Read Greenscrubs 2008-2009.pub text version

Fall 2008

HUMBOLDT STATE UNIVERSITY

GREEN SCRUBS

The Journal of Student Nursing Evidence Based Research

Special points of interest:

· Over 100 research articles reviewed for this publication · Useful information for all levels of nursing students and nurses in the workforce · Fun crossword puzzle

Instructor: Piri Barger RN,MSN, CCRN

Inside this issue

Cultural Safety Group Dynamics

2-3

4-5

NCLEX SuccessHURST review

6-7

Childhood Obesity 8-9 Stress Management 1011

Test your Nursing Knowledge!!

Crossword Puzzle In-Side Page 20

Answers included on pg 21

Mental Health in University setting Cultural Competence MRSA Pressure Ulcer in Geriatric Population Crossword Puzzle

1213 1415 1617 1819

20

Volume 2

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Cultural Safety

tion of Cultural Safety for nurses and nursing students. Research shows that knowledge gained from traveling can influence practicing nurses' decisions when determining how, why, and where they choose to continue their practice. Increased self-awareness is a direct result of these insights.5 The more self-aware one becomes, the more holistic care a nurse is able to provide, resulting in improved client outcomes. Multiple studies found that the ability to provide culturally competent care to clients of Cultural Safety is a nursing the- different cultural backgrounds can only be achieved by first developing selfory that focuses on the nurse being awareness.2,5,8 Self-awareness and unaware of what he or she believes and derstanding of one's own cultural bivalues, and then realizing how these ases is key to building a culturally personal beliefs affect his or her praccompetent practice. Cultural competice. Irihapeti Ramsden (2003), the tence involves a strong personal and founder of Cultural Safety, states professional respect for others.6 "Nurses need to know what invisible biases and baggage they are bringing Researchers found that travelto their practice to be able to deliver ing helped students to increase their culturally competent care."8 Cultural understanding of social justice and Safety challenges nurses to identify globalization, improve their relationdifferences in how people experience 2 life and view the world. Selfship skills, foster their ability to see the awareness is the first step in becoming whole person, and implement holistic culturally safe. This concept is impor- nursing care.5 Several studies show tant for nurses practicing in the United that international nursing experiences stimulated nursing students' cognitive States. The Bureau of the Census development, cultural sensitivity, cul(2004) states that 10.7 percent of all RNs identified themselves as a racial tural competence, and personal growth by challenging their established values or ethnic minority while 34% of the United States population is comprised and beliefs.2,4 Students who particiof racial or ethnic minorities.10 As dipated in a cultural immersion program versity within the United States grows, had increased ratings in cultural comthe importance of developing a cultur- petence.3,4 Nursing students who travally competent practice is more crucial eled to another country reported than ever. This article focuses on how "renewed enthusiasm for practice, traveling can increase self-awareness, greater cultural insight into their praccultural competency, and the applicatice, and increased confidence and selfAs the world becomes more diverse, there is a growing need for nurses who offer competent care for individuals of different cultural backgrounds. Research indicates that travel for the purpose of cultural immersion has profound effects on student nurses and can potentially improve patient outcomes. Traveling is an excellent way for nurses to immerse themselves into another culture, to increase their self-awareness, and to begin the implementation of Cultural Safety.

Authors Jill Bidwell Molly Evenson Sarah Scott Kristen Cowan Tracy Motzny Kaitlyn Shipe

"As diversity within the United States grows, the importance of developing a culturally competent practice is more crucial than ever."

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Resources on Culture and Nursing:

reliance."2

There is limited research on the long-term effects of cultural immersion 5. Evanson, T., & Zust, B. (2006). Bittersweet Knowledge : The Long-Term Effects experiences and their relationship to of an International Experience. Journal of nursing practice. Future studies should Nursing Education, 45(10), 412-419. be conducted with larger sample sizes to evaluate the long-term effects. An6. Maier-Lorentz, M.M. (2008). Transcultural nursing: Its importance in nursing other limitation to this body of repractice. Journal of Cultural Diversity, 15 search is the presence of selection bias (1), 37-43. related to voluntary participation.7

The Effect of Student Participation in International Study. Journal of Professional Nursing , 237-242.

