

impact on safe and competent nursing practice. 

In Section 1300.90 of the Rules, Unethical or 

Unprofessional Conduct, examples include: 

“2) A departure from or failure to conform to the 

standards of practice as set forth in the Act or 

this Part. Actual injury to a patient need not be 

established. 

5) Demonstrating actual or potential inability to 

practice nursing with reasonable skill, safety or 

judgment by reason of illness, use of alcohol, drugs, 

chemical or any other material, or as a result of any 

mental or physical condition. 

6) Engaging in activities that constitute a breach of the 

nurse’s responsibility to a patient.” 

And, in the Rules Section 1300.350, Standards of 

Professional Conduct for Registered Professional Nurses, 

Section 1300.445, Standards of Conduct for APRNs, and 

Section 1300.260, Standards of Professional Conduct 

for LPNs, each is to practice nursing, advanced practice 

nursing, and licensed practical nursing respectively only 

when in functional physical and mental health. 

The RN is right to be concerned about his feelings of 

sadness and it is in his best interest, both professionally 

and personally, to seek treatment as soon as possible. 

Seeking treatment is a win-win for the RN and for any 

nurse licensee. It is especially an advantage under the 

Act and Rules because voluntary treatment is indirectly 

encouraged. 

In the Section Grounds for Disciplinary Action, if the 

RN, or you, would be subject to an involuntary admission 

or a judicial admission to a hospital as provided in the 

Illinois Mental Health and Disabilities Code, one’s license 

is automatically suspended. 

The suspension terminates only upon a finding by a 

court that the individual is no longer subject to either of 

the admissions to a hospital and issues an order to that 

effect and discharges the person. Then and only then, 

upon recommendation of the Board of Nursing to the 

Secretary of the Illinois Department of Financial and 

Professional Regulation (IDFPR) that the nurse licensee be 

allowed to return to nursing practice (225 ILCS 65/70-(c)). 

And, if the RN’s mental distress is such that his 

continuing to practice constitutes an immediate danger 

to the public, the Secretary of the IDPFR can immediately 

suspend his license (a summary suspension) without 

a hearing. A hearing within 30 days must occur to 

determine what disciplinary action may be taken against 

the nurse. 

So, whatever mental distress this RN or you are 

experiencing, seek guidance from a mental health 

professional as soon as you can, including a Psychiatric- 

Mental Health APRN, and follow through with his or her 

recommendations. 

You can read the entire Illinois Nurse Practice Act 

and its Rules by going to the Illinois Nursing Workforce 

Center’s website at: nursing.illinois.gov/nursepracticeact. 

asp. 

You can also access the Illinois Mental Health and 

Developmental Disabilities Code at: ilga.gov/legislation/ 

icls/icls5.asp?ActID=1496&ChapterID=34 

Erratum to: March 2021 The Nursing Voice 

PRACTICE CORNER Illinois Law & Nursing 

Practice 

Nancy J. Brent. MS, JD, RN 

Erratum: 

After publication of the original article, it came to 

the author’s attention that there were two editorial 

errors in the first sentence of the RESPONSE in 

the article. There should not be a period after the 

word “No” and the word “state” should not be 

capitalized. 

RESPONSE: 

No. State statute or administrative rule requires 

you to have a second RN witness a parent’s phone 

consent for his or her minor child who is being 

treated in your healthcare facility. 

The correct text is: 

No state statute or administrative rule requires 

you to have a second RN witness a parent’s phone 

consent for his or her minor child who is being 

treated in your healthcare facility. 

Founding Director of the RN to BSN Program 

Department: Daniel L. Goodwin College of Education 

Northeastern Illinois University invites applications and nominations for the position of Founding Director of the RN to BSN Program 

Full Time, Continuing Position 

The Founding Director of the RN to BSN Program reports to the Chair of the Department of Health Sciences and 

Physical Education and is responsible for all curricular, budgetary, and personnel matters of the Program; and provides 

leadership/vision in fulfilling the Program, Department, Daniel L. Goodwin College of Education, and University 

missions and goals. 

Develop a quality innovative RN to BSN completion program that is accessible to a diverse and multicultural student 

population. The Director reports to the Chair of the Department of Health Sciences and Physical Education (HSPE) and 

is responsible for all Departmental curricular, budgetary, and personnel matters; and provides leadership/vision in 

fulfilling the Department, Daniel L. Goodwin College of Education, and University missions and goals. 

Minimum Qualifications 

An earned masters or doctorate from an accredited institution in nursing or a health related discipline; holds a current 

unencumbered nursing license in the State of Illinois or is able to obtain the license within 6 months of appointment; 

a minimum of 5 years of nursing experience within the last 10 years; 3 to 5 years of experience in an administrative 

role in an academic nursing program; a record of excellence in program and curriculum development; experience with 

national, regional, state, and professional accreditation processes. 

Preferred Qualifications 

• Demonstrated ability to develop a quality innovative on-line RN to BSN completion program that is accessible to a 

diverse and multicultural student population; 

• Progressive experience in providing leadership and working collaboratively with faculty in the development of 

online and hybrid academic nursing programs; 

• Commitment to and experience working with diverse populations consistent with the University’s mission 

documents and description of “Diversity at Northeastern Illinois University” located at 

http://www.neiu.edu/about/strategic-plan/diversity-northeastern; 

• Experience establishing educational and clinical partnerships that promote health and health care to meet the 

needs of a dynamic, diverse, and multicultural global society; 

• Experience with program assessment and evaluation of student outcomes; 

• Demonstrated experience working in collaboration with faculty, students, administrators, staff and external 

constituencies; 

• Willingness to work in a collective bargaining environment 

Salary and Benefits 

Salary is commensurate with qualifications and experience. Comprehensive benefits package including health, dental 

and vision benefits, sick and vacation days, and participation in the State Universities Retirement System. This 

position requires a background check. 

To Apply: 

In order to be considered for employment by Northeastern Illinois University (NEIU) you must submit the following and send 

all documents within one PDF/Word document to GCOENursingSearch@neiu.edu. 

• A letter of interest addressing your qualifications for this position 

• Current Curriculum Vitae 

• Three (3) current academic and professional references 

• Current Illinois RN licensure 

• Employment Application 

• Statement of Annuitant Status 

• Copies of unofficial transcripts are accepted; however, official transcripts for all earned degrees will be required of 

candidates selected for on-campus interviews 

• This position requires a background check 

In addition to the links provided above for the Employment Application (fillable), Affirmation Action Form and Statement of 

Annuitant Status, you can also obtain these forms at the NEIU Office of Human Resources, Bernard Office Building (BOB), 

5555 N. Bernard Street, Chicago, IL 60625, Monday through Friday, 8:30a.m.to 4:30p.m. 

Review of applications begins September 15, 2021 and continues until the position is filled. 

https://www.neiu.edu/founding-director-of-rn-bsn-program-0 

Northeastern Illinois University is an Equal Opportunity/Affirmative Action Employer and invites applications from Women, Minorities, Veterans and Persons with Disabilities, as well as Other Qualified Individuals. Northeastern Illinois University's positions are contingent upon the University's receipt of its State of Illinois appropriation.


CONTINUING EDUCATION OFFERING 

The Right to Designate a Caregiver Prior to Discharge 

Dhara Mehta 

Introduction 

The Caregiver Advise, Record, and Enable Act, which 

became effective on January 27, 2016, gives admitted 

patients or their legal representatives the right to elect 

a caregiver before the patient's discharge from the 

healthcare facility for after-care services (IHA, 2016). 

Caregivers offer after-care to a patient post-discharge 

according to the healthcare team's discharge plan (IHA). 

After-care services refer to clinical assistance provided to 

a patient after their discharge. They can include activities 

of daily living, tube feeding, medication administration, 

ventilator care, and follow-up appointments (IHA). 

Implementing this policy offers the patient more 

autonomy over their care once they leave the healthcare 

facility and can be considered as the facilities' role in 

supporting patient-centered care even after discharge. 

By allowing patients or their legal representatives to 

choose their caregiver, patients are included in the 

discharge planning process and experience less anxiety 

in the transition from hospital care to home care. The 

purpose of this paper is to evaluate the advantages 

and disadvantages of this policy along with its political, 

financial, and social impacts so that further revisions can 

be recommended. 

Policy Relevance to Health Care 

Hospital discharge planning is very complex and entails 

several steps leading to the discharge, the discharge, and 

even after to manage the patient's care. This includes 

evaluating the patient to determine if they no longer 

need inpatient services, determining if the caregiver 

needs training, and even arranging follow-up healthcare 

(Flink & Ekstedt, 2017). This policy plays a crucial role 

in this process, as it allows the patient or their legal 

representative to decide and appoint a trusted caregiver 

to be a part of this discharge process. In one qualitative 

study of seventeen patients, thirteen of them stated that 

most decisions were made for them and wanted to be 

more involved in making decisions regarding their care 

(Jerofke-Owen & Dahlman, 2018). Additionally, healthcare 

is focused on providing patient-centered care. Allowing 

patients to choose who provides them care once they 

leave the facility is part of this patient-centered approach. 

Research shows that when care is patient-centered, 

patients feel in control, are more satisfied with the care, 

and have positive outcomes (Kuipers et al., 2019). 

Similarly, when health care is taken outside the 

healthcare facility with the same approach, patients are 

more willing to participate in their care, accept care from 

their caregivers, and respond better to care. This policy 

supports the patient-centered approach and maintains 

Director of Undergraduate Programs 

Illinois State University is recognized by The Chronicle of Higher Education, 

as the only public university in Illinois to be a “Great College to Work For”! 

The Mennonite College of Nursing is seeking a faculty member 

to direct our Undergraduate Programs. 

Responsibilities for this position include: 

• Planning and developing the implementation of all sequences within the 

undergraduate program, 

• Completing course and clinical schedules, 

• Prepares, teaches and evaluates assigned courses, and 

• Assists in faculty orientation and mentoring. 

Qualifications include: 

• A Master’s degree in Nursing and prior teaching and administrative 

experience in a baccalaureate or higher degree program is required. 

• A Doctorate in Nursing is preferred. 

Salary is commensurate with experience and qualifications. 

Illinois State University is located in Bloomington-Normal. With a 

population exceeding 125,000, the twin-cities are half way between 

Chicago and St. Louis and are known for having a high quality of life 

including a small-town atmosphere, high standard of living, stable 

economy and high educational attainment. 

Review of applications will start immediately. 

To learn more about this exciting opportunity and 

to apply, please contact by June 13, 2021: 

Lissa Bevins at mabevin@ilstu.edu or (309) 438-3143 or visit: 

jobsearch.illinoisstate.edu/en-us/search/?search-keyword=mennonite 

nursing.illinoisstate.edu 

the patient's sense of autonomy to help yield better 

overall health outcomes for patients, making it relevant 

in healthcare. Furthermore, while this policy is relevant 

in healthcare as it can provide other benefits, this policy 

also raises a number of issues. 

Strengths of the Policy 

Giving patients or their legal representatives the right 

to choose their caregiver provides several benefits aside 

from giving them a sense of autonomy and supporting a 

more patient-centered approach. It also reduces patient 

anxiety and is a financially cost-effective option for 

patients. This policy helps reduce the anxiety and fear 

that overwhelms the patient when they need to focus 

on healing, coming to terms with their health issues, 

preparing to make lifestyle changes if needed, and 

planning for discharge. A study looking at the effects 

of stress and anxiety in patients during their discharge 

process determined that the discharge process generates 

significant stress (Sharif et al., 2014). By allowing the 

choice of a caregiver, patients experience less anxiety 

when preparing for discharge and after-care. 

