Kids Basketball and Nursing

Today I was literally moved to tears watching a bunch of 7 to 9-year-old kids play basketball.  I was there to support my youngest daughter in her cheerleading endeavors, another post entirely, and was unavoidably drawn into the excitement on the court.  The two teams of kids I observed have played each other several times, with the point of the league being to expose kids to good sportsman-like conduct, rules of the game, teamwork, and expose them to exercise.

Today, something magical happened.  One team had obviously been advised by their coach prior to the game that one of the players had not yet ‘scored’ during any of the previous 5 games.  His kids were listening, more than listening, they made it their mission to help this player succeed at scoring.  Today was game 6 and close to the end of these little ones’ basketball season.   Every single time this team took the ball to their end of the court to score, every player, no matter their age, gender, or talent, sought out the player who had not scored and passed him the ball, encouraging him to ‘shoot it’.  Time after time I watched these kids, who played with utter joy and no trace of resentment, work to provide this child with the opportunity to shoot the ball. Every time they went down the court their eyes sought him out. They moved to pass him the ball and then they verbally cheered him on.  Sometimes he did not catch their pass and the ball moved out-of-bounds to the other team, sometimes he passed it off, and many times he shot, improving each time, but never making the score.  None of the children showed any sign of resentment, tantrum, or bitterness.  They continued to play with happiness, smiling and laughing as they bounded up and down the court.

Now, it is at this point many people roll their eyes and would comment that these kids are not really learning the true meaning of sports, competition, being the best, etc., and that this team was creating false sense of relevancy for this player.  I beg to differ.  What I observed was a miracle of human kindness, humanity, encouragement, learning, team work, and joy.  The coach never reminded or encouraged any of his players to take on the cause of this one child.  The children took this on themselves.  They worked hard to provide opportunity to learn, not unfair advantage.

Observing all of this I wondered… how often do we miss this chance within the nursing profession?  More importantly, how many times have I exhibited this same encouragement, teamwork, and opportunity with sheer joy, pleasure, and happiness?  The world in general, and nursing specifically, could stand to watch a few kids basketball games like this.  I am better, and thankful, for having observed this true miracle.  May we as nurses play with sheer joy and advocate for our members, their opportunities to learn, and for true teamwork.

• Research is sometimes far removed from bedside nurses
• Research is COOL!
• Research is about PATIENTS and not fame/fortune of researcher
• Research is critical to practice and there are big gaps that nurses need to fill
• Bedside nurses may be the most crucial link in research ideas, translation, and practice.

My Thoughts

Creating nurse scientists has been somewhat difficult for the profession of nursing.  I can only guess as to why this has been, but unlike other fields of biology, chemistry, and the like, where employment is often found in seeking answers, solving mysteries, and in effect being ‘scientists’, nursing has traditionally and rightfully been a ‘hands on’ profession of action for patients to produce desired outcomes. (Forgive the brevity of the definition of nursing, it is quite complex, but one gets the idea.)

Often nurses are too busy keeping patients alive, preventing complications, and working over time to consider solving the larger problems of their patients or their profession.  However, nothing could be more critical.  I believe that the hard-working, nose to the grindstone, mentality has kept nurses from exploring the science of their practice and answering important patient/practice questions.  Likewise, many nurses may not be empowered enough at the bedside, another post entirely, to solve problems, lacking support from administration.  There is also some distant mystery in the idea of being a nurse scientist.  Personally, I used to believe that I could never be a nurse scientist.  They were the rock-star like icons I only read about, but were not present in my health care institution, my local universities, and certainly, I believed, not pushing medications with me at the bedside.  (I still would love to get several autographs – so nurse scientists out there, send them in with your photos. Linda Aiken, Robin Newhouse, Bernadette Melnyk , etc.)