Transcultural Nursing Society

http://www.tcns.org/

Journal of Transcultural Nursing

http:tcn.sagepub.com

Major outcomes of cultural immersion experiences are changes in values, increased communication skills, and the development of culturally focused nursing practice.5 Nurses' integration of cultural immersion experiences can potentially increase the health outcomes of clients.1 Overall, research supports travel as a successful means of expanding a nurse's selfawareness and cultural competence within his or her practice to improve patient outcomes.

References

7. Paul, C.R., Devries, J., Fliegel, J., Cleave, J.V., Kish, J. (2008). Evaluation of a culturally effective health care curriculum integrated into a core pediatric clerkship. Academic Pediatric Association, 8(3), 195-199. 8. Ramsden, I. (2003). Cultural Safety in Nursing Educationin Aotearoa and Te Waipounamu. Victoria University of Wellington PhD thesis. 9. Underwood, S., Shaikha, L., & Bakr, D. (1999). Veiled Yet Vulnerable. Cancer Practice, 7(6), 285-290. 10. U.S. Bureau of the Census (2004). Retrieved December 3, 2008 from http:// www.census.gov/

1. Ariff, K.M., & Beng, K.S. (2006).

Transcultural C.A.R.E. Associates "People don't care how much you know, until they know how much you care."

Unknown http:// www.transculturalcare.

Cultural health beliefs in a rural family practice: A Malaysian perspective. Australian Journal of Rural Health, 14, 2-8. 2. Button, L., Baker, C., Green, B., Johansson, I., & Tengnah, C. (2004). The impact of international placements on nurses' personal and professional lives: Literature review. Journal of Advanced Nursing, 50(3), 315-324. 3. Caffrey, R. A., Neander, W., Markle, D., & Stewart, B.(2004). Improving the Cultural Competence of Nursing Students; the Results of Integrating Cultural Content in the Curriculum and an International Experience. Journal of Nursing Education , 234-240. 4. DeDee, L. S., & Stewart, S. (2003).

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Authors

Group Dynamics

emotional aspects of interdisciplinary teamwork and reflect on how this influences interaction and behavior." 1, 2, 3 Individual values and attitudes contributed to the overall success and/or conflict in the group as well. These values or attitudes included trustworthiness, cooperation, equality, and a variety of disruptive behaviors. According to the studies, the most important contributor to group satisfaction and healthy work environments was the presence of professional leadership in the form of a facilitator or managerial support.2,3,4 "Participants found that the energy and commitment of the facilitator sustained the group through the ebb and flow of its natural evolution and transformation."4 The leader must understand and recognize verbal and nonverbal cues during the group process. Group members can then seek outcomes that are beneficial to all other group participants.

Debra Barrios Martha Meade

"Group Dynamics is the study of group behavior, especially the interactions that occur among persons in small groups. Group dynamics is concerned with the structure and functioning of groups and with the types of roles played by members." Because of the diverse nature of the human experience within a group, relevant research articles utilizing both quantitative and qualitative designs were collected for this synthesis. These studies help researchers and practitioners understand, improve, facilitate and use group dynamics. Many notable themes emerged from the research. The majority of themes confirmed that group members need self-management and communication skills, higher education, experience working in groups, an ability to initiate sharing workloads, and handling conflict to create positive professional interactions. "It may be timely for nurse managers to consider the

Group Dynamics involves much of the human experience. "Group Dynamics is the study of group behavior, especially the interactions that occur among persons in small groups. Group dynamics is concerned with the structure and functioning of groups and with the types of roles played by members." 6 There is much scientific research focusing on group dynamics within a wide range of fields including healthcare.