Another benefit that arises from the ability to choose a 

caregiver is the financial aspect. In many cases, Medicare, 

Medicaid, and other private health insurance companies 

do not entirely cover caregivers leaving individuals to pay 

out-of-pocket (Lai, 2012). Independent caregivers are 

paid $10-$20 hourly to provide care which may not be 

feasible for older adults who live on government support 

and pension (Lai). It may also involve working with a 

stranger compared to the flexibility of choosing a trusted 

caregiver. In most cases, the caregivers chosen are often 

family members who provide the care for little to no 

compensation (Lai). As a matter of fact, in 2017, the Public 

Policy Institute estimated that $470 billion of unpaid 

assistance was offered by family caregivers (Reinhard et 

al., 2019). Therefore, having a trusted family member to 

provide care is both convenient and cost-effective. 

Weaknesses of the Policy 

Simultaneously, this policy has its disadvantages. 

While it provides autonomy, supports a patient-centered 

approach, reduces patient anxiety, and is cost-effective, 

it raises concerns on the competence of the patient's 

appointed caregivers, ineffective training systems, and 

the process of verifying a caregiver before the patient's 

discharge. This policy covers the right of a person or their 

legal representative to choose their caregiver. However, 

it does not include any criteria about how caregivers are 

evaluated to determine if they can indeed perform the 

needed tasks for the required length of time as planned 

by the healthcare team. Patients are not qualified to 

decide whether those caregivers will be capable and 

available to perform those tasks. 

This policy also states that caregiver training will 

mainly occur by observing health care professionals and 

taking initiatives to perform those tasks while under their 

supervision (IHA, 2016). Additionally, there is an option 

for a pre-recorded video that can be given to caregivers 

to watch, allowing for little physical interaction and the 

opportunity to ask questions. At a minimum, this policy 

states that caregivers should have the opportunity to see 

a live or pre-recorded video demonstration, the ability to 

ask questions before discharge and be provided answers 

in a culturally competent and appropriate language (IHA). 

However, there are no other training criteria to ensure 

that caregivers have received adequate training and 

will be able to provide adequate continued care after 

discharge. One study shows that appropriate care as 

per the discharge plan decreases over time. It becomes 

challenging to provide care due to other obligations that 

may lead to caregiver fatigue (Schulz et al., 2020). This 

unstructured training increases the risk of caregivers 

overlooking certain vital steps in the discharge plan. 

Finally, another weakness in the policy states that 

hospitals should make some effort to contact the 

patient's appointed caregiver. If they cannot be reached 

for training and instruction, it should not hinder the 

patient's discharge process when appropriate (IHA, 2016). 

With no regulations set in place to verify patients have 

an acceptable caregiver to perform after-care, the risk of 

readmission and poor patient health outcomes increases 

(Hahn-Goldberg et al., 2018). Additionally, suppose 

caregivers have not made an effort to receive any 

instruction or training pertaining to their patient. In that 

case, the chances of failing to provide adequate after-care 

will increase (Hahn-Goldberg et al.). 

By analyzing the policy's strengths and weaknesses, it 

is evident that there is support for and against this policy. 

It is equally important to evaluate this policy regarding its 

effect on political, financial, and social platforms. 

Policy Issues: Political Impact 

Policies must be evaluated for their political influence 

as politics play a crucial role in creating and implementing 

policies. The biggest political influences on this policy 

come from health insurance organizations, specifically 

from Medicare and Medicaid, and third-party home care 

organizations. If patients are allowed to choose their 

own caregiver, then third-party home care organizations 

would lose potential revenue to make if patients were 

to use their services instead (Slayter et al., 2019). If 

more people started appointing their caregivers, these 

organizations would lose money, resulting in layoffs and 

further loss of profit. 

Medicare is a federal program for those over 65 and 

those under 65 with disabilities (Landers et al., 2016). 

Medicare and most other private health insurances only 

cover home care short-term if it is medically necessary 

(Landers et al.). Other non-medical home care and aftercare 

services that unskilled caregivers can deliver are 

not covered and require additional costs (Landers et 

al.). On the other hand, Medicaid is a joint state and 

federal program that provides coverage to seniors with 

low income and limited assets (Janus & Ermisch, 2015). 

They may cover medical and non-medical home care 

depending on the state policies (Janus & Ermisch). 

Additionally, Medicaid offers Home & Community 

Based Service Waivers (HCBS), which can be used to pay 

for medical and non-medical home care services (Janus 

& Ermisch, 2015). Since money and other resources are 

invested into these programs at federal and state levels, 

it is in the best interest of Medicaid, Medicare, and 

even other private healthcare agencies to support this 

policy. Given that Medicare does not always cover home 

care, allowing patients to appoint a caregiver that can 

be trained provides benefits such as improved patient 

outcomes, reduced readmission rates, and proper aftercare 

management (Landers et al., 2016). For Medicaid, 

allowing patients to choose a caregiver is a cost-effective 

option relieving them from providing coverage (Janus 

& Ermisch). With the increasing aging population and 

greater demand for Medicaid coverage due to low 

income, Medicaid alone covered 70 million people, of 

which 9 million were over the age of 65, nationwide in 

2020 (Medicaid, 2020). Therefore, by supporting this 

policy and advocating for patients to choose a caregiver, 

Medicaid can divert additional costs associated with 

offering home care and ultimately save federal and state 

resources. 

By assessing the political influence on this policy, 

it can be determined that private health insurances, 

Medicaid, Medicare, and home health agencies greatly 

influence this policy and may have played a key role in 

how it was written. For example, the policy specifically 

states that the hospital should allow the patient or legal 

representative to name a caregiver and make some 

effort to get in touch with that person (IHA, 2016). This 

benefits the patients and organizations, like Medicaid 

and Medicare. However, if the caregiver's contact is 

unsuccessful, then it should not be a reason to interrupt 

the patient's discharge as long as its deemed appropriate 

(IHA). This would benefit private home care organizations 

as those patients who need caregivers will have to bear 

out-of-pocket costs to hire a caregiver. Based on the 

evaluation of how politics influence health policy, it 

can be seen how influential politics is in creating health 

policies. 

Policy Issues Impacting the Nursing Profession: Financial 

In 2019, Medicare cut payments to 2,583 health 

facilities nationwide due to increased readmission 

rates, translating to a cut of about $563 million for the 

year (Rau, 2019). Annually, hospitals are evaluated to 

determine how often patients are being readmitted 

within 30 days of being discharged for conditions 

including myocardial infarction, chronic lung disease, 

heart failure, coronary artery bypass, pneumonia, and 

hip/knee replacements (Rau). Readmission rates are a 

significant concern because they affect patient outcomes 

due to increased risk of exposure to hospital-acquired 

infections, a need for further extensive management, 

and medical errors (Rau). One study also determined 

that in some cases, readmission occurred due to other


factors such as poor after-care activities, which included 

medication management and adhering to follow-up 

appointments (Felix et al., 2016). In this study, patient 

surveys determined that although 2/3 of patients rated 

their discharge positively, they were still readmitted 

within 30 days, and 1/3 of the total patients readmitted 

were noted to have missed one or more follow-up 

appointments (Felix et al.). Simultaneously, this can also 

be costly for the hospitals. In 2012, hospitals in Arkansas 

reported that readmission costs resulted in an annual 

excess of $12 billion (Felix et al.). When considering 

the negative impacts of readmission rates on hospitals 

and patient outcomes, it can also affect the nursing 

profession. Readmission increases nurses' workload in 

providing patient care since those patients often take 

longer to be discharged the second time (Felix et al.). If 

patients were initially discharged with a trained caregiver, 

readmission rates would be much lower, decreasing 

the workload for all healthcare professions, including 

nursing. An additional study showed that when patients 

can choose their own trusted caregiver, they are likelier 

to comply with the post-discharge management plan 

(Skufca, 2019). Without this policy and keeping the 

politics mentioned before in mind, patients may not 

obtain an adequate caregiver to assist them, increasing 

their risk of poor after-care leading to readmission. 

On the other hand, this policy allows the discharge 

process to continue even if the caregiver is not present 

as long as the healthcare team feels it is appropriate (IHA, 

2016). This aims to reduce hospital costs from keeping 

patients longer than needed once the healthcare team 

has provided the care that was needed. These hospital 

costs include hospital room, bed, food, and medical 

and non-medical supplies. The nursing profession is 

impacted here because while this policy aims to reduce 

unnecessary workload for nurses and optimize their 

skills and time for patients that require immediate 

care if patients are readmitted due to poor after-care 

compliance, it increases the nurses' workload. Through 

this evaluation, it can be seen that this health policy 

has both positive and negative impacts on the nursing 

profession. 

Policy Issues Impacting the Nursing Profession: Social 

Aside from the political and financial influence 

on this health policy, there are also social issues that 

impact this policy and affect the nursing practice. 

The major social concerns in the nursing profession 

include short staffing, long work hours, and increase 

workload (Matthews, 2012). To represent the nursing 

force and address these social influences, organizations 

such as the American Nurses Association (ANA), which 

aim to advance and protect the nursing profession, 

have released position statements and have their own 

Code of Ethics (ANA, 2015). One statement is known 

as "Addressing Nurse Fatigue to Promote Safety and 

Health," which is geared towards reducing the risk of 

nurse burnout associated with increased shift work and 

long working hours (ANA, 2014). By doing so, they aim 

to protect the health and safety of those in the nursing 

profession and their patients (ANA, 2014). This position 

affects the Caregiver Advise, Record, and Enable Act in 

several ways. The policy states that caregivers can obtain 

training and instruction as the "opportunity arises," which 

means that the caregiver has the right to stop and ask 

the health professionals to train and instruct them in 

performing those tasks that are expected to be part of 

the discharge orders (IHA, 2016). While the ANA Code of 

Ethics Provision 4.1 states that the nurse's responsibility 

includes direct nursing care activities and teaching, 

social issues such as insufficient staffing and long work 

hours affect this ability (ANA, 2015). Being asked to 

train, instruct, and assess caregivers on care practices in 

handling multiple patients when short-staffed can lead 

to nurse fatigue, poor patient outcomes, and inadequate 

caregiver training (Matthews). Nurses need to be able to 

balance patient care during the shift, and having to take 

the time in the middle of the task to provide efficient 

training can decrease the quality of care they provide to 

other patients, the time they spend with other patients, 

and risk rushed and inadequate training for the caregiver 

who can lead to longer shift hours in an already shortstaffed 

environment. Being expected to train caregivers 

without a structure during busy times will make the 

caregivers' training ineffective and will neither occur in 

the culturally competent manner nor allow enough time 

for the caregiver to ask questions as this policy requires 

(IHA). Therefore, the current issues of short staffing and 

long shift hours that ANA and the Nursing Code of Ethics 

are trying to address can impact the expectations in this 

policy. 

Another position statement from ANA is "Care 

Coordination and Registered Nurses' Essential Role," 

which states that an essential role of the nursing 

profession is to promote patient-centered care and 

advocate for patients during care coordination (ANA, 

2012). This position statement directly impacts the health 

policy because this policy allows for a more patientcentered 

approach to the patient's care, in conjunction 

with ANA's Code of Ethics which includes advocating for 

patient autonomy through self-determination (Provision 

1.4) and a patient-centered approach (Provision 2.1), 

giving the patient the right to choose a caregiver for their 

after-care promotes this patient-centered approach and 

sense of autonomy (ANA, 2015). However, social issues 

such as short staffing and long work hours influence 

the effectiveness of a patient-centered approach. One 

study showed how social issues such as staffing, work 

hours, and workload are key barriers to effective patientcentered 

care (Lloyd et al., 2018). Based on the ANA's 

position statement and the Code of Ethics, it can be 

seen how social issues can impact this health policy. 

While this health policy promotes the idea of a patientcentered 

approach and patient autonomy, it also requires 

nursing professionals to train and instruct, provide care, 

coordinate care, and make reasonable efforts to contact 

the caregiver for the patient. However, the social issues 

that currently exist in the nursing profession can interfere 

with patient care and, ultimately, the discharge process in 

which the caregiver needs to be trained appropriately. 