The Need for More Evidence:

Evidenced Based Practice (EBP) is more than the latest buzzword for the vernacular of health care facilities and nursing schools.  It IS health care, and yet it is still emerging.  For nurses, there are so many practice areas where we have not verified with research what we do.  I recently worked with a group of RN-BSN students on identifying a problem within their working units that they would like to change and I am always encouraged by their resounding frustration at not being able to find any ‘research’ on the area they want to change. Topics like decreasing cost of medical care waste, pain medication dosage/timing in post-operative patients, non-pharmacological practices for comfort measures at the bedside, nurse managed out-patient protocols for stomatitis in oncology patients, direct admission of septic oncology patients from out-patient/office triage, music as an anxiety reliever in pediatric emergency room waiting,  use of certain products as bedside cleansers in ICU patients, and so forth … pepper their projects but baffle their attempts to find printed, peer-reviewed, research.  The students are thinking and ready, but it is important for them to find nothing on their topics.  They must be aware that THEY must be the catalyst for evidence and change, and that interdisciplinary evidence, and pilot projects are needed to test their theories.  Science is a mystery that continues to change and nurses are the critical detectives, the Perry Masons of health care and patients, with their outcomes at the center of the mystery.

Research is Personal

As much as science provides statistics and evidence, it also has unseen faces, lives, and effects.  Numerous unidentifiable persons participate in research in hopes of improving their own lives or to help improve the lives of others.  They believe in health care scientists and our ability to move health forward.  Beyond the research awards, publications, funding, and all of the rest, they are central.  They are the purpose, the catalyst, and the mechanism through which we will discover answers.  This was never more clear to me than when I completed a recent study and saw first hand the hope and desire for improved health of participants.  For the researcher, who remains professionally detached,  we learn that research is about people.  Who better than nurses, who know people/patients well, to seek answers to the most pressing questions our patients face?  Often, nurses see the bigger gravity in what are considered ‘minor’ issues by others in health care and how they affect patients.  Patients need evidence and nurses can help them get it.

Now Where?

Nurse researchers really were at the bedside with me, guiding theory, practice, and nursing.  They were the ones who pushed for things like Primary Care nursing, improving patient relationships through listening and communication, and the like.  The need for evidence is no less pressing and is indeed growing.  Pulling in nurses at all levels of health care to help discover and translate evidence is needed.  Building consortiums of nurse researchers to bring nursing out to smaller health centers and hospitals as the ANA is doing, or building hospitals that function with bringing nurses into evidenced based practice at every level, and actually empowering them to act/translate/search/implement as Johns Hopkins is doing are models that should be echoed throughout health care agencies.

Nursing Research Matters to Everyone

With the increase in age of patients, nurses, nursing faculty, the pending large influx of patients into the U.S. health care system, and the push to a preventive-team approach to health instead of acute care-reactionary medicine, the time is now to create more nurse scientists.  Below are some links of importance to nursing science and highlights of nursing research being done.
Nursing science and EBP matter, for our patients.

• The NINR
• Nurse Researcher Hall of Fame at STTI
• Massage for blood pressure control (recent nursing research in the news)
• In home therapy improves disabled elder’s health outcomes (recent nursing research in the news)
• Vitamin C helps heart failure patients (recent nursing research in the news)

Thanks!

Dr. Carole Eldredge DNP, RN, NEA-BC – “Administrator’s Dream or Nightmare?: Effective Use of Social Media in Clinical Settings”

Dr. Eldridge’s Handouts are as follows: Guide to formatting a social media policy, NCSB social media policy statement, ANA social media toolkit.

Dr. Terri Schmitt Ph.D., RN, FNP-BC – “Professionalism, Communication, and Collaboration: Use of Social Media in Nursing Curriculum for Student Self-Enhancement.”

Dr. Schmitt’s handouts are as follows:  Social media integration for learning tip sheet, PDF of presentation

Rob Fraser MSN, RN – “From Theory to Pracice: understanding and Applying Concepts of Social Media” – His great handouts are on his blog at Nursing Ideas.

Teresa Heithaus MSN, RN-BC.  Teresa spoke on Sunday and also with us.  You should check out her blog, Nursing Staff Development Behind the Fire Wall.

Sigma Theta Tau International Nursing Honor Society’s (STTI) biennial convention is currently taking place in Grapevine, Texas and I am once again privileged to be here as an attendee. Dr Karin Morin, current president, reminded attendees at the opening session of the amazing, ever expanding, and tireless work that the organization continues to pursue. STTI is the only international nursing organization. Likewise, it is the only nursing NGO for the United Nations, continues to expand partnerships to fund learning and mentoring academies like the maternal child and leadership cohorts, and has published over 24 timely text titles in the last biennium. They are not just setting goals, to fuel nursing scholarship, evidence based practice, and to improve the health of the world’s global citizens through nursing science, but they are achieving them.

