The Vermont Nurse Connection - May 2022

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Page 4 • Vermont Nurse Connection May, June, July 2022 Letter from the New Executive Director Amy Martone, MBA, BSN, RN, NPD-BC I am honored to share the news with you that I have assumed the role as Interim Executive Director for the ANA- Vermont. I want to recognize Dr. Meredith Roberts, PhD, RN, for the incredible contribution that she has made to the ANA-Vermont over the last five years in her role as the Executive Director! For anyone that has ever had the privilege to work with Meredith, her commitment to the nurses of Vermont and passion for the advancement of the nursing profession in our state was wildly evident. She has left me with some very big shoes to fill – and I have promised her to do my best. Please join me in thanking Meredith for all she has accomplished and in wishing her the best in retirement! Amy Martone As we kick off Nurses Month in May 2022, there are so many things to celebrate – and much work for us to do! This is an important time for nurses as we reflect back on the incredible ways that we led colleagues, teams, and organizations through the COVID-19 pandemic using our knowledge and skills to provide best outcomes for patients and to keep our communities as safe as possible. This is just one of the many reasons that nurses continue to be voted the most trusted profession, for over 20 consecutive years in a row. Now, as we begin to enter into the pandemic recovery period, and as we are faced with a healthcare workforce crisis unlike we have ever seen, we must come together as nurses and continue to lead. The national ANA represents the over four million nurses nationwide, and our ANA Vermont represents the 15,000 nurses that are licensed in our state. When you join ANA- Vermont, it also includes membership to the national ANA. That is two memberships for only $15 per month! I encourage you to join us today by completing the form in this mailing, going to anavermont.nursingnetwork.com, or emailing memberinfo@ana.org. As a member, it is important to check your emails and follow us on social media to stay up to date on communications. You can find us on Facebook at https://www.facebook. com/VTNurses. At this time, I am working closely with the ANA-Vermont Board of Directors to finalize the 2022-2023 Strategic Plan. We are excited to complete it and share it with you! Our primary focus over the coming year will be to connect with our current members, re-engage with past members, and recruit new members. We will also explore the opportunity to form a Coalition with our state partners in nursing, such as the Vermont Nurse Practitioners Association. This priority is based on the understanding that we are stronger together and can share resources to advocate for change with the issues facing nursing. This includes workplace violence, compensation and value, health equity, and workforce shortage solutions. These partnerships will also ensure that we are using our collective nursing talent to provide high-quality continuing education and ongoing professional development opportunities to our members. Another priority will be to increase the visibility of nursing in Vermont and promote the ANA-Vermont as our professional organization. We have started by updating the ANA-Vermont website to best represent the nurses of Vermont and provide more information about the organization. This is still a work in progress and so I ask you to check back and visit the website often. You should also look for our Nurses of Vermont social media campaign that is rolling out this month. We will use this campaign to highlight some of the incredible nurses that are practicing across our state and the broad continuum of specialties that our nurses represent. As Interim Executive Director, I will bring over 15 years of diverse healthcare experience as an accomplished nurse leader to the ANA-Vermont. I look forward to working alongside the talented, diverse, and dedicated ANA Vermont Board of Directors and our remarkable members to achieve the strategic priorities of the organization and our Vermont nurses. I look forward to Nurses Month 2022 with great optimism and ask you to join us in accomplishing our vision to “Inspire Vermont nurses to advance the nursing profession and the health of Vermonters." If you have any questions about ANA- Vermont, or are interested in joining the Board of Directors or a committee, please feel free to contact me at vtnurse@ana-vermont.org.