Policy Revision: Proposal 

After evaluating the Caregiver Advise, Record, and 

Enable Act through its strengths and weakness and 

political, financial, and social influence, a proposal for 

policy revision can be made. Three changes that are being 

proposed include structured training and instruction for 

caregivers, implementing a minimal criterion for chosen 

caregivers to meet the patient's after-care needs, and 

initiating a top 2-choice in caregiver for patients. Applying 

a structured training and instruction process will alleviate 

many issues that have been presented in this assessment. 

A structured training program will allow caregivers to 

learn and ask questions about the patient's after-care 

needs without the stress of feeling rushed. It will also 

improve the caregiver's understanding of their after-care 

to lower readmission rates, financially benefiting both 

health insurance organizations and the hospital. At the 

same time, it will help lower the risk of nurse fatigue and 

assist in addressing the social issues (increase workload, 

long shifts, and short staffing) hindering the nursing 

profession from providing quality patient care while being 

expected to train caregivers in suboptimal settings. 

Implementing a minimal criterion for chosen 

caregivers to be eligible for the patient's after-care 

needs is another crucial aspect. To make sure that the 

discharging patient will be receiving the appropriate 

after-care as determined by the healthcare team, 

caregivers must be competent and willing to provide 

care for that patient in the first place. The health policy 

states explicitly that the assigned caregivers are under no 

obligation to continue providing after-care to the patient, 

raising concerns (IHA, 2016). If the caregiver chooses 

to discontinue care, the patient will be at higher risk of 

missing their medications and follow-up appointments, 

increasing their risk of being readmitted. To counter 

this, having a minimal criterion that includes whether 

or not the caregiver is willing to provide after-care for 

the patient for the given timeframe if they are physically 

and mentally competent to provide the necessary care, 

and if they are willing to receive structured training, will 

improve the patient's outcomes. 

Initiating a top 2-choice in caregiver for patients will 

significantly impact the healthcare team's effort to secure 

a caregiver that is both the patient's and is available for 

the patient after discharge. Since the current policy does 

not obligate assigned caregivers to partake in after-care 

and allows for a patient's discharge if appropriate even 

if the caregiver has not been successfully contacted, 

having a second choice would increase the likelihood of 

having a trained caregiver before discharge (IHA, 2016). 

This would address readmission rates and poor aftercare 

compliance and prove to be financially beneficial for 

healthcare facilities and health insurance organizations. 

It will also assist in decreasing the nurse workload and 

nurse fatigue. 

These three proposed points can have numerous 

benefits if included in this health policy. They address 

the weaknesses of this policy and aim to satisfy political, 

financial, and social issues surrounding the nursing 

profession. 

Conclusion 

The Caregiver Advise, Record, and Enable Act gives 

patients the right to appoint a caregiver of their choice 

(IHA, 2016). This opportunity allows patients to receive 

after-care from someone they trust and supports nursing 

goals of providing patient-centered care and autonomy. 

This policy also helps reduce patient anxiety and is 

financially cost-effective. At the same time, this policy 

has specific weaknesses: concerns of patient-appointed 

caregivers' competence, the training process, and the 

method of verifying a caregiver before discharge. When 

evaluating this policy further in terms of politics, it is 

undeniable how influential health insurance organizations 

such as Medicaid, Medicare, and private health insurance 

companies are regarding this policy. Financial influences 

on the nursing profession caused by readmission rates 

due to poor after-care compliance, and social issues 

such as increased workload, extended shift hours, and 

short staffing impact how this policy is carried out. The 

social issues impacting this policy can lead to further 

nurse fatigue and decrease overall patient care quality. 

The financial issues can lead to a surge in hospital costs, 

patient out-of-pocket costs, and increased use of medical 

resources. However, with the revised proposal, these 

issues can be addressed through three points: structured 

training for caregivers, implementing a minimal criterion 

for chosen caregivers, and initiating a top 2-choice in 

caregiver. These revisions can lead to better patient 

outcomes and reduce readmission rates directly 

addressing the appointed caregivers. Evaluating this 

health policy to see its impact on patients and nursing 

professionals through different platforms provides an 

overall picture to propose further recommendations for 

its improvement. 

REFERENCES AVAILABLE UPON REQUEST 

CE Offering: #2021-06-015- The Right to Designate a 

Caregiver Prior to Discharge 

1.0 Contact Hour 

This offering expires in 2 years: 

June 10, 2023 

Learner Outcome: 

Learners will demonstrate knowledge on the 

advantages and disadvantages, as well as the 

political, financial, and social influences of The 

Caregiver Advise, Record and Enable Act and its 

proposed policy revisions by passing a post-test with 

80% or better. 

HOW TO EARN 

CONTINUING EDUCATION CREDIT 

This course is 1.0 Contact Hour 

1. Read the Continuing Education Article 

2. Go to https://www.surveymonkey.com/r/2021- 

06-2021Self_Study to complete the test and 

evaluation. This link is also available on the INF 

website www.illinoisnurses.foundation under 

programs. 

3. Submit payment online. 

4. After the test is graded, the CE certificate will 

be emailed to you. 

HARD COPY TEST MAY BE DOWNLOADED via the 

INF website www.illinoisnurses.foundation under 

programs 

DEADLINE 

TEST AND EVALUATION MUST BE COMPLETED BY 

June 1, 2023 

Complete online payment of processing fee as 

follows: 

ANA-Illinois members & Affiliates - $8.00 

Nonmembers- $15.00 

ACHIEVEMENT 

To earn 1.0 contact hour of continuing education, 

you must achieve a score of 80% 

If you do not pass the test, you may take it again at 

no additional charge 

Certificates indicating successful completion of 

this offering will be emailed to you. 

DISCLOSURE 

There is no conflict of interest for anyone with the 

ability to control content of this activity. 

ACCREDITATION 

This continuing professional development activity 

was approved by the Ohio Nurses Association, 

an accredited approver by the American Nurses 

Credentialing Center’s Commission on Accreditation. 

(OBN-001-91) 

CE quiz, evaluation, and payment are available 

online at https://www.surveymonkey.com/r/2021- 

06-2021Self_Study or via the INF website www. 

illinoisnurses.foundation under programs.


Detection and Treatment of Delirium Experienced by 

Patients in the Long-Term Care Setting 

Michelle E. Jordan MSN, AGPCNP-BC 

The American Psychiatric Association (APA) defines 

delirium as an acute disturbance in attention and 

awareness accompanied by cognitive disturbances that 

cannot be explained by a disorder in neurocognition 

that precedes the delirium and cannot be explained by 

another medical condition (for instance, a brain tumor). 

Delirium is not a disease but a multi-causal clinical 

syndrome causing a serious disturbance of a patient's 

mental abilities, affecting patient functioning, safety, 

and quality of life. A thorough assessment of factors 

contributing to delirium should be followed by prompt 

treatment. 

Delirium Is Prevalent in Long-Term Care Settings 

Estimates of the elderly diagnosed with delirium 

in long-term care settings have been estimated to 

be around 40%. However, the prevalence of delirium 

in a long-term care setting is estimated to range 

between 13-88%. The problem is that delirium is often 

undiagnosed or misdiagnosed. Delirium appears 59- 

88% in patients near death. These variations can be 

attributed to the following: the multi-causal nature of 

the condition; the number of tools clinicians use to make 

the diagnosis; clinicians' knowledge of the condition; 

and the diversity of the population who experience 

delirium. 

Many patients who transition to long-term care 

settings suffered delirium during or resulting from 

a recent hospitalization. Delirium is often a surgical 

complication of older adults with an incidence of 25% 

after elective surgery and 50% after high-risk surgery, 

such as hip fracture repair and cardiac surgery. The 

elderly who presents at the emergency room are 

diagnosed with delirium in the range of 8-17%; some will 

eventually be admitted to long-term care settings. 

Problems Associated with Delirium Recognition and 

Treatment 

Delirium often goes unrecognized and, therefore, 

untreated. Failure to recognize delirium is a 

longstanding problem. Clinicians may be insufficiently 

trained to recognize delirium. Caretakers in longterm 

care settings often lack sufficient knowledge 

of a patient's normal cognitive function, a necessary 

benchmark as a point of comparison. Caretakers need 

to take sufficient time to establish this with patients or 

with the help of family members. Engaging with patients 

is critical because continual brain stimulation is essential 

for normal cognitive functioning. When family members 

are not available, one case being the restrictions placed 

on family visits during the recent Covid epidemic, lack of 

family support and engagement may contribute to the 

development of patient delirium. Poor communication 

among caretakers, especially nurses, and the patient's 

family members can lead to failure to recognize when 

patients begin to veer from their normal cognitive 

function into delirium. Caretakers may not have or 

may not utilize proper assessment tools such as the 

Confusion Assessment Method (CAM). 

The relationship between delirium, dementia, 

and depression can be misunderstood. Delirium 

and dementia, the two most common causes 

of mental impairment in older populations, are 

frequently confused and lead to failure to treat 

delirium. Dementia is a neurodegenerative condition 

that develops slowly and progressively leads to 

diminished cognitive functioning that interferes with 

a patient's independence and ability to engage in 

daily life activities. In contrast, delirium is a syndrome 

characterized by a rapid onset that leads to inattention, 

impaired cognition, and fluctuating symptoms. The 

problem is further complicated when delirium is 

superimposed on dementia or depression. 

Psychoactive medications for delirium can 

exacerbate delirium, cause additional problems, or 

mask the condition. Polypharmacy can have negative 

consequences for older adults. Patients in long-term 

care settings are frequently treated with psychoactive 

medications for agitation, depression, or insomnia, 

but these medications can exacerbate delirium, cause 

additional problems, or mask the condition. Antipsychotic 

medications (APMs) make agitated patients 

more comfortable, but they can mask hyperactive 

delirium and convert it to hypoactive delirium. 

Hypoactive delirium is characterized by apathy, 

withdrawal, and lethargy. APMs generally put patients 

at risk of falls due to hypotension, disorientation, 

oversedation, and extrapyramidal symptoms. Due to 

their overuse, the Center for Medicare and Medicaid 

Services in 2017 limited prescriptions for APMs to 14 

days and required a written reassessment rationale for 

new prescriptions. 

Nursing homes often fail to treat delirium properly— 

patients who have dementia and delirium challenge 

long-term care facilities. Since facilities must report 

the use of physical restraints to control symptoms like 

agitation, restlessness, wandering, and aggressiveness, 

they treat patients with psychotropic medications. 

Various federal regulations regarding these medications 

have contributed to inconsistent compliance. Financial 

concerns have led to increased APMs, the decrease of 

costly registered nurses (RNs), and the increase of less 

expensive licensed practical nurses (LPNs). A higher 

percentage of RNs in nursing homes are associated with 

lower rates of APMs, while higher numbers of LPNs are 

associated with higher rates of APMs. The point has 

already been made that caregiver engagement with 

patients increases the brain stimulation necessary for 

normal cognitive function. When caregiver engagement 

decreases, patient brain stimulation is lessened, 

preparing the way for delirium. 

Non-Pharmacological Treatment of Delirium 

The pharmacological treatments for delirium 

(APMs, anti-depressants, anti-anxiety medications) are 

still being used and are often necessary; prevention 

and treatment of delirium with non-pharmacologic 

approaches are now widely considered the most 

effective strategy. Delirium screening, such as the 

Confusion Assessment Method (CAM), is both a method 

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to detect delirium (evaluative) and a frequent, timely 

interaction with the patient that serves to promote 

cognitive functioning (therapeutic). The CAM, consisting 

of a series of questions asked of the patient, takes less 

than five minutes; a frequency of every eight hours 

is sufficient. Staff scores the patient on a change in 

mental status, including fluctuations, inattention, levels 

of wakefulness, and disordered thinking. Patients will 

anticipate holding the hand of their nurses, and after 

learning the drill, will strive to become better at it. Both 

the physical and verbal exchange serve as a human 

connection for the patient and an opportunity for the 

caretaker to assess changes signaling delirium. Once 

delirium is detected, the patient should be reassessed 

for physical contributors—infection, organ dysfunction, 

polypharmacy, drug withdrawal--and treated 

accordingly. 