Even as I type this, I am sitting in an intimate room with nurses from all countries and occupational settings preparing to hear a presentation on how to build sustainable nursing research teams that flourish.  There is hardly an empty seat in the room.  Such diversity, and yet oneness of purpose, is awe inspiring indeed. Part of me desires to bring more acute care and bedside nurses to such events and discussions. I am acutely aware right now that what is occurring here in this room is the way to inspire nurses and move the profession forward.

With such impressive activities and 469 chapters globally, one might ask… why aren’t all nurses members? Time, finances, lack of access to a chapter, and numerous other excuses may come to mind, but really, wouldn’t any of us like to be part of something bigger than ourselves, something that is changing nursing throughout the globe? I have found my STTI membership to be one of the most beneficial and cost effective nursing organization memberships that I posses. Community members are invited to join, but if you cannot find a local chapter then there is a virtual chapter that you can also access. I encourage you to consider joining and becoming involved. Perhaps I will see you in 2013 in Indianapolis.

More Journal Club Fun

The journal club gang had another great time this last week, the first time since we have been together since last spring, sans one great member.  There were great articles and discussion by all.  The following were the articles we discussed:

1.  Wade, G. & Kasper, N. (2006). Nursing students’ perceptions of instructor caring: An instrument based on Watson’s theory of transpersonal caring. Journal of Nursing Education, 45(5), 162-168.

This article focused on psychometric development about caring, but for the nurse educators in the group was an interesting concept to measure.  Most instructors want to know if they appear ‘caring’ to their students, while not being overly indulgent or showing signs of lateral/horizontal violence or some of the authoritative ‘old guard’ mentality that can create negative feelings in students toward the nursing profession. The initial statistics on the 31 item questionnaire were interesting, but we wondered if it would change based on the day/situation/emotional state of the student? Check it out and let us know what you think.

2. Newhouse, R. et al. (2011). Advanced Practice Nurse Outcomes 1990-2008: A systematic review.  Nursing Economic$.  Available for free at https://www.nursingeconomics.net/ce/2013/article3001021.pdf

This landmark systematic review of RCTs of NP to physician outcomes is a must read for all nurses and patients.  Likewise, it is an excellent example of a very well done systematic review, with charts, pictures, and excellent data. It would make a great example for a graduate research course.

3. Bonnel, W. (2008). Improving feedback to students in Online Courses. Nursing Education Perspectives, 29(5), 290-294

AND – Andresen, M. (2009). Asynchronous discussion forums: Success factors, outcomes, assessments and limitations. Educational Technology and Society, 12(1), 249-257.

These two articles reviewed the need for certain actions and characteristics of the faculty member in on-line learning, particularly as Bonnel points out, positive and energizing feedback to motivate students to self-improve.  Detailed and timely feedback by nursing instructors were also cited as much needed by Andresen.  Neither were really research, but had good points based in sound literature.

Be looking for our next update from the journal club coming in February!

Nursing Student Work

An excellent colleague who is finishing a certification as a nursing informaticist, has taken over the NUR3563 course I teach and is doing amazing things with it! She has wonderful insight, energy, and experience to take the course to the next level, which it so desperately needed. One of her RN-BSN students chose to do a multi-media project about how she saw Nursing Informatics.  It is very well done, with much work/effort/learning evident throughout.  You should check it out here.

She also continues to have the students blog and twitter, many with new found enthusiasm for use of technology.  Keep looking for them on twitter.

Blog Updates

NURSING STUDENTS and NEW GRADUATES – Check out the New Nurse Survival Guide at BestNursingDegree.com.  It looks very interactive and applicable.

I will post more soon. Thanks for reading and for supporting the profession of nursing! GO NURSES!

On with the post.

So, several months back Rob Fraser of Nursing Ideas challenged me to post each month about nursing research and it’s application.  Although, I read nursing research all of the time, I have been remiss for a while to post about it… so here… are my updates.

