The North Dakota Nurse - July 2022

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Page 8 The North Dakota Nurse July, August, September 2022 August is National Breastfeeding Month Richelle Johnson, MSN, RN, NDNA VP of Finance Nursing Needs a Mental Health Makeover Easy access to resources and erasing stigma are key. Since 2011, the United States Breastfeeding Committee (USBC) has claimed August as National Breastfeeding Month. Breastfeeding, more commonly known as nursing, is a means to feed a child human breast milk. It has been proven to be an excellent prevention strategy that ultimately builds a foundation for health and wellness in infants and parents (USBC, n.d.). The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months of life and then continue to be breastfed up until twelve months or older while solid foods are being introduced. Current research still supports the many health benefits for both mother and baby as well as potential environmental and economic benefits for communities. According to the Centers for Disease Control and Prevention ([CDC], 2021), these benefits include but are not limited to: 1) Breast milk is the best source of nutrition for most babies. 2) Breastfeeding can help protect babies against some short- and long-term illnesses and diseases. 3) Breast milk shares antibodies from the mother with her baby that formula cannot provide. 4) Mothers can breastfeed anytime and anywhere. 5) Breastfeeding can reduce the mother’s risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure. As natural as the breastfeeding process may seem, problems can occasionally arise. When problems arise, they may interfere with the mother's milk production and the baby's ability to get the nutrients they need. For this reason, it is imperative that mothers seek help if they have trouble with breastfeeding or observe a change in their baby's behavior such as short (or long) nursing sessions, baby seeming hungry after feedings, baby not gaining weight, breast engorgement, etc. Lastly, breastfeeding may not be possible for all women and for many, the decision is solely based on their comfort level, lifestyle, and even certain medical situations. For mothers who decide not to or cannot breastfeed, infant formula is a healthy alternative as it does provide babies with the proper nutrients to thrive and grow. The decision to breastfeed is a very personal one. Encourage mothers to weigh the pros and cons of breastfeeding as well as talk to their doctor and/or a lactation consultant. These health care providers can give mothers more information about their options and help them make the best decision for their family. References Centers for Disease Control and Prevention. (2021). Breastfeeding benefits both baby and mom. Retrieved May 9, 2022 from https://www. cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index. html#:~:text=Breastfeeding%20can%20help%20protect%20babies,ear%20 infections%20and%20stomach%20bugs. U.S. Breastfeeding Committee (USBC). (n.d.). State and territory breastfeeding reports. Retrieved May 9, 2022 from http://www.usbreastfeeding.org/p/cm/ ld/fid=257 Belcourt, ND Multiple Nursing Opportunities in OB, Clinic, Med/Surg & ER The Quentin N. Burdick Memorial Health Care Facility is an Indian Health Service unit located on the Turtle Mountain Reservation in Belcourt, ND. The Facility provides comprehensive primary care and preventive care and hosts a medical clinic, dental clinic, optometry clinic, pharmacy, radiology services, mental health services, outpatient surgical services, labor and delivery services, emergency room and inpatient/ acute care unit. The site qualifies as a student loan payback site and offers benefits including annual and sick leave, health/dental/vision benefits, life insurance, and retirement. For more information, please visit www.usajobs.gov or call Lynelle Hunt, DON (701) 477-6111 ext. 8260. All RNs encouraged to apply or call for more information. Holly Carpenter, BSN, RN; Dawn Webb, MSN, RN, PMH-BC; and Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC For too long, nurses have struggled quietly with mental health issues, fearing stigma or negative consequences associated with getting help. Even before the COVID-19 pandemic, nurses had higher rates of depression and suicide than the general population. Suffering in silence can’t be a part of our profession. Survey results from Healthy Nurse, Healthy Nation (HNHN), the American Nurses Association nurse wellness community, show that nurses’ mental well-being has worsened during the pandemic. The Healthy Nurse® Survey found that, during the pandemic, respondents had statistically higher instances of anxiety and depression disorders than before. In addition, 