However, the studies have several limitations. One primary theme stated that in most situations, roles have to be either adopted or designated in order to achieve a goal, but group roles were not addressed separately in a study. "Since it is impossible to assess every variable present in any setting, it is critical to consider which

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"Participants found that the energy and commitment of the facilitator sustained the group through the ebb and flow of its natural evolution and transformation."

variables have an effect on the rela- team-player work environments. 2 tionship under study." 7 There were References: also limitations on how cultural diversity, gender, race, age, and ethnicity affect the group dynamic. 1. Clark B.A., Miers M.E., Pollard, K.C., and Thomas J. (2007). ComFor example, few of the articles replexities of learning together: Students' flected on intervention strategies Experience of Face-to-Face Interprothat could manage conflict. fessional Groups. Learning in Health Working in any branch of and Social Care, 202 ­ 212. health care requires involvement in many group activities and a multidisci- 2. Chinn, P.L., and Jacobs, M.K, plinary approach to client care. Nurses (1987). Theory and Nursing. St. Louis, MO: C.B. Mosby Co. must work effectively in groups to provide safe, holistic, comforting and satisfying care to clients and family mem- 3. Dimeglio, K., Padula, C., Piatek, C., Korber, S., Barrett, A., Ducharme, bers. M., Lucas, S., Peirmont, N., Joyal, E., Research consistently demonDinicola, V., & Corry, K. (2005). strated five themes present in successGroup Cohesion and Nurse Satisfacful group dynamics. tion: Examination of a Team-Building Initially, job strain was reduced Approach. Journal of Nursing Adminiand empowerment increased through stration, 35 (3), 110-119. collaboration, communication, and project-based learning between health- 4. McCallin, A., & Bamford, A. (2007). Interdisciplinary teamwork: Is the incare team members. 3 Secondly, small group meetings worked best to help validate experiences and practices. This gave 5. Pereles, L., Lockyer, J., & Fidler, H. team members an opportunity to com(2002). Permanent Small Groups: municate with peers, to review proceGroup Dynamics, Learning, and dures, and learn or teach new methChange. The Journal of Continuing Eduods.4 cation in the Health Profession, 22, 205Also, incentives provided in the 213. form of rewards encouraged participation. 5 6. Yifeng, N.C., Tjosvold, D., and Fourth, creating an environPeiguan, W. (2007). Effects of warmment that supports interpersonal comheartedness and reward distribution on negotiation. Group Decision Negotiamunication is essential to creating a 3 tion, 17:79-96. satisfying work environment. Finally, offering workshops to 7. http://Encarta.msn.com/encyclopedia, 761569392, group dynamics, Nov, build and support communication 2008. skills would be a team-building intervention. This single effort would encourage an on-going building of this skill and thus help to ensure positive

fluence of emotional intelligence fully appreciated? Journal of Nursing Management, 15, 386-391.

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NCLEX Success­ HURST Review

NCLEX: To pass or not to pass? Three years of nursing school, countless hours of studying and anxiety all culminate into one crucial exam: the NCLEX. After all, this exam determines the fate of our future nursing careers. The question nursing students want answered is "how do we pass the NCLEX?" Many research articles attribute multiple factors to NCLEX success such as cumulative GPA, clinical proficiency, commercial reviews, study habits and life stressors. 3, 4, cess rates, found that to improve success for nursing graduates, the program should include "assessment testing, instruction on effective test taking, student self assessment, review courses, and review books."

14

Authors Kelly Pettit Heidi Mosher Renae Flores Thomas Holmes Missy Lundstrom Allison Pals

"Many studies agreed that early preparation is crucial to improving NCLEX success"