UPDATE 1:  The journal club is still on!
Yes, nursing friends my previous post about my journal club is still going. We meet again in October and I will update you then.  If you want to read my original post about how to start your own nursing journal club you can go HERE.  I am contemplating starting a nursing journal club that meets once a month on twitter, but am not quite there yet time wise.  Stay tuned…

UPDATE 2:  Sigma Theta Tau International 41st Biennial Convention

A source for all things scholarly and nursing, there is a great convention coming up and it will be in Dallas (grapevine) this year.  Check it out or sign up to come here.  I have the privileged of speaking with the famous Rob Fraser, Carole Eldridge, and Teresa Heithaus about integration of technology and social media into nursing practice.  There will be much research application there.  Stay tuned for a report…

UPDATE 3:  Research Article of the Day

You cannot access it yet, but mine came in the mail today and the entire issue is awesome, but one article in particular in the Sept/Oct issue of the Journal for Nurse Practitioners was on the top of my current interest list.

Bruney, T. (2011). Childhood obesity: Effects of micronutrients, supplements, genetics and oxidative stress.  Journal for Nurse Practitioners. 7(8); 647-653.

Brief Overview:  Obesity is a problem.  Rates of obesity in children have tripled since 1980.  WHO reports that 60% of disease burden for future will be chronic disease related to obesity.  Obesity, based on current research, is not just an affect of the number of calories, but the quality of food.  The article provides a good overview of research surrounding the effects of high fructose corn syrup, microflora of the gut, zinc and Vitamin D supplementation, antioxidants, nutrigenomics, and types of diets on obesity.

Take home for me:  Our kids are getting more processed foods with little nutrients. We need more fresh foods and higher intake of fruits and vegetables as well as supplementation.  It appears that once obesity is already a problem, that it may be difficult for Atlas to let go of the world, meaning it is more difficult to break out of the cycle of reactions in the body that occur because of obesity and cause one to stay obese.  The author never comes out and says this, but after reading the research it makes one wonder.  Nutrition, nutrition, nutrition…

So, even though I am still a research slacker, this post helps.  Dissertation defense next week so back with more in October.  Thanks for reading!

Objectives lead to outcomes, which lead to the completion of an overall plan where more than new knowledge or a degree are obtained, but where lives are forever altered by new goals, opportunities, ideas, creativity, and the like.  Course objectives are the where and why in traveling to where students are headed.  Oh how I wish life had course objectives at times, then I would know when I have arrived and could get off of one train and board the next.

For me, the last 5 years have been consumed with one outcome, my station of destiny if you will.  My family, friends, faculty, colleagues, co-workers, students, and even my patients have been a part of my travels toward this goal.  (Often, they carry me forward in my journey without even realizing that they are the vehicle helping me move ever closer to the spot on the map that I am determined to get to. For this I am truly grateful).  The journey, as the cliche goes, is more important than the specific arrival point, but without the planned destination one would not know in which direction to head to reach the goal.  For me, this goal has been obtaining my PhD in nursing science and I have almost arrived (if you would like to know the days/hours/minutes/seconds to the end send me an e-mail because I have them counted down).

Moving toward this goal has been my main objective and has left me with a determined tunnel vision and unable to plan much beyond arriving at station PhD.  I naively believed that upon arrival I would not do anything else but rest, apply the knowledge I had learned to my current position, read a number of ‘mind candy’ novels, and sleep in on Saturdays.

However, now that this stop is growing closer I am surprised to find that I need to ride the train a while longer, or disembark and hitch a ride on another one.  The very nature of doctoral nursing education demands more of those who have obtained it.  Such an education is a privilege and in itself requires the nurse to set new goals, ponder possibilities and new places to travel, and to consider the objectives of travel.  (Can you hear my Id and Super Ego fighting it out… i.e. the angel and devil on my shoulders… “Pajamas and made for T.V. movies!!!!… no, no, no… Where in the world could you start a nursing school for women who would not otherwise get an education and to where people have no access to health care?…”)

I have a few collaborative ideas that will demand more informal learning (if any of you want to work jointly on some projects… hint, hint), but I also have not arrived at ‘mid life’ and have decided that one of the best things I could do is survey where I am on all life fronts and build some ideas for where I would like to be when the train finally stops for good.  I have started Michael Hyatt’s free Life Plan e-book.

Perhaps, if I set my own course objectives in life, the rest will fall into place… I will keep you posted.