34% of nurses reported feeling sad, down, or depressed for two weeks or more over the past 30 days during the pandemic, compared to 29% pre-pandemic. Mood and anxiety disorders commonly coexist with substance use disorders (SUD). Increases in substance use and drug overdoses in the United States during the pandemic, along with higher rates of depression and suicide among nurses, make it clear that nurses are at high risk for SUD and mental health conditions due to the stressors of simply being a nurse. Nurses have worked on self-care and resilience building interventions. Now, we need healthcare employers, nursing associations, schools of nursing, legislators, and other interested parties to invest in nurses’ mental health. Recently, HNHN expanded its focus by adding mental health to its existing domains of rest, physical activity, nutrition, quality of life, and safety. HNHN’s Advisory Committee endorsed this change and formed a subcommittee to address nurses’ mental health, specifically confronting mental health stigma, identifying nursing leadership and employer responsibilities and planning strategies for improved mental health. For more information, visit www.hnhn.org. Many mental health and well-being resources support nurses. Several—such as HNHN—are free of charge and readily accessible: • 2022 Healthcare Workforce Rescue Package. A one-pager from the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience. (bit.ly/35FyQKG) • Nurse Suicide Prevention/Resilience. ANA site dedicated to promoting mental health and suicide prevention. (bit.ly/3jeLcg1) • Substance Use Disorder in Nursing. Substance use disorder resources from the National Council of State Boards of Nursing. (bit. ly/3NHQPS5) • The Well-Being Initiative. Launched by the American Nurses Foundation, this site offers free tools and apps to support nurses’ mental health and well-being. (bit.ly/3jcBb2T) Many employers offer support through employee assistance programs, peer support, mental health screenings and services, healthcare insurance, and wellness officers. Helpful resources are accessible, anonymous, and affordable or free. Every organization must instill an “It’s ok not to be ok” culture. The Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667) will supply millions in funding to train healthcare professionals about suicide prevention, burnout, and SUD. An awareness campaign for healthcare professionals will promote assistance with mental health and substance use issues and resiliency. Nurses need to be the CEOs of their own mental health. Please don’t wait until you are in crisis. All nurses should advocate and educate for the underserved—in this case, ourselves. Holly Carpenter is a senior policy advisor at ANA. Dawn Webb is director of nursing practice at Texas Nurses Association. Katie Boston- Leary is director of nursing programs at ANA. JOIN US AT UMC Unity Medical Center, located in Grafton is recruiting for Med Surg/ER Nurses to work in our new addition that consists of 11 new patient rooms and a new ED department. 12 hour shifts rotating days and nights every 3rd weekend and rotating Holidays. Please contact Jenny, CNO at 701-379-3002 or apply online at www.unitymedcenter.com.
July, August, September 2022 The North Dakota Nurse Page 9 Violence in the Healthcare Industry: What is Being Done to Protect Healthcare Workers? Penny Briese, PhD (c), RN, North Dakota Nurses Association, Director of Advocacy On Wednesday, June 1, 2022, a man walked into The Warren Clinic, a specialty care office within Saint Francis Hospital in Tulsa, Oklahoma, with a gun he had purchased that very day and opened fire. Michael Louis murdered four people; a receptionist, a patient, and two doctors including Dr. Preston Phillips, an orthopedic surgeon who had recently operated on Mr. Louis’ back. According to sources, Mr. Louis was dissatisfied with the level of pain following his surgery. He had sought medical help several times in the days leading up to the shooting and blamed Dr. Phillips for not receiving adequate pain relief. Mr. Louis took his own life at the scene; a letter found on his body confirmed his intent and motive (Hanna & Watts, 2022, June 3). Workplace violence is not uncommon, however it is five times more prevalent in the healthcare industry. “According to the American College of Emergency Physicians and the Emergency Nurses Association, almost half of emergency physicians and 70% of emergency nurses reported being physically assaulted on the job” (Skog, 2022, para. 1). In a recent 2022 survey of 2,500 hospital nurses, 48% reported having experienced violence in the workplace, a 31% increase since just last year. According to testimony given on Capitol Hill by Todd Haines, a member of the Emergency