May, June, July 2022 Vermont Nurse Connection • Page 5 Skin Care in COVID Lauren Beck, BSN, RN, WCC, SANE Southwestern Vermont Medical Center The COVID-19 pandemic challenged healthcare workers in ways that many of us had never before experienced. Ever-changing policies, protocols, and keeping up with the influx of new and fluctuating information seemed like a never-ending battle. Symptoms were constantly Lauren Beck evolving, and what originally seemed like a predominantly pulmonary-dominating virus exploded into what we now know to be a systemic illness that can impact multiple organ systems. My curiosity in this topic began when I transitioned into the wound care role at my facility this past winter during yet another one of our COVID-19 surges. As I hit the ground running during a high acuity, high census, and high stress time, I began to notice that I was seeing skin manifestations that I couldn’t make sense of. Consult after consult showed low-risk COVID-19 patients with pressure-like injuries, but with all the proper interventions and measures in place to prevent them. Lesions, blisters, rashes, and discolored toes appeared seemingly overnight with no explanation and furthered my interest in the matter. Disease severity seemed irrelevant, and nearly asymptomatic individuals and critically ill patients alike were demonstrating abnormal skin findings. Additional review of our organization showed that out of the pressurelike injuries we were seeing within our facility, the majority we were seeing in our COVID-19 patients. Risk assessment scales didn’t seem to accurately predict who was at risk anymore. What was going here? COVID-19 presents differently in each patient, and while symptoms have ranged from mild to lifethreatening, some effects can be more subtle and difficult to recognize. The last two years have provided an opportunity to research these impacts, and latest evidence has identified a lesser known but increasingly recognized challenge facing patients diagnosed with COVID-19- and it lies within our skin. Studies have shown that as many as 20% of patients diagnosed with COVID-19 have had the presentation of dermatologic-related complications and manifestations including (but not limited to) urticaria, chilblain-like eruptions more recently dubbed “COVID Toes” (Burke, McGinnis, & Petronic-Rosiv, 2021), vasculitis, and varying types of rashes and lesions without any prior history or substantial risk factors (Gottlieb & Long, 2020). Both patients with asymptomatic cases, as well as those with severe illness, have been shown to be impacted by dermatological symptoms (Sadeghzadeh-Bazargan, Rezai, Nobari, Mozafarpoor, & Goodarzi, 2021). Research suggests that pressure-like injuries in patients infected with COVID-19 may not solely be pressure related, but a combination of effects that puts patients at higher risk of skin breakdown due to infection (Mawhirt, Frankel, & Diaz, 2020). These findings have complicated the staging and wound care process for direct care providers internationally in both implementing appropriate interventions based on standardized risk assessment scales, as well as correctly identifying skin breakdown and its causes. While the exact pathophysiology for what causes these complications is still being studied, early research indicates a multitude of factors that can compromise the integumentary system during COVID-19 infection, including complement-mediated microvascular injury, coagulation pathway derangement, cytokine release, and cutaneous ischemia (Gottlieb & Long, 2020). Determining the presentation of unusual or unexplained dermatologic symptoms in patients may be helpful in both identifying the presence of COVID-19 as well as assisting providers in guiding treatment plans for patients (Sadeghzadeh-Bazargan et al. 2021). Additionally, accurately identifying early cutaneous signs and symptoms may be a predictor of deterioration in acutely ill patients, and further research is ongoing in this respect (Mawhirt et al., 2020). As nurses it is our responsibility to continue to monitor and apply the latest evidence-based research as more is learned about the impacts of COVID-19 in relation to skin. A critical element of providing comprehensive care to COVID-19 patients is recognizing that typical risk assessment scales may not accurately predict risk of skin breakdown, and higher interventions may need to be implemented in this population. The National Pressure Injury Advisory Panel has recognized and acknowledged the unique challenges identified within COVID-19 patients and released a position statement stating that the unprecedented findings associated with skin may lead to unavoidable pressure injuries, with further information anticipated to be released with continuing evaluation of research (Black et al., 2020). So what does this mean for healthcare providers? As nurses we commit ourselves to life-long education: we assess, we learn, and we adapt. The COVID-19 pandemic has demonstrated the unyielding resilience and resourcefulness of healthcare workers worldwide. Knowing the latest evidence-based research and implementing it within our practice is not only our job, but our responsibility to our patients and our communities. It is imperative that we strive to provide the best, most upto-date care to improve patient outcomes during these extraordinary times. References Black, J., Cuddigan, J., Capasso, V., Cox, J., Delmore, B., Munoz, N., & Pittman, J. on behalf of the National Pressure Injury Advisory Panel (2020). Unavoidable Pressure Injury during COVID-19 Crisis: A Position Paper from the National Pressure Injury Advisory Panel. https://www.npiap.com Burke, K., McGinnis, K., Petronic-Rosiv, V. (2021). Covid toes: Pernio-like lesions. Clinics in Dermatology, 39(3), 380-383. https://doi.org/10.1016/j.clindermatol.2021.01.016 Gottlieb, M & Long, B. (2020). Dermatologic Manifestations & Complications of COVID-19. American Journal of Emergency Medicine, 38(9), 1715-1721. https://doi. org/10.1016/j.ajem.2020.06.011 Mawhirt, S., Frankel, D., Diaz, A. (2020). Cutaneous Manifestations in Adults Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Healthcare Workers. Currently Allergy and Asthma Reports, 20(12), 75. https://doi.org/10.1007/s11882-020- 00974-w Sadeghzadeh-Bazargan, A., Rezai, M., Nobari, N., Mozafarpoor, S., Goodarzi, A. (2021). Skin manifestations as potential symptoms of diffuse vascular injury in critical COVID-19 patients. Journal of Cutaneous Pathology, 48(9), 1266-1276. https://doi.org/10.1111/cup.14059 TRIAGE NURSE White River Family Practice is looking for an experienced RN to fill the role of our Triage Nurse. We are a small, cohesive practice of 8 providers and 15 clinical and administrative staff who are dedicated to our patients and to each other. Your role will be integral to our office and we will support you as you adjust to your new position. Best of all, you will have the chance to get to know many of our wonderful patients! Candidates should be prepared to work in this role 4 days weekly with an occasional 5th day to cover vacations. Competitive salary and benefits. Please submit a cover letter with resume to lneedham@wrfpvt.com
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The Vermont Nurse Connection - May 2022

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