Providing a calm environment and encouraging 

the use of medical supplies and personal objects can 

alleviate delirium. Hyperactive delirium patients, 

characterized by agitation, can benefit from reduced 

stimulation. Earplugs at night, delirium rooms, an 

orderly, quiet environment, and pain management 

protocols help contribute to a calm environment. 

Coordination of nursing interventions, elimination of 

alarms, well-lit rooms, and the inclusion of personal 

objects provide benefits. Hypoactive delirium patients, 

who often appear sedated or depressed, benefit 

from the stimulation provided by dentures, canes, 

walkers, wheelchairs, books, radios, personal clothes, 

and belongings. Physical therapists and occupational 

therapists can assist with mobilization. Caregivers 

can remind the patient of the time; a clock, watch, or 

calendar kept close can help patients keep track of 

time and dates. Patient families should be involved and 

supported. The use of volunteers, aids, and other nonlicensed 

professionals can assist and cut the cost of 

implementation. 

Staff training, educational programs, and 

interdisciplinary consultation should be established. 

Interdisciplinary teams should round daily together 

to discuss all aspects of patient care; pharmacists 

should be included to help with polypharmacy. 

Family, physicians, nurses, pharmacists, physical 

and occupational therapists, social workers, nursing 

assistants, and chaplains are all part of a patient's team. 

A new and increasingly available approach is the 

Hospital Elder Life Program (HELP), designed to prevent 

and treat delirium. HELP, already used in over 200 

hospitals worldwide, is a multidimensional intervention 

proven to be effective and cost-saving. It promotes 

a review for reduction and possible elimination 

of psychoactive medications, early and frequent 

mobilization, sleep hygiene, along with encouraging 

hydration and nutrition, providing vision and hearing 

aids. More information can be accessed online. 

Conclusions 

The elderly admitted into an extended care facility 

are moving into a high-risk environment. These patients, 

many of whom have recently been hospitalized, 

frequently enter with physiological decline, including 

brain vulnerability. A high percentage also enter with 

chronic illness, polypharmacy, and psychological 

morbidities. They now find themselves in a foreign 

setting that generates fear, isolation, restriction 

and are without family and friends to give the usual 

support. These conditions are immutable and dispose 

the patient to delirium. Additionally, many facilities 

are inadequately staffed due to financial pressures, 

and clinicians are under tremendous time pressure 

to manage their patient load. Clinicians are often not 

trained well enough to recognize delirium and may not 

consistently assess for it. 

Clinical staff may need additional delirium training. A 

complete mental status exam that establishes a patient's 

baseline cognitive function is necessary. Knowing that 

over 50% of patients will develop delirium, caregivers 

need training and should consistently utilize a delirium 

assessment tool like the CAM. Non-pharmacological 

approaches (for instance, active communication, 

addressing eyesight and hearing deficits, and improving 

mobility) are highly effective in preventing delirium 

and should be the first approach in treatment. 

Pharmacological approaches are appropriate when 

the patient is at risk due to agitation, restlessness, and 

combativeness, but utilizing them should be carefully and 

conservatively considered and continually reevaluated as 

they put patients at risk. Pharmacological treatments are 

appropriate with delirious patients at the end of life.


IACN Looks Forward: The Future of Nursing Leadership 

What is leadership in nursing, and how will it change? 

It is a difficult question to answer because to everyone, it 

is different. 

According to Tina Decker, Chair of the Department 

of Nursing at Trinity Christian College, "Leadership looks 

like applying the nursing process (through assessment, 

diagnosis, planning, implementing, and evaluating) at 

a macro level with patient-centered care being at the 

center." 

According to Holly Farley, Chair of the School of 

Nursing and Assistant Professor at Eastern Illinois 

University, "Leadership can be described as 'facilitating.' 

Leaders determine goals with input from followers and 

facilitate the path to meeting those goals." 

The Illinois Association of Colleges of Nursing (IACN) 

knows that leadership -- and the ways that it is changing 

– is an important topic for all nurses, both those currently 

practicing and incoming student nurses. Read on for an 

examination of leadership in nursing! 

Nursing Leadership in 50 Years 

Like everything in the healthcare field, nursing 

leadership is rapidly changing. Tina Decker shared, 

"Nurses need to become the voice of the future of 

healthcare. Nurses are so used to advocating for 

patients on an individual level. The future of healthcare 

requires nurses to become more versed at advocating 

for the vocation of nursing and nurses themselves. This 

will directly impact patient outcomes as the nursing 

workforce is the largest healthcare profession in our 

country. Nurses need to be a significant voice at the table 

where healthcare decisions are being made. This includes 

all levels from acute care settings, to community planning 

to national legislation." 

While some ways in which nursing leadership will 

evolve seem clear, others are not so obvious. Holly Farley 

said "I know it will be different, but I do not know that 

the changes will be. Thirty years ago, I could not have 

imagined the technological changes that we would be 

experiencing and the fast-paced advances. I think nurses 

will continue to take on more responsibility in patient 

care and coordination." 

Becoming a Nurse Leader 

Although nursing leadership will look different in 50 

years, IACN's members believe the path to leadership will 

remain similar. 

"New nurses need to get involved with professional 

organizations and research," said Lea Monahan, Director, 

and Professor of the School of Nursing at Western Illinois 

University. 

Holly Farley instructs students hoping to become 

nursing leaders to "Embrace change at every level and 

take every opportunity to be a part of it." Tina Decker 

similarly advises students to "Opt-in. Participate. Assess 

what changes are needed, and not be afraid to look for 

solutions!" 

Qualities of a Nursing Leader 

Students and nurses alike can become future nursing 

leaders, but some qualities are absolute necessities. "As 

cliche as it may sound, leaders need to know themselves 

pretty well before they lead others. They need to know 

their strengths and weaknesses, their triggers, the things 

that inspire them. They need to be self-aware before 

attempting to help others be their best selves in the 

workplace," said Tiffany Greer, Associate Dean of the 

School of Nursing at Olivet Nazarene University. "I think 

it can be as easy as taking a few personality tests, talking 

with some honest colleagues, and maybe doing some 

reflective journaling. Then find a great mentor who can 

cheer you on in the tough moments and stretch you in 

the good times. The bottom line is that we need good 

leaders who are willing to serve others, encourage them 

to be their best, and humbly lead change." 

IACN Encourages Leadership 

At the IACN, we encourage all nurses who desire 

to work towards leadership positions, whether at the 

bedside, organizational, state, or national level. While 

the process can be long and difficult, it begins with 

the first step! For nurses wishing to work towards 

leadership positions, IACN recommends taking the 

advice of many of our members and getting involved in 

the nursing community. For advice on how to become 

involved in the community and general advice about 

nursing leadership, feel free to contact us here (https:// 

illinoiscollegesofnursing.org/contact-us/).


Philippine Nurses Association of Illinois in Action 

Philippine Nurses Association of Illinois (PNAI) has 

been volunteering at Kendall County Health Department 

Covid -19 Vaccination program since February 2021. 

The organization continues to promote use of mask, 

social distancing, and hand washing to prevent the 

spread of Covid-19 despite having received the COVID -19 

Vaccine. ***Get vaccinated It will save not only your life, 

but others as well. *** 

Left to right: PNAI Vice President Dean Baron 

BSN, RN, Tessie Dagger MSN, BSN, RN,Secretay; 

and Bryan Ranchero, RN, Board Member, 

volunteered at Yorkville High School, Yorkville, IL 

during their COVID-19 Community Vaccination 

last February 27, 2021 

PNAI Officers; Left to right: Tessie Dagger 

MSN, BSN, RN ,Secretary; Marilou Dangalan, 

RN, President Elect,and Bryan Ranchero, RN, 

Board Member; volunteered at Oswego East 

High School, Oswego, IL Covid-19 Community 

Vaccination on March 21, 2021. 

PNAI Nurses administering COVID-19 Vaccine at 

Kendall County, IL


The Student Nurses’ Association of Illinois 

The Student Nurses' Association of Illinois (SNAI) has an update on what has been 

happening since October 2020 and what is currently being planned for this fall! Stay 

tuned to our website and social media for further information! 

Here is a list of our current members and where they attend nursing school. Each of 

them was elected in October 2020, and their term will end in October 2021. 

Madison Morgan, President, Blessing-Rieman College of Nursing and Health Science 

Sara Engel, 1st Vice President, Elmhurst University 

Kerixtzy Ballines, 2nd Vice President, Aurora University 

Sana Bhalli, Secretary, 

Phillip Adeleye, Treasurer, Chamberlain University at Tinley Park 

Nandini Patel, Breakthrough to Nursing, Northern Illinois University 

Kelechi Asonye, Legislative Director, Northern Illinois University 

Marisa Morice, Marketing Director, Chamberlain University 

Hiral Patel, Membership Director, Chamberlain University 

Hunter Varnes, Image of Nursing Director, University of Illinois at Chicago 

Joophil Kim, Nominations and Elections Chair, Resurrection University 

Alexis Hodges, Executive Elective Consultant, Aurora University 

72nd Student Nurse Association of Illinois Annual Convention 

Out of the abundance of caution, we are planning to host our annual convention this 

Fall on October 16th, 2021. Our theme this year is 'Empowering Ourselves to Empower 

Others.' We realized that we must take care of ourselves through this past year to 

provide the best care for our patients. Learning how to take time for yourself, tend to 

your needs, and learn the word 'no', is vital to establish ourselves before going into our 

careers. This will help eliminate nursing burnout, errors made by the nurse, and overall 

better patient care. We hope to see you there as we have very exciting things planned 

for our guests! We plan to have a keynote speaker, many guest speakers, an NCLEX 

review session, and a new graduate nurse panel to answer any questions you may 

have about the process of applying for jobs, interviewing, studying for NCLEX, and tips 

and tricks to pass NCLEX. Also, be sure to look forward to many giveaways and awards 

handed out during the event by SNAI and our guests. We cannot wait to see everyone 

there! 

Check out our website for more information on how to run and attend our Annual 

Conference in October for a chance to pre-slate for running for office on SNAI. 

Talk about Pets for the Elderly 

This year for our spring event, we wanted to ask people to get involved remotely 

due to the current pandemic. We felt that giving back to our community was the most 

important thing since resources and everyday life were in disarray. We thought about 

the loneliness and sadness that residents in nursing homes must have felt when their 

families could not visit them. We came across Pets for the Elderly on social media 

and fell in love with their posts of adoption day. We reached out to them and agreed 

to raise money for their Foundation, explicitly in Illinois. Pets for the Elderly is located 

in many states. We felt that it was essential to focus on Illinois. They also ensured 

that 100% of our proceeds would be given back to the shelters with no overhang 

fee. This fundraiser was held over six weeks. We were able to raise $309, which was 

essentially able to help six animals find their forever home with an older person to 

provide compassion. The costs that were covered included the adoption charges, 

immunizations, and spay/neuter surgeries. If you missed out on our fundraiser, you 

could still make donations to Pets for the Elderly at this link: https://petsfortheelderly. 

org/donate/index.php 

Student Nurse Political Action Day 

This year at ANA-IL's first virtual Student Nurse Political Action Day (SNPAD), a panel 

of SNAI board members were able to speak on their roles, spring fundraiser, upcoming 

annual conference, and new graduate obstacles amidst the COVID-19 pandemic. This 

year students who were in attendance learned about the policies that are in the Senate, 

such as the Nurse Licensure Compact Bill. Illinois has been trying for many years to 

get the bill through the Senate, and for the first time in many years, the Senate finally 

passed it. Illinois is now waiting on the House of Representatives to pass the compact 

licensure before it goes to the governor for final approval. The compact licensure would 

be a huge success with Illinois and the shortage of nursing. It would allow nurses to 

utilize their licenses in multiple states that agree with the Nursing Licensure Compact. 