Nurses Association, nurses have been “bitten, punched, knocked unconscious and strangled with stethoscopes, all while just trying to provide basic care to patients” (Mensik, 2022, May 5, para. 1). So what is being done? Legal protections for healthcare workers are already in place in many states. According to the Emergency Nurses Association, 31 out of 50 states have made it a felony to assault a healthcare worker and they are lobbying for it to become a felony nationwide. Wisconsin state law already makes battery against a healthcare worker a felony, however in March 2022 they passed a law making it a felony to even threaten a healthcare worker. In May of 2020, Oklahoma Governor Kevin Stitt signed The Medical Care Provider Protection Act (Senate Bill 1290) increasing penalties from one year to a mandatory two to five year sentence and requiring that assaults on healthcare workers be reported to the state health department. (Rowland, 2020, May 20). At the federal level, The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195) was introduced in February, 2021 with strong bipartisan support. The bill was passed in the US House of Representatives in April of 2021 and sponsors of the bill are pushing to have it brought to the forefront in the US Senate. This bill would require that healthcare facilities receiving Medicare funds “develop and implement a comprehensive workplace violence prevention plan and carry out other activities or requirements…to protect health care workers, social service workers, and other personnel from workplace violence” (Congress.gov, 2022, p. 10). The bill has met with some opposition with regard to cost to healthcare facilities and questions as to the actual outcome of such programs. And here in North Dakota? In 2015, legislation was introduced in North Dakota that would make it a felony to assault a healthcare worker, including by putting excrement or bodily fluids on them. It did not pass. In 2017, legislators in North Dakota tried again, introducing Senate Bill 2216 which called for an amendment and reenactment of sections 12.1-17-01.1 (Assault), and subsection 1 of section 12.1-17-11 (Contact by bodily fluids or excrement) of the North Dakota Century Code. This Bill discussed assault of health care facility providers, specifically via contact by bodily fluids or excrement. Peace officers and correctional institution officers working at the North Dakota state hospital were already covered under this section and it was, and remains, a Class C felony to assault them while they are acting in the course and scope of their employment. Senate Bill 2216 called for intentionally making contact of bodily fluids (blood, emesis, excrement, mucus, saliva, semen, vaginal fluid or urine) with a healthcare provider a Class A misdemeanor “…if the victim is employed or contracted by a health care facility, which the actor knows to be a fact, and the assault occurs on the health care facility property” (Dever et al., 2017). This time, the bill was successfully passed. In 2021, S.B. 2268 was introduced to once again try to amend and reenact section 12.1 17 01 of the North Dakota Century Code, making it a felony to assault a healthcare Face Shields and Face Coverings worker in North Dakota (Roers et al., 2021). Despite strong support from the North Dakota Medical Association, this bill failed to pass. But healthcare provider advocates and supporters are not giving up just yet. The 68th legislative session is due to begin in January, 2023 so don’t be surprised if this issue is once again brought forward. As a healthcare provider, you can be a part of the action by lending your voice. Like so many doctors and nurses in other states across the nation, healthcare workers in North Dakota deserve to be protected. References Congress.gov. (2022). H. report 117-14-workplace violence prevention for health care and social services workers act. Retrieved from https:// www.congress.gov/congressional-report/117thcongress/house-report/14/1?overview=closed Dever, D., Burkhard, R., Nelson, C., Karls, J., Nelson, M., & Westlind, G. (2017). Senate bill no. 2216. Retrieved from https://trackbill.com/bill/northdakota-senate-bill-2216-an-act-to-create-andenact-a-new-subsection-to-section-12-1-17-11-ofthe-north-dakota-century-code-relating-to-thedefinition-of-a-health-care-facility-to-amendand-reenact-subsection-1-of-section-12-1-17-11- of-the-north-dakota-century-code-relating-tocontact-by-bodily-fluids-or-excrement-and-toprovide-a-penalty/1339077/ Hanna, J. & Watts, A. (2022, June 2). Gunman who killed at Oklahoma medical building had been a patient of a victim, police chief says. CNN. Retrieved from https://amp.cnn. com/2022/06/02/us/tulsa-hospital-shotingthursday/index.html