And so, the train rumbles on, not through the night as in an Agatha Christie novel, but instead through all sorts of landscapes, experiences, possibilities, and ideas.

*Prior to reading this post please be aware that I am not providing medical advice to anyone nor encouraging any lifestyle change or activity without consulting your primary health care provider.  In fact… I am really preaching to health care providers themselves (me included)

My most recent interest?…Reading and learning about nutrition and exercise.  As a nurse I have had some training in nutrition, which was required for my basic diploma degree, but no training in exercise physiology.  The world of nutrition, exercise, and alternative medicine have grown substantially since my white cap days.  I am by no means an expert, only scratching the surface of knowledge, but I thought I would share some opinions I have formed from my recent research.

My new found push to be ‘healthier’ (whatever that means) has evolved from several factors.  (1 ) I am aging and my mother had open heart surgery for complete blockage of a major artery in her early 40′s (you can’t change genetics).  (2) I have been doing some crossfit (yes, I am apparently into self punishment… but I have more than doubled the weight I can lift and both increased my speed and endurance in the last 2 years… crossfit is COOL!).  (3) Most importantly, I am finding my patient population in primary rural health to be sicker, more obese, and needing more medications, but let me be frank… medications are NOT fixing their health.

All of this has lead me to seek out what can really benefit my patients and not surprisingly the answer is EXERCISE AND DIET!  Exercise appears to be the proverbial ‘magic bullet’ for numerous diseases including heart disease, Type 2 diabetes, depression, anxiety, osteoarthritis, fibromyalgia and reduces the risk of a host of other diseases including cancer.

Further, the implications of nutrition in the treatments of such illnesses, while not as widely studied as pharmaceuticals, is impressive.  The implications for a vegetable and fruit based diet in preventing and altering heart disease risk is impressive.  Good nutrition in itself benefits diseases like diabetes and decreases obesity.   The use of nutrition to improve memory, anemia, prevent migraines, improve mood and sleep, and a host of other uses for fruits and vegetables and vitamins, has shown promise and needs more research.  So far, this discussion does not even include current problematic treatment of chronic pain in this country and the alternative therapies, diet, and exercise that could benefit such patients (another post perhaps?).

Let’s be honest, medications are dangerous.  With current adverse drug reactions and drug overdoses claiming more than 100,000 American lives alone per year, clinicians need to find a safer and more permanent way to improve chronic health in this nation.  There has got to be a more adventitious way, a safer way, to improve the health and quality of life of a nation (and to reduce skyrocketing health care costs)!  There is…. nutrition and exercise.

Pills, Pills, Pills… do they create more ills? I am begining to wonder if the toxic nature of long-term pharmaceuticals is an issue for my patients? Seriously, this is a legitimate question.  I am not trying to throw the baby out with the bath water.  Pharmaceuticals are good.  I am thankful for pharmaceuticals and for common life saving drugs, but for the long term treatment of chronic diseases that are all life style related… is our current practice of medical care in this country (acute care hospitalization and primary care medication pushing) working? Look, in a published report on vitamin adverse reactions and deaths in the U.S. in 2007 there were only 8 adverse reactions and 0 deaths.  Yet, I would honestly like to know the general health outcomes, quality of life improvements, improvements in mood/sleep/lifestyle, and what patients generally die from who are on long term pharmaceuticals for chronic problems? Longitudinal research anyone?

Further, I have many patients who would benefit from yoga, massage therapy, physical therapy, acupuncture, and the like as supplements to their chronic pain management.  The majority of these patients have no health insurance or money, and if they do have health insurance it does not include coverage for such therapies… however, it pays for medications… an issue for another post.

With all of the empirical evidence as to patient improvements in disease through diet and exercise, why don’t we/health care providers (me included) use them more?  Wouldn’t we like to wean all of our patients off of their metformin, lisinopril, and lipitor? I know I would!

Several Bottom Lines: Bottom line number one, time constraints within a primary care visit, what ever they may be, and a culture of going to get a prescription for our ailments has lead us here.  It is a poor and pitiful excuse and I am not proud to write that I have fallen into the trap of both time and a patient’s desire for a prescription to fix instead of the hard work of lifestyle change.  I am confident though that health care providers can lead the charge to change how we practice and how we promote health in the U.S. and around the world!  We can do it in conjunction with athletic trainers, dietitians, exercise physiologists, and the like in cooperation.