Having the ability to practice in other states, who accept the Nursing Compact License, 

would benefit the economy. Travel nursing is on the rise, and this allows nurses to 

practice in a multitude of areas. Overall, the appeal of working and living in Illinois 

would only increase for those who are nurses and seeking a new nursing opportunity. 

Misericordia Home is a campus based community 

in Chicago, providing care and support to 

over 600 children and adults with Intellectual 

and Developmental Disabilities through a full 

continuum of care. 

We are hiring Full-Time and Part-Time 

RNs and LPNs 

Highly Competitive Wages & Benefits! 

Inquiries and Resumes should be sent to 

careers@misericordia.com


Join the American Lung 

Association’s Online 

Community: Health 

Professionals for Clean Air 

and Climate Action 

Are you involved, or would you like to get involved in efforts to protect the health of 

the patients and communities you serve from air pollution and climate change? 

Climate change is already harming our health in many different ways – from 

worsened ozone pollution due to warmer temperatures, to more frequent and intense 

wildfires producing dangerous particle pollution. 

When it comes to rising to the challenge of addressing climate change, leadership 

from the health and medical community is essential. Nurses treating patients on the 

front lines are critical to raising awareness of the severe health burdens caused by air 

pollution and climate change – and to help build public will for solutions. 

The American Lung Association’s “Health Professionals for Clean Air and Climate 

Action” is a campaign designed for nurses, doctors, public health workers, and other 

health professionals to learn more about health impacts of air pollution and climate 

change, share their story why fighting air pollution and climate change is important, and 

take action on critical policy issues. The website also highlights physicians and health 

professionals who are speaking out for strong climate action. 

One key action nurses can take is to add their name to the American Lung 

Association’s Health Professionals Declaration on Climate Change. More than 1,500 

doctors, nurses, academic and health professionals from across the country have signed 

this declaration urging elected officials to take stronger action against climate change 

to protect public health. Health professionals can add their name here. 

Learn more and sign up to receive the free monthly Health Professionals for Clean 

Air and Climate Action newsletter on the American Lung Association’s website lung.org/ 

ClimateChangesHealth. 

For more information, please contact Diana Van Vleet, National Director of Outreach 

and Engagement, Healthy Air Campaign, American Lung Association, Diana.VanVleet@ 

lung.org. 

There is still time to earn 

up to 65.5 contact hours*! 

That breaks down to just $8 

per contact hour of quality 

education! 

The Association for Nursing Professional Development (ANPD) will hold its annual 

convention on August 3-6, 2021, which will be presented in-person and online. 

Access cutting-edge nursing professional development (NPD) education with peers 

by attending Aspire to Inclusivity, the 2021 ANPD Annual Convention and earn up to 

65.5 contact hours! This year, choose to attend in-person in Chicago, Illinois or online. 

For registration and more information, please contact the ANPD National Office at 

312.321.5135 or info@anpd.org. Hotel and Travel, and Health and Safety Information 

can be found at anpd.org 

See you there!!! 

*Contact hours are awarded for each individual session. Successful completion of a 

session requires attendance or viewing of the recorded session and completion of an 

online evaluation.


Nurses want to provide quality care 

for their patients. 

The Nurses Political Action Committee (Nurses- PAC) makes sure 

Springfield gives them the resources to do that. 

Help the Nurses-PAC, help YOU! 

So. . . . . . . if you think nurses need more visibility 

. . . . . . . . . if you think nurses united can speak more 

effectively in the political arena 

. . . . . . . . . if you think involvement in the political 

process is every citizen’s responsibility. 

Become a Nurses-PAC contributor TODAY! 

❑ 

❑ 

❑ 

❑ 

I wish to make my contribution via personal check 

(Make check payable to Nurses-PAC). 

I wish to make a monthly contribution to Nurses- 

PAC via my checking account. By signing this 

form, I authorize the charge of the specified 

amount payable to Nurses-PAC be withdrawn from 

my account on or after the 15th of each month. 

(PLEASE INCLUDE A VOIDED CHECK WITH 

FORM) 

I wish to make my monthly Nurses-PAC contribution 

via credit card. By signing this form, I authorize the 

charge of the specified contribution to Nurses-PAC 

on or after the 15th of each month. 

I wish to make my annual lump sum Nurses-PAC 

contribution via a credit or debit card. By signing 

this form, I authorize ANA-Illinois to charge the 

specified contribution to Nurses-PAC via a ONE 

TIME credit/debit card charge. 

❑ Mastercard ❑ VISA 

________________________ ____________ _________ 

Credit card number Expires CVV 

 

Signature:______________________________________ 

Date:__________________________________________ 

779-529-2012 

Printed Name:___________________________________ 

E-Mail:________________________________________ 

Address:_______________________________________ 

City, State, Zip Code:_____________________________ 

Preferred Phone Number:__________________________ 

Please mail completed form & check to: 

ANA-Illinois 

Atten: Nurses-PAC 

PO Box 636 

Manteno, Illinois 60950 

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Download the Illinois employment 

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If you have any questions, please 

contact IDPH Human Resources at 

(217) 785-2031 or DPH.HR@illinois.gov 

EOE


The 33rd Annual National Black Nurse's Day Celebration - 

Honoring the Legacy of Provident Hospital Nurses Alumni 

By Carolyn Rimmer-Owens, BSN-RN¬-C 

Public Relations Chair of the NBNDC 

"They Dared to Dream" 

"If I can help somebody, as I pass along 

If I can cheer somebody, with a word or song. 

If I can show somebody that he's traveling wrong 

Then my living shall not be in vain " 

(Alma Bazel Androzzo 1945, recorded by Grace Field in 

1948, and also recorded by Mahalia Jackson years later.) 

The 33rd Annual Black Nurses' Day Celebration took 

place February 26, 2021, as a Virtual Zoom Program. 

There were more than 200 people in attendance. The 

National Black Nurses' day committee is a coalition 

of professional nursing organizations whose work 

has centered around highlighting the contributions of 

African American nurses' role in healthcare and society. 

The organizations include Alpha Eta Chapter of Chi 

Eta Sorority, Inc; Beta Mu Chapter of Lambda Pi Alpha 

Sorority, and The Chicago Chapter of the National Black 

Nurses' Association. Each President shared the history 

of their organization and welcomed all of the evening's 

guests. 

Dr. Sandra Webb-Booker, Chair of the Black Nurses Day 

Celebration and the Mistress of the ceremony, gave the 

welcoming address and a historical overview regarding 

the Provident Nurses' Alumni. Dr. Webb told the audience 

that it started with a dream that Emma Reynolds, a 

young woman, had of becoming a professional nurse. 

"She had written letters and made applications to 

numerous schools, only to be denied admission because 

of restrictions on admitting Blacks into nursing schools." 

In 1889, Emma Reynolds and her brother, the Reverend 

Louis H. Reynolds, contacted Dr. Williams about 

incorporating a nursing school at Provident Hospital, 

where blacks could train to become nurses. She thanked 

Reverend Reynolds, Dr. Daniel Hale Williams, and God for 

transforming the dream into a reality. 

Dr. Williams opened Provident Hospital on May 4, 

1891, the only school in America where blacks could train 

to become nurses. Emma Reynolds enrolled in the first 

nursing class along with seven other young women, and 

graduated in 1893. Ms. Reynolds went on to receive her 

M.D. from the Women's Medical College of Chicago at 

Northwestern University in 1895. 

This celebration acknowledges and salutes Emma 

Reynolds because her dream was one of racial equality 

and racial inclusion, said Dr. Sandra Webb-Booker. 

She acknowledged the memorialized and the current 

Provident nurses that are still living legends. Dr. Webb 

told the audience that "we can proudly say we had 

a hospital that gave African American Nurses the 

opportunity and training to become professional nurses. " 

The keynote Speaker was Nailah S. Muttalib, 

President of Provident Women's Auxiliary of Provident 

Hospital. She acknowledged Dr. Annie Lawrence Brown's 

professional contributions, the former Dean of Provident 

Hospital School of Nursing. "Annie is lauded by many 

for her outstanding contributions, which led to the 

1:1 Nurse 

(Registered Nurse) 

Student Support Services/School Nurse needed for 

position at Enger School in Franklin Park, IL. 

Must possess a strong desire to work in an 

educational setting. Candidates will reposition 

student and work on academic activities under 

teacher direction in addition to nursing care. 

Apply online at 

https://www.d83.org/district/employment 

National League for Nursing 

accreditation of Provident 

Hospital School of Nursing. 

Her hard work was a gift to 

the nursing profession- past, 

present, and future ". 

Ms. Mattalib shared the 

rich history that the Auxiliary 

and Provident Hospital Nurses 

shared in their volunteer 

efforts working on behalf of the 

hospital and the community. 

In the year 2020, she proudly stated that the auxiliary 

celebrated its 60th anniversary. 

"Mark Twain is credited with saying, " the two most 

important days in your life are the day you are born, and 

the day you find out why." 

Her question was this; "What is your purpose in life"? 

She spoke passionately about how part of life's purpose 

should not be limited to financial remuneration but that 

we should also contribute to humanity." How can we help 

our fellow men and women"? What contributions can you 

give to make your community, your workplace a better 

place"? 

Ms. Mattalib told the audience that the nursing 

profession provides many opportunities to address those 

needs. She encouraged the nursing students to put a 

plan in place regarding their chosen specialty. According 

to her, the decisions they make will lend toward defining 

their purpose in the nursing profession. 

Her message to those new to nursing was not to forget 

their volunteer contributions to the larger community. 

She wanted them to know that even though they may feel 

it does not matter, it matters to someone. 

She cited a couple of lines from a poem written by 

Mayo Angelou. "I have learned that you should not go 

through life with a catcher's mitt on both hands; you need 

to be able to throw something back." 

She spoke about how Provident Hospital nurses 

established a history of professionalism that included 

giving back to the community. "They were expected to 

be prepared for their regular job.” assignments, and they 

were prepared; they did not wait until the last moment to 

prepare- they prepared well in advance and left time to 

volunteer outside working hours." 

There were numerous volunteer activities done 

collectively between the Nurses and Provident Hospital 

Women's Auxiliary to raise funds and collect linen for the 

hospital in what was known as "the Cotton Ball." 

Provident Hospital Nurses were a part of the Red Cross 

Provident Hospital Nurses Alumni Scholarship Awardees 

each received $ 1,000.00: Presented by Jacki Smith, RN. 

1. Jennifer Reed; pursuing a Master of Science from 

Purdue University with a GPA of 4.0 

2. Briana Daniel; pursuing a Bachelor of Science in 

nursing from Chamberlin College with a GPA of 3.0 

National Black Nurse's Day Committee 

Louise Broadnax, President of Provident Nurses 

Alumni; Valerie Hubbard President of Lambda Pi; Ethel 

L Walton President of Chicago Chapter National Black 

Nurses Associations; Dr. Sandra Webb-Booker, Chair 

of National Black Nurses Day Committee; Mr. Ronald 

Campbell, Co-Chair of National Black Nurses Day 

Committee, Adrian Priester-Coary, President of Alpha Eta 

Chapter of Chi Eta Phi Sorority, Inc; Rev. Dr. Evelyn Collier- 

Dixon, Jacki Smith, Carolyn Rimmer-Owens, and Marilynn 

Parker. 

Rev. Dr. Evelyn Collier-Dixon performed libation, which 

paid tribute to all those who have gone on before us. 

Mr. Ronald Campbell gave the closing remarks 

reminding the audience of the Provident Nurses Alumni's 

sacrifices and their great Legacy. He challenged us all to 

dream of a better life for our people. 