Mensik, H. (2022, May 5). ER providers push for federal protection against rising health worker violence. HEALTHCAREDIVE. Retrieved from https:// www.healthcaredive.com/news/workplaceviolence-prevention-healthcare-workers-billpandemic/623244/ Roers, K., Dever, D., Heinert, J., Nelson, M., & Westlind, G. (2021). Senate bill no. 2268. Retrieved from https://www.ndlegis.gov/assembly/67-2021/ documents/21-0918-02000.pdf Rowland, R. (2020, May 20). Okla. Governor signs law to protect EMS, hospital personnel from violence. EMS1 by Lexipol. Retrieved from https://www. ems1.com/ems-assaults/articles/okla-governorsigns-law-to-protect-EMS-hospital-personnelfrom-violence-6OB6YzG6rspiLISv/ Skog, A. (2022, March 3). Other views: HB 4142 could reduce assaults on health care workers. Retrieved from https://www.lagrandeobserver. com/opinion/columns/other-views-hb-4142- could-reduce-assaults-on-health-care-workers/ article_2205d5ea-98e1-11ec-959c-3bb7762060c7. html Appraised by: Natalie Hadrava, Rachel Hill Clinical Question: Are face shields more effective than face coverings and between the two options, which face protection had a higher success rate in preventing the spread of Covid-19? Articles References: Coclite, D., Napoletano, A., Gianola, S., Del Monaco, A., D'Angelo, D., Fauci, A., & Iannone, P. (2021). Face mask use in the community for reducing the spread of COVID-19: a systematic review. Frontiers in medicine, 1060. Lindsley, W. G., Blachere, F. M., Law, B. F., Beezhold, D. H., & Noti, J. D. (2021). Efficacy of face masks, neck gaiters, and face shields for reducing the expulsion of simulated cough-generated aerosols. Aerosol Science and Technology, 55(4), 449-457. Pooja, A., Kabir, S., & Surabhi, S. (2022, December). Real-world assessment, relevance, and problems in the use of personal protective equipment in a clinical dermatology practice in a COVID referral tertiary hospital. EBSCOhost. Retrieved April 13, 2022. Wendling, J.-M., Fabacher, T., Pébaÿ, P.-P., Cosperec, I., & Rochoy, M. (2021, February 17). Experimental efficacy of the face shield and the mask against emitted and potentially received particles. International journal of environmental research and public health. Retrieved April 12, 2022. Synthesis of Evidence: In the review of literature, we used keywords such as “face mask,” “face covering,” “face shields,” and “Covid-19 prevention” in our search engines (google scholar, Mayville State University online library databases). To narrow the search even further, we looked at articles and studies that have only been conducted in the last five years, as well as only looking at scientific articles and studies from reputable sources. We, as partners, chose the best articles that we both found and used them to create an answer to our question. Bottom Line: The evidence found that face coverings are better for the prevention of the spread of Covid-19. In all four articles, face coverings were found to be more effective than face shields. The best face covering to prevent the spread of Covid-19 is the N95 respirator mask, and face shields were ineffective when used by themselves to prevent the spread of Covid-19. The studies that were used had different ways of showing how face coverings were effective, different experiments to show the efficacy of face coverings vs. face shields, and flaws of wearing a face covering and a face shield. Implications for Nursing: Knowing this information, all healthcare facilities should be using face coverings rather than face shields within their facilities. If some facilities prefer to do both, that will also work because the face shield could stop a few particles before they reach the face covering. However, face shields should not be used on their own because of their ineffectiveness. The N95 respirator mask would be the most ideal face covering to have due to the mask’s ability to stop the greatest number of particles. Bedside Reporting continued from page 7 Implications for Nursing Practice: Implications for nursing practice include to use bedside report rather than traditional report to help reduce the number of errors on a shift (Small & Fitzpatrick, 2017). Using the SBAR method will help make sure all information is provided about the patient (Becker et. al, 2021). During bedside report the nurses can observe the lines, drips, and wounds in the patient room and note if any changes. The research including the patient in bedside report is an effective nursing intervention that provides better shift outcomes for patients, allowing the patient to be a part of their care and ask questions if needed.
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The North Dakota Nurse - July 2022

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