Bottom line number two, the most common prescription we need to write is for diet and exercise.  However, will that make anyone any money?  As much as all health care providers hate it, money drives our system.  Of course, a patient being sick generally does not bring me personally any more revenue.  I would love to see healthy patients all day, or do something else if my patients were so healthy they did not need me (how great would that be!).  To cut costs, someone has got to stop making money.  Honestly,  if I could prescribe only two things to help almost every patient I had  in my practice it would be increasing fruits and vegetables in their diets and getting daily exercise.  (FYI- I am also going stop encouraging whole grains, because patients interpret this as bread and cereal and then eat processed cereal/bread and think they are being healthy.)

Bottom line number three, we have to help our patients get well through modeling. We have to start with ourselves.  No more should we as health care providers say… “well, I am going to eat this candy bar because I take my lipitor for it and I have to die of something anyway.”  No more cop outs.  No more excuses.  We can model the health we want our patients to have.

Now, go crossfit or something…

Rather than drone on in paragraph by paragraph format I simply have some brief bullet points of what I learned during a great and passionate presentation by Dr. Debra Ilchak clinical professor at Arizona State University.

Facts

• Chlamydia, caused by C. trachomatis, is the most common STD in the U.S. with over 2.8 million diagnosed cases each year, cost to U.S. health system annually is about $15.9 billion dollars, screening compliance in GPs is LOW, and 70% of infected women have no symptoms of the disease.
• Untreated Chlamydia sequela include: Ectopic pregnancy, infertility, and PID. (24,000 women become infertile each year in the U.S.)
• It is costly, prevalent and we are missing cases in primary care.  Here is the CDC map on reported/diagnosed cases by state.

Screening Guidelines (help your office, urgent care, ER implement these)

• Females:  In sexually active women 25 years and younger, screen yearly.  In pregnant females screen at first prenatal visit.  Screen women older than 25 who have a new partner, history of STD, greater than one partner in last several months with inconsistent barrier contraception use.
• Males: Screen annually in men who have sex with men and as needed based on setting, risk factors, and circumstances.
• Urine specimens and vaginal swabs are acceptable specimens (Do not need to swab the cervix necessarily), but NAAT (nucleic acid amplification tests) screening tests are the most sensitive.
• Its quick, its easy, its easily treatable, and its CHEAP.  Screening has such impressive results that it has been added to the government’s HEDIS insurance evaluation system of medical record reviews for appropriate care.
• Women should be empowered to ask if they are getting screened at annual GYN exams.

CDC Treatment Guidelines

The treatment for Chlamydia has changed in the last several years.  The latest guidelines are simple, clear and advocate single dose treatment to increase compliance.  You can find them here at the CDC website. Treatment guidelines change based on co-infection with gonorrhea or other condition. 

See how a few simple facts can empower us to provide better care.  Now make sure your patients are being screened!

Below are a few that have come across my desk in the last few weeks, but if any of you out there have others you would like me to post or tweet about (pending understanding that they must be legitimate and reputable) then I will happily do so.  I am particularly fond of nurses completing research projects for graduate school.

NCLEX PREPARATION – BestNursingDegree.com is interested in nurses experience with the NCLEX exam.  This survey is going to ask you for personal contact information and the information is going to be compiled for others taking the exam.  If any part of that bothers you then you might skip this survey – https://www.surveymonkey.com/s/CNXMTRC

WAS NURSING WHAT YOU EXPECTED – BestNursingDegree.com is interested in relatively new nurses experiences working in nursing.  This is an anonymous survey that looks to gather some important information about the culture of nursing and hospitals.  Check it out and fill it out at – https://www.surveymonkey.com/s/CB9QH9P

ADVANCE NP and PA ANNUAL SALARY SURVEY – Advance for NPs & PAs has opened it’s annual salary survey.  You can find a link to it in this article here – http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Online-Extras/2011-National-Salary-Survey-of-NPs-PAs.aspx

Just an update from me on dissertation writing – rough draft of chapters 1-4 done and almost 10,000 words (no appendices or extras even). Writing chapter 5 rough draft this weekend.  Thanks for all of the shout outs from readers.  Plugging onward…. I just want it to be very, very good!