Louise Hoskins-Broadnax, President of the Provident 

Hospital Alumni and long-time member of The National 

Black Nurses Day Committee, passed away on February 

27, 2021, the day after the celebration. 

It is also noteworthy to mention that Marilyn Render 

Danzy, a Provident Nursing Alumni and a Nurse Cadet 

member, got her heavenly wings on March 26, 2021. 

Class of 1904 

PART-TIME ADJUNCT FACULTY | VARIES BETWEEN CAMPUSES 

Workforce Trainers provide skills-based training and experiences in a 

traditional or non-traditional classroom setting and/or lab environment. 

Bachelor’s degree required with a preference for a graduate degree in the 

social sciences. Valid certification as a Mental Health First Aid instructor. 

Apply at 

www.waubonsee.edu 

EEO: minority/female/disability/veteran 

Provident Hospital and Nursing Training School 

was founded in 1891. Located at 36th and 

Wabash in Chicago, Illinois. 

Color Guard Presentation: The audience 

sang "Lift Every Voice and Sing". MAJ Wilson 

organized the ROTC Salute.


Illinois Nursing Workforce 

Center Registered Nurse 

(RN) Survey 2020 

RNs completing license renewal were invited to participate in this survey between 

3/10/20 and 9/30/2020. The data was collected during the renewal process post 

payment of the license renewal fee. The 2020 license renewal period was extended 

from May 30 to September 30, 2020 by Executive Order during the initial period of the 

COVID-19 pandemic. A total of 41,983 RNs completed the survey for a survey response 

rate of 22%. Report available on website http://nursing.illinois.gov/ResearchData.asp 

Key Findings: 

• Employment: 92% of nurses work full-time at one job and are actively employed 

in nursing. 

• Employment setting: the majority of Illinois RNs, 52%, work in an acute care 

setting such as a hospital; 11% are employed in an ambulatory care setting. RNs 

positions vary in each setting, 

• Diversity: consistent with the increase in ethnic and racial diversity in Illinois, 

there is a slight increase in the diversity of the Illinois nurse workforce. There is 

more racial, ethnic and gender diversity of RNs under the age of 45 years in the 

Illinois workforce. 

• Age: approximately 52% are over 55 years of age; age cohorts for Illinois RNs in 

2020 are similar to those reported in 2018. 

• Education: 58% of RNs have either a bachelors, masters or doctorate as the 

highest nursing degree. 

Diversity 

• 58% of Hispanic/Latinx nurses are less than 45 years of age. 

• 45% of nurses that are male are less than 45 years of age. 

• 42% of Asian nurses are less than 45 years of age. 

• 56% of nurses that identify as Multiracial are less than 45 years of age. 

Age of the RN Workforce 

• 52% of the RN workforce is 55 years of age and older. 

• 31% are between the ages of 55-64 years. 

• 70% of nursing faculty are 55 years of age and older. 

RN Employment Settings 

• 52% of RNs practice in a hospital/acute care setting – especially nurses in the 

younger age cohorts. 

The hospital is the most common acute-care employment setting where nurses 

have different roles. 

• 11% of RNs practice in ambulatory care settings, including outpatient clinics, 

private practice, doctor offices. 

• 9% of RNs practice in a nursing home/extended care/assisted living setting. 

• 4% of RNs are school nurses. 

RN Position Role 

• 66% of RNs provide direct patient care as staff nurses working in acute and nonacute 

care settings. 

• 15% Identify as a nurse manager, administrator or patient care coordinator. 

• 3% Identify as nursing faculty. 

• In Illinois the average staff nurse salary ranges from $55,000-$85,000; the 

average administrator/manager’s salary ranges from $75,000-$185,000; the 

average nursing faculty salary ranges from $65,000-105,000. 

*APRNs and APRN-FPA’s who are also licensed as RNs were not included in the survey 

data. 

One stop – Illinois 

Department of Financial 

and Professional 

Regulation (IDFPR) home page for your 

online resources 

The IDFPR home page (https://idfpr.com/) has a direct link to the following: 

• To print your license or download an electronic copy to your phone: use the icon 

under the blue middle section of the IDFPR homepage. www.idfpr.com 

• Address update: Please note that all IDFPR correspondence are now delivered 

electronically, including renewal reminders (in lieu of the paper postcard sent 

by U. S. Mail). Licensees are strongly encouraged to visit IDFPR’s online address 

change webpage (https://www.idfpr.com/applications/LicenseReprint/) to 

provide a current email address and ensure contact information is up-to-date and 

accurate. 

• Name change: Change of name CANNOT be completed via this online process. If 

your name has changed, you must submit a written notice to the Department 

and include documentation of the name change (marriage license, court order, or 

divorce decree) For a copy of the written notice, please use this link https://www. 

idfpr.com/Forms/DPR/DPRCOAnamechange.pdf 

The State of Illinois Coronavirus Response Site: The COVID-19 Vaccine Plan, up-todate 

information on what Illinois is doing protecting the health, safety, and well-being 

of Illinoisans. It can be found at https://coronavirus.illinois.gov/s/ 

The Illinois Nurse Practice Act Rules were finalized on January 4, 2021. 

A copy is available at this link: https://www.ilga.gov/commission/jcar/ 

admincode/068/06801300sections.html 

The Illinois Nursing Workforce Center 

(http://nursing.illinois.gov/) 

Education: Post-licensure Illinois nursing 

education programs are separated between 

baccalaureate degree completion and graduate 

education opportunities. The graduate education page includes a grid of which practice 

specialty each graduate program includes. http://nursing.illinois.gov/Gradeducation.asp 

Reports: the 2020 RN survey results highlighting data collected during online license 

renewal are now available at http://nursing.illinois.gov/ResearchData.asp There are 

also supply and demand reports of Illinois nurses dating back to 2007. 

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Increasing Patient Engagement through Electronic Health 

Record Portal Adoption: 

A Nurse Care Coordination and Education Opportunity 

Susan Watkins Ph.D., RN & Lauren Wiseman MSN, RN-BC 

The American healthcare system is disjointed, difficult to navigate, and illnessfocused. 

The fragmentation between patient care services, healthcare organizations, 

and electronic health record systems has resulted in duplicative, costly, and poor-quality 

care outcomes (Frandsen et al., 2015). Patient adoption of Electronic Health Record (EHR) 

portals has been postulated as a key strategy to improve patient engagement levels 

(Centers for Medicare and Medicaid Services [CMS], 2016). Increased patient engagement 

in health management is a prerequisite of healthcare transformation initiatives to 

reduce fragmentation, improve care outcomes, and increase cost-efficient care delivery 

(Powell & Meyers, 2018). EHR portals are designed to provide patients access to their 

laboratory values, encounter documentation, medication, and appointment information. 

The portal can also allow patients to securely communicate with their healthcare team 

(ONCHIT, 2021). Healthcare providers have been incentivized and subsequently required 

to demonstrate compliance to the CMS Promoting Interoperability objectives of certified 

electronic health record technology (CEHRT), previously known as Meaningful Use (CMS, 

2016). Healthcare providers who have low patient EHR portal registration and utilization 

will not demonstrate this compliance, potentially reducing CMS payment reimbursement 

totals (ONCHIT, 2021). 

Patient adoption of EHR portals remains suboptimal and slow to expand nationwide 

(National Institutes of Health [NIH] Health Information National Trends Survey [HINTS], 

2021; Hong et al., 2020; Powell & Myers, 2018). The HINTs 2020 patient respondents 

indicated that 79.3% of their Health Care Providers (HCP) maintain their information 

in a computerized system; however, only 50% have been offered online access to their 

medical record, and only 42.3% have been encouraged by their HCP, nurse, or office 

staff to use the patient portal. Only 30.5% of the respondents had accessed their 

electronic healthcare information within the last 12 months before participation in 

the survey. Of those who did access the patient portal, the survey cites that the most 

frequent reasons are scheduling appointments, requesting medication refills, access 

laboratory results, sending secure messages to their HCP, and completing needed 

healthcare forms. Of those that accessed their electronic health information, 27.3% 

perceived the information as easy or very easy to understand (NIH, 2021). This data 

yields beneficial information for HCPs to consider for promoting EHR portal adoption to 

increase patient's engagement in their healthcare. 

EHR Portal Barriers 

Evidence supports patient's concerns with confidentiality, lack of experience with 

digital health tools, insufficient internet access, and social determinants of health as 

associated factors with patient adoption of EHR portals (Hong et al., 2020). Patients 

with complex health needs are frequently overwhelmed when they present to their 

HCP. Registering for the EHR portal may seem like another complicated task without 

education or explaining the value to their healthcare (ONCHIT, 2021). 

Powell and Myers (2018) conducted a qualitative analysis of patient and HCP 

perceptions about how the usability of EHR portals may contribute to chronic disease 

self-management support. Their results support the importance of user interface and 

education as contributing factors to sub-optimal portal adoption (Powell & Myers, 

2018). Patients indicated that if the portal's navigation to log in and access information 

is too complicated, it deterred them from engaging beyond the log-in page. The data 

supports that the portal user interface must be efficient and visually appealing. The 

patient can quickly obtain information, send messages, request refills, schedule or 

cancel appointments, and share their electronic healthcare information as needed. 

Patients indicated the portal should include a mobile interface that is easily accessible, 

intuitive, and simple to navigate for information access and input. The portal interface 

should accommodate different health literacy levels. Patients revealed they received 

insufficient education from their HCP or other care team members on portal usability 

and the benefit to their health self-management. The authors concluded that clinicians 

need to actively engage patients in portal enrollment, utilization, and the benefits of 

maximizing disease self-management support efficiency (Powell & Myers, 2018). 

EHR Portal Facilitators 

Powell and Myers (2018) reinforce that improving adoption of the patient portal 

can be achieved by mimicking other user adoption methods, such as education and 

personal assistance using the applications. Their data and conclusions are consistent 

with the ONCHIT (2021) standards that reinforce the need for clinicians to invest more 

time in educating patients and their support systems about portals. The ONCHIT (2021) 

standards recommend clinician support to include assisting patients in creating their 

user-profiles and teaching them to navigate the portal to experience the personal 

benefits it offers. These standards also encourage clinicians to engage in their personal 

EHR portals to become more familiar and proactive in providing portal education and 

its value to their patient populations for increased efficiency and care coordination. 

Patient messaging communication through the portal can improve efficiency barriers 

caused by telephonic and mail communication documentation burdens related to the 

additional time needed to transcribe phone messages, print and mail information, 

postage costs, and miscommunication issues. As healthcare clinicians, it is essential to 

invest more time proactively when patients are engaged in our services to promote 

portal adoption and increased utilization for patient-centered care (Powell & Myers, 

2018). Nurses have the opportunity to educate and promote this valuable service. 

Strategies to improve patient engagement in EHR portals may include adding patient 

portal engagement strategies into the standard office visit workflow, including access 

assistance, navigation education, and practice locating each feature (ONCHIT, 2021). 

One example is introducing the patient to the portal during an RN care coordination 

visit when care planning communication preference is discussed. If the patient prefers 

electronic communication, it would be ideal for introducing the portal and benefits 

to the patient for efficient communication, information retrieval, and accessibility to 

the practice clinicians. The patient can create their account alongside the nurse, who 

can demonstrate the functionality. The nurse can also send an introductory letter 

with the web access link information home with the patient. It is imperative to involve 

the patient's key social supporters in the EHR portal introduction and accessibility 

information, including additional proxy account availability. This will allow the patient 

to have support in using the EHR portal and empower the patient's family also to be 

engaged. It is a standard of care for nurses to educate the patient and their social 

support systems to improve self-care disease management; therefore, the same 

principles should apply when educating patients about EHR portal use and benefits for 

healthcare accessibility. It is not helpful to introduce the portal without explaining its 

value and how valuable it is to their healthcare. If it is discussed quickly and without 

meaning, it sounds like any other nonessential grocery store "rewards card" seems 

beneficial but proves to be too complicated to receive any benefit (ONCHIT, 2021). 

Consumers are flooded with marketing tactics to 'sign up" for incentives accounts, 

provide online feedback, provide email for customer promotions, and have become 

untrusting and fatigued to this type of advertising. If healthcare aims to become 

patient-centered, more time needs to be invested in introducing, educating, and 

assisting patients in navigating within their EHR portals (ONCHIT, 2021). Nurses 

can use the fundamental Knowles Adult Learning principle, first provide a logical 

explanation about the topic being discussed when teaching new information to adult 

learners. Keeping the instruction task-focused instead of memory-based and delivered 

in a format conducive to individual learning styles will guide the learner to become 

self-directed (Knowles, 1984). Using these principles with more patient-centered 

engagement techniques can help the patient become more empowered and improve 

their healthcare experience and outcomes. 

References 

Centers for Medicare and Medicaid Services. (2016). Electronic Health Record (EHR) 

Incentive Programs. https://www.cms.gov/regulations-and-guidance/legislation/ 

ehrincentiveprograms?redirect=/ehrincentiveprograms 

Frandsen, B. R., Joynt, K. E., Rebitzer, J. B., & Jha, A. K. (2015). Care fragmentation, quality, and 

costs among chronically ill patients. American Journal of Managed Care, 21(5), 355. https:// 

www.ajmc.com/journals/issue/2015/2015-vol21-n5/care-fragmentation-quality-costsamong-chronically-ill-patients?p=2 

Hong, Y. A., Jiang, S., & Liu, P. L. (2020). Use of patient portals of electronic health records 

remains low from 2014 to 2018: Results from a national survey and policy implications. 

American Journal of Health Promotion [Online], 34 (6), 677–680. https://journals.sagepub. 

com/doi/10.1177/0890117119900591 

Knowles, M. (1984). The adult learner: A neglected species (3rd Ed.). Houston, TX: Gulf Publishing. 

National Institutes of Health. (2021). Health Information National Trends Survey. https://hints. 

cancer.gov/data/download-data.aspx 

Office of the National Coordinator for Health Information Technology (2021). Health IT Playbook. 

https://www.healthit.gov/playbook/certified-health-it/ 

Powell, K., & Myers, C. (2018). Electronic patient portals: Patient and provider perceptions. 

Online Journal of Nursing Informatics (OJNI), 22(1). https://www.himss.org/resources/ 

electronic-patient-portals-patient-and-provider-perceptions


Hispanic Nurses Embrace Precision 

Medicine Through the All of Us 

Research Program to Ensure the 

Hispanic/Latinx Community is 

Represented in Biomedical Research 

Susana Gonzalez RN, MSN, MHA, CNML 

Past President, National Association of Hispanic 

Nurses – ILLINOIS Chapter 

All of Us (NAHN-Illinois) grant Co-P.I. 

Monica J. Rodriguez 

Director of Communications and Engagement 

All of Us Research Program, Precision Medicine 

Initiative, Northwestern University 

Since 2016, nurses from the 

National Association of Hispanic 

Nurses – ILLINOIS Chapter 

(NAHN) began educating their 

Hispanic/Latinx communities in 

the Chicagoland area with the All 

of Us Program grant. The nurses 

collaborated and built partnerships 

and provided a strong, trusted 

presence to help educate and 

encourage hundreds of diverse 

community members and health 

care professionals to learn and 

participate in this research 

initiative. 

The All of Us Research Program 

is a part of the Precision Medicine 

Initiative from the National 

Institutes of Health (NIH). The 

program provided NAHN with 

an opportunity to launch an 

educational campaign to spread 

awareness about this necessary research. The "one size 

fits all" model of health care does not adequately address 

the health care needs of our diverse population. Through 

the work of the All of Us Research Program, Hispanic 

nurses in the Illinois chapter, along with their Health 

Care Provider Organizations (HPO) partners, including 

the Illinois Precision Medicine Consortium and other 

Community-based organizations (CBO) partners, are 

working hard to impact change. 

Precision medicine is based on you as an individual. 

It considers your environment, lifestyle, and your family 

health history, and genetic makeup. This may help 

healthcare providers tailor healthcare to individual 

needs. Until now, little research 

of this kind has invited minority 

and under-served populations to 

participate. 

NIH's goal of reaching one 

million or more people from 

diverse backgrounds is impressive. 

With the help from nurses who 

work with patients every day and 

are the most trusted healthcare 

workforce, we can make this goal 

achievable. Join this historic effort 

and become ONE in a MILLION. 

NAHN-Illinois continues to be 

part of the All of Us is a historic 

effort to gather data from one 

million or more people living in the 

United States to ensure medical 

researchers have a data source 

representing the diversity of the 

United States. We ask that you join 

All of Us Research. 

To learn more about the All of Us Research Program, 

please go to https://allofus.nih.gov/ or contact NAHN- 

ILLINOIS Chapter nurses at https://www.nahnillinois.org/ 

Hektoen Nurses 

and Humanities 

Arts Exhibition 

Sandy Gaynor RN PhD 

Nurses’ Relaxation and Renewal Through the Arts 

COVID-19 delayed us a year, but it could not stop 

the enthusiasm for the very first Nurses' Relaxation and 

Renewal through the Arts exhibit! More than 100 nurses 

and nursing students from throughout the Midwest 

submitted visual art, print, prose, photography, poetry, 

musical performance, and crafts. A COVID-19 restricted 

"soft opening" was held April 9, 2021, at the International 

Museum of Surgical Science (IMSS) 1524 N. Lake Shore 

Drive, Chicago, to celebrate with a small group of 

masked artists, Hektoen Advisory nurses, and donors in 

attendance. Opening remarks by Mary Ann McDermott 

RN, EdD recognized the efforts of the many volunteers 

who made this art show happen, from raising sponsorship 

money, encouraging and contributing art, to physically 

arranging and hanging the exhibit. Guests toured the 

three galleries that house our exhibit, including artists' 

statements about what art-making means to them. 

Of the 150 pieces submitted to the project, 60 are on 

display at the IMSS. The entirety of the exhibit is shown 

continuously on a film loop at the museum, and the 

digital catalog can be seen on the Museum website: 

www.imss.org, as well as the Hektoen Nurses and 

Humanities website: hektoen.org/nurses-the-humanities/ 

The museum has a classroom available for those who 

may want to bring a clinical group or a management 

team to discuss the role of art in health care and their 

own clinical practice. The foundation statement of the 

Hektoen Nurses and Humanities group is "our mission 

is to expose a broad array of art forms for nurses to use 

for healing in both their patients and themselves." This 

exhibit displays representational art and art as a craft, 

art as team building, and art as creativity for personal 

rejuvenation. Special event opportunities are available 

for nursing groups with prior arrangements. Saturday, 

May 22, 2021, we will host Karen Egenes RN, EdD: 

"Nightingale on the Nile" presentation cosponsored by 

Hektoen Nurses' and Humanities and the University of 

Illinois Nurses History Project. If you would like to reserve 

a room or plan a special event, please contact Mary Ann 

McDermott at maryannmdermott@msn.com or Sandy 

Gaynor at dsgaynor@sbcglobal.net. 

Come Celebrate the extended World Health 

Organization (WHO) designated 2020/21 Year of the 

Nurse! Donations from generous sponsors have provided 

FREE ADMISSION for all nurses and nursing students. 

The exhibit will be on display every day from 10 am until 

4:30 pm until July 11, 2021 (closed Memorial Day and the 

4th of July). 

palladianmgt.com/careers


Identifying Self-Care Practices in Heart Failure Patients 

Jeana Koster BSN, RN 

Despite advances in pharmacologic and technological 

management, heart failure's chronic disabling condition 

continues to have profound effects on approximately 

6.2 million adults in the United States (Centers for 

Disease Control and Prevention [CDC], 2020). In 2018, 

over 350,000 death certificates had heart failure as 

the cause of death (CDC, 2020). Heart failure in 2012 

cost the United States over 30 billion dollars in medical 

care (CDC, 2020). Heart failure carries a risk of mortality 

compared to common cancers and has one of the highest 

rehospitalization rates of all chronic diseases (Biddle, 

Moser, Pelter, & Robinson, 2019). 

Heart failure is defined as a syndrome that results 

from structural or functional disorders of the heart 

preventing the ventricles from filling or ejecting blood 

(Knecht & Neafsey, 2017). Although there have been 

advancements in understanding pathophysiology and 

treatments for heart failure, patients are ultimately 

responsible for managing their self-care behaviors which 

can be complex. Noncompliance with a recommended 

course of treatment is the primary cause of poor healthrelated 

outcomes in heart failure patients (Biddle et al., 

2019). 

Adherence rates to treatment plans range from 35% 

to 50% (Biddle et al., 2019). Many factors affect these 

rates, such as disease acuity, self-care behavior explicit 

to illness, social and financial standing of the patient, and 

communication methods used by the provider (Biddle et 

al.). Many complex treatments for heart failure patients 

involve education and counseling to help modify lifelong 

health behaviors. Health literacy, skills, and motivation 

are all obstacles that can place a daily burden on these 

individuals. 

Chronic heart failure (CHF) is highly prevalent in 

older individuals and a significant cause of morbidity, 

mortality, hospitalizations, and disability. Checking 

weight is critical in heart failure patients in preventing 

symptom exacerbations. Although the healthcare 

industry promotes high-quality, patient-centered care for 

health failure patients, it appears heart failure patients 

continue to have high readmission rates (Biddle et al., 

2019). Effective self-care is invaluable in maintaining 

physical fitness stability and improving health outcomes 

in patients with heart failure (da Conceição, dos Santos, 

dos Santos, & da Cruz, 2015). This study aims to see 

what percent of heart failure patients practice healthy 

heart self-care behaviors, such as daily weights, limiting 

fluids, eating a low-sodium diet, taking their prescribed 

medications, and exercising regularly. 

Literature Review 

A literature review was conducted by searching the 

Open Athens online library using the following key terms: 

adherence, heart failure, quality of life, self-care, and 

health promotion. Inclusion criteria consisted of articles 

about heart failure, quality of life, and self-care, from 

peer-reviewed journals. Exclusion criteria included studies 

published before 2013 and non-English language studies. 

In this study, the term "heart failure" describes a group 

of disorders that have affected the heart's pumping 

ability; such complications generally include ischemic 

heart disease and cardiomyopathy (Norris, 2019). 

Ischemic heart disease is caused by atherosclerosis. 

As cholesterol particles build up in the arteries' walls, 

plaque forms, and blocks the blood flow to the heart. 

Cardiomyopathy is anything that causes the heart muscle 

to lose its ability to pump well. Alcohol abuse, some 

medications such as chemotherapy, viral infections, 

coronary artery disease, and hypertension are some 

causes of cardiomyopathy (Johns Hopkins Medicine, 

2021). 

Congestive heart failure impacts the sufferer's quality 

of life significantly (Ravindran, Vaishnaruby, Karthik, 

& Merciline, 2019). Ravindra et al. (2019) conducted a 

study to recognize the deficits in cognition impairment 

in the domains of attention, executive functions, working 

memory, psychomotor speed, and visuospatial ability 

in patients with congestive cardiac functions. Cognitive 

impairment was found to compromise patient decisionmaking 

capabilities leading to poor self-care outcomes 

and quality of life (Ravindran et al.). 

Self-care behavior adherence such as daily weighing 

and understanding when to seek help when symptoms 

occur is essential to optimize heart failure patients' 

outcomes and prevent exacerbations. Jaarsma, Abu- 

Saad, Dracup, and Halfens (2013) examined self-care 

behaviors of 128 hospitalized heart failure patients. 

During their hospitalization, the Self-Care Behavior Scale, 

developed for this study, was used to assess limitations in 

knowledge, judgment, and decision making. Through the 

hospital's educative support program, each patient in the 

intervention group was provided teaching and guidance 

about the different aspects of heart failure treatments. 

The intervention group also received a follow-up phone 

call one-week post-discharge. The phone call was from 

a support nurse. The nurse assessed potential problems 

and also set up home visits for the patient. During the 

home visits, the visiting nurse reinforced heart failure 

education with the patient and family. If the patient 

had any concerns between home visits, the patient was 

encouraged to call the nurse (Jaarsma et al., 2013). 

The research concluded that intensive education 

significantly enhanced self-care behaviors in heart failure 

patients one month after discharge. The comparison 

group, who received standard care only at discharge, 

also had enhanced self-care behaviors at this time. Selfcare 

behavior scores were significantly lower at both 

three and nine months, yet the intervention group was 

still practicing more self-care behaviors than the control 

group (Jaarsma et al., 2013). 

Despite the intensive education and support in this 

study, the research points out the patients' limitations 

include knowledge, judgment, decision making, and skills. 

Improving these patient limitations through supportive 

educative nursing interventions would enhance self-care 

behaviors, self-care behavior support strategies, and 

social support (Jaarsma et al., 2013). 

Older patients who have chronic conditions and 

congestive heart failure have a poor health-related 

quality of life. These patients' particular needs make selfcare 

a challenge, leaving them dependent on others for 

survival (Falk, Ekman, Anderson, Fu & Granger, 2013). The 

study's objective by Durante et al. (2019) was to find out 

from the caregiver what contributions they gave to aid 

in self-care maintenance and management in treatment 

adherence and symptoms monitoring. The researchers 

found that although the caregivers described contributing 

to the patient's heart failure self-care maintenance and 

management, some of their practices were incorrect. This 

study pointed out how clinicians should routinely assess 

and educate caregivers to ensure best practices are 

utilized, considering caregiver contributions can improve 

patient outcomes in areas of concern such as treatment 

adherence and symptom monitoring and management of 

symptoms as they occur (Durante et al.). 

Daily weighing is recommended by the American 

College of Cardiology/American Heart Association 

guidelines to manage heart failure (Donlansky et al., 

2017). A significant contributor to hospitalizations is 

the rapid increase in weight due to fluid retention or 

decompensating heart failure. Only 40% of patients 

practice weighing themselves daily, and less than 33% 

understand how to manage the information they gather 

about their weight gain (Donlansky et al.). The most 

valuable component of heart failure management is 

demonstrating the ability to adhere to a daily weight 

regimen. In the study by Donlansky et al., the aim was 

to investigate if cognitive function predicted adherence 

to daily weights and actual weight gain as an indicator to 

report. The researchers found that daily weighing was not 

influenced by cognitive function in patients with heart 

failure. Still, as cognitive function diminished, the heart 

failure patient experienced clinically significant weight 

gain (Donlansky et al.). 

In a study by Lu et al. (2016), the patient's 

baseline knowledge level was generally low. Despite 

an improvement in knowledge after educational 

interventions, the improvement was still not ideal. 

Education cannot be used as the only factor in predicting 

if a patient will be compliant or not with their weight 

monitoring (Lu et al.). 

Methods 

Design 

This research project was a mixed-method descriptive 

study using a five-question yes or no questionnaire. At 

the end of the questionnaire, participants were given two 

additional questions asking why they were practicing selfcare 

or why they were not practicing self-care. 

Sample 

The 16 participants were recruited from a heart failure 

clinic associated with a 327-bed acute care hospital 

located in rural west-central Illinois. Data were collected 

between January 4, 2021, and February 1, 2021. The 

study was approved by the Institutional Review Board 

and the participating health system's Research Review 

Committee. Eligible participants had a diagnosis of heart 

failure and were under the care of their heart failure 

cardiologist or nurse practitioner. The age range of the 

participants was 40-99. If the participant did not want 

to share their age, an "other" option was available. 

Exclusion criteria included anyone who did not have a 

heart failure diagnosis or who was cognitively impaired. 

All participants spoke English. 

Procedure 

After patients checked in to the heart failure clinic 

for their cardiologist's appointment, they were asked 

if they would like to participate in a research project by 

the principal investigator. The patients who agreed to be 

in the study were provided with a detailed explanation 

of the study protocol. The informed consent was the 

acceptance to participate by the patient. A plain white 

business envelope was provided to place the survey 

once completed to protect the participant's privacy 

and confidentiality. The principal investigator collected 

the sealed envelope and stored it in a locked cabinet in 

the phase II cardiac rehab gym. There were no patient 

identifiers. The survey was completely anonymous. 

The study risks included the possibility of the 

participants feeling psychological discomfort or stress 

related to revealing through the survey possible 

noncompliance of daily weights. The participants could 

quit the study at any time. As a benefit, participation 

in the study will contribute to a better understanding 

of how well patients understand and manage their 

congestive heart failure symptoms. 

Results 

Listed below are the questions from which the 

quantitative data was collected for this study. 

Quantitative Data 

The following Yes/No questions were on the heart 

failure survey questionnaire: 

1. I weigh myself every day 

2. I limit the amount of fluids I drink 

3. I eat a low salt diet 

4. I take my medications as prescribed 

5. I exercise regularly 

This study identified that 100% of the patient 

participating reported taking all their medications 

as prescribed. Less than half of the patients, 43.75%, 

reported exercising regularly. Of the 16 participants, 

68.75% reported weighing themselves daily and eating 

a low sodium diet. Lastly, most of the patients, 75%, 

reported limiting the amount of fluids they drink. 

Of the two participants in the 40-49 age group, yes 

was answered to all the questions except number two, 

"I limit the amount of fluid I drink." Both patients in this 

age group answered no to this question. There were no 

participants in this study who identified themselves in the 

50-59 age range. Three participants reported being in the 

60-69 age group. Of the three, only one person identified 

as not practicing daily weights. All patients in this age 

group answered yes to practicing the remaining self-care 

practices. The 70-79 age group was more diverse in their 

self-care behaviors. Of the six patients in this group, four 

answered yes to weighing daily and limiting fluids. Less 

than half answered yes to eating a low salt diet, and 100% 

answered yes to taking medications as prescribed. Half of 

this group answered yes to exercising regularly. Answers 

were also varied in the 80-89 age group. Three out of four 

answered yes to weighing daily, with 100% responding 

yes to limiting fluids and taking medications as 

prescribed. One out of three answered yes to exercising 

regularly. One patient identified as "other" in this study 

replied yes to practicing all self-care practices listed on 

the heart failure questionnaire. 

Qualitative Data 

Two questions, numbers six and seven, were offered 

for patients to answer at the end of the heart failure 

questionnaire. Question six asked why the patient was 

practicing self-care activities, and question seven asked 

why the patient was not practicing self-care activities. 

A total of 14 excerpts were coded from the analysis of 

questions 6 and 7 following an initial descriptive coding 

cycle method (Miles, Huberman, & Saldana, 2014; 

Saldana, 2009). First Cycle coding allows for assigning 

codes to data chunks. Using descriptive coding, data were 

labeled or coded by a word or short phrase. This helped 

identify the topic and laid the groundwork for Second 

Cycle coding, resulting in 14 codes and seven themes 

(Miles et al., 2014). See Table 1. 

Table 1 Selected codes and themes 

Codes 

Question Six 

Good for me 

Heart health 

To stay alive 

To stay healthy 

To get healthier 

Themes 

Wellness 

Motivation


I was told to 

Doctor orders 

Keep chest clear 

Keep edema under control 

Question Seven 

Lazy 

Inability to make meals 

Trying to cut down salt 

Low salt not always available 

Bad weather 

Prevention 

Self-blame 

Dependency 

Motivation 

Inconvenience 

A total of 16 participants were allowed to elaborate 

on why they were practicing self-care (Question 6) or 

why they were not practicing self-care (Question 7) to 

obtain qualitative data. Of the 16 participants, 68.75% 

answered question six and 25% answered question seven. 

Table 2 lists the age groups of the participants and how 

they answered question number six. For this question, 

there were no answers from the age group 60-69. Table 

3 lists the age groups and how they answered question 

number seven. Age groups, 40-49 did not respond to this 

question. 

Table 3 Question Six: Why do you practice self-care? 

40-49 Age Group 70-79 Age Group 80-89 Age Group 

To get healthier It is good for me Doctor 

recommended it 

Better heart 

health 

Doctor's orders 

Doctor said so 

Heart 

Because I want 

to stay alive 

Doctor told me 

to 

I was told to 

Keep edema 

under 

To keep chest 

clear 

To stay well 

Table 3 Question Seven: Why are you not practicing 

self-care? 

40-49 Age Group 70-79 Age Group 80-89 Age Group 

Lazy 

I cannot make 

my own meals 

Dependent on 

assisted living 

Low salt is not 

always available 

I am trying to cut 

down on salty 

snacks 

I try every other 

day 

Sometimes I 

don’t get it done 

Don’t get out 

to walk in bad 

weather 

Too cold in the 

winter 

Discussion 

The burden of heart failure is alarming in terms of 

increasing incidence, frequent hospital readmissions, high 

mortality, and substantial medical costs. Adherence to 

self-care practices is vital to improve health and prevent 

life-threatening exacerbations. Although there is evidence 

of self-care practices' effectiveness, such as daily weights, 

literature shows only 10.3% of heart failure patients can 

provide self-care management due to impaired cognition, 

depression, lower education level, and poor family 

functioning (Lu et al., 2016). 

This study supports the evidence that heart failure 

patients do adhere to self-care practices such as daily 

weights. Further investigation is needed on how heart 

failure affects a person's cognition and the formation 

of their self-management beliefs and behaviors. The 

evidence does support the need for ongoing education 

and assessment for caregivers and heart failure patients 

as the heart failure patients' cognition declines. 

Motivation, dependency, prevention, self-blame, 

inconvenience, and wellness were the main themes that 

evolved from the data collected for this research project. 

Dependence, compliance, and cognitive function were 

the most apparent themes found in the literature review. 

Limitations 

This study had several limitations. First, the data 

collection period was cut short due to a prolonged wait 

time for the approval to conduct the study. Initially, the 

data collection would be on Wednesdays and Fridays. 

Later, it was determined that heart failure patients were 

only being seen on Wednesdays. Second, the principal 

investigator had to read the survey questions to several 

heart failure patients because they could not read due to 

poor eyesight. Therefore, the principal investigator may 

have influenced their answers. Other limitations included 

a small sample size at one location, so the results could 

not be generalized to other heart failure patients. 

Implications for Future Research 

All the data gathered in this study was self-reported, 

as were many studies found in the literature review. Selfreported 

data may be affected by measurement errors 

due to the patient's health literacy. Future studies, using 

objective data entirely or studies that combine selfreported 

data and objective data, would increase the 

study's validity. Furthermore, incorporating multiple 

heart failure clinical sites across the region would provide 

more data for subsequent analysis. A larger sample size 

would allow the researcher to optimize data collection to 

determine their study's validity better. 

Conclusion 

Practicing self-care behaviors is essential for 

preventing disease progression in heart failure patients. 

This study demonstrates that heart failure patients 

perceive themselves as adhering to healthy self-care 

practices. Statistics prove that many heart failure 

patients and caregivers do not fully understand selfcare 

behaviors for mitigating heart failure exacerbations 

leading to hospital admission. Further investigation is 

needed to determine if the study's patients had recent 

hospital admissions because of fluid volume overload. 

More information would be required to decide whether 

the patient perceived themselves as following self-care 

behaviors as they were instructed. Health literacy and 

support systems are vital to the success in the prevention 

and management of heart failure. 

REFERENCES AVAILABLE UPON REQUEST

The Nursing Voice - June 2021

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