One factor that will increase NCLEX pass rates is the inclusion of exam preparation strategies throughout the curriculum. Faculty can use methods such as incorporating NCLEX style test questions, increasing competency in specialty 5, 6, 7, 13 areas, and increasing confidence in delegation, prioritization, and use of stress manThere is a misconception that the agement skills.9, 15 Many studies agreed NCLEX is a comprehensive examination that early preparation is crucial to improvof all knowledge that has been taught in ing NCLEX success.1, 3, 5, 12, 11, 13 Some nursing school. It isn't. McDowell (2008) students report an inability to prepare for found that it is impossible for current nurs- the NCLEX during the last semester of ing curricula to cover all of the knowledge their senior year due to course workload.5 that nurses could possibly need for nursing Just as professional nurses implement dispractice. The NCLEX targets the knowlcharge planning upon admission, nursing edge and skills required for minimum safe, students should begin NCLEX preparation effective nursing care. early in their program. Researchers found that new graduates should study a substanCurrently, to promote NCLEX tial number of hours for the NCLEX and preparation, Humboldt State University particularly emphasize studying the week (HSU) requires ATI's standardized nursbefore the exam.1 ing competency testing throughout the program. Although a live content based In response to the needs assessreview has not been incorporated in conment of HSU nursing students, a group of junction with the ATI, informal quantitaseniors proposed the addition of one-unit tive surveys conducted by senior HSU nursing seminar in the form of a live conresearch students identified student desire tent-based review course. The goal is to to implement such a change. Of the ensure first time NCLEX success, provide alumni that responded, all found a live students with additional preparatory supreview useful and highly recommended port, as well as increase overall program that it be included in the HSU nursing cur- pass rates. According to the California riculum. Out of 56 current nursing stuBoard of Registered Nursing, HSU 2008 dents surveyed, 44 support the change. graduates had a pass rate of 82.61%.2 The Literature supporting a live review 30 HSU 2008 graduates who completed Hurst Review's live course prior to examicourse is limited. However, current research does illustrate that a review course, nation achieved a first time pass rate of 93.33%.8 These statistics demonstrate that combined with other factors, greatly increases the NCLEX pass rates for graduat- implementation of a live review course will likely increase the pass rates for the ing nursing students. 1, 3, 4, 7, 10, 12, 14, 15 A HSU nursing program. In the upcoming study on the promotion of NCLEX suc-

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"The 30 HSU 2008 graduates who completed Hurst Review's live course prior to examination achieved a first time pass rate of 93.33%"

Spring 2009 semester, the Hurst Review will be offered as part of the Humboldt State nursing curriculum in the form of an optional one-unit credit/no credit course. This change in the program could answer the longstanding question...to pass or not to pass?

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Higgens, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates. Journal of Nurs ing Education. 44(12), 541-547. King, M. Personal Communication, Hurst Review services. Sept. 02, 2008. Kostovich, C.T., Poradzisz, M., O'Brien, K. L., Wood, K., (2005) Learning style preference and student aptitude for concept maps. Journal of Nursing Education. 45(5), 225-231.

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9. References 1. Beeman, P.B., & Waterhouse, J. K. (2003). Post-graduation factors predicting NCLEX-RN success. Nurse Educator. 28 (6), 257-260. 2. California Board of Registered Nursing (2008). NCLEX Pass Rates. Retrieved Sept. 22, 2008 from http://www.rn.ca.gov/ index.shtml. 3. Chung, M; Daley, L; Frazier, S; Kirkpatrick; Moser, D. (2003) Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation. Journal of Nursing Education. 42 (9), 390-398. 4. Crow, C.S., Handley, M., Morrison, R. S., Shelton, M. M. (2004). Requirements and interventions used by BSN programs to promote and predict NCLEX-RN success: a national study. Journal of Professional Nursing. 20(3), 174186. 5. Eddy, L. L. & Epeneter, B. J. (2002). The NCLEX-RN experience: qualitative interviews with graduates of a baccalaureate nursing program. The Journal of Nursing Education. 41(6), 273-278. 6. Hammer, V. R., Craig, G.P. (2008). The experiences of inactive nurses returned to nursing after completing a refresher course. The Journal of Continuing Education in Nursing, 39(8). 358-367.

10. McDowell, B.M. (2008). KATTS: A framework for maximizing NCLEX-RN performance. Journal of Nursing Education. 47(4), 183-186. 11. McGann, E.,Thompson, J.M. (2008). Factors related to academic success in atrisk senior nursing students. International Journal of Nursing Education Scholarships. 5(1), 1-15 12. Poorman, S; Webb, C. (2000). Preparing to retake the NCLEX-RN the experience ofgraduates who Fail. Nurse Educator. 25 (4), 175-180. 13. Sewell, J., Culpa-Bondal, F., Colvin, M. (2008). Nursing program assessment and evaluation:evidenced-based decision making improves outcomes. Nurse Educator. 33(3), 109-112. 14. Waterhouse, J. K., & Beeman, P.B. (2003). Predict ing NCLEX-RN success: can it be simplified? Nurs ing Education Perspectives. 24(1), 35-39. 15. Wendler, M.C., Bonis, S., Taft, L. (2007). Strategies to promote success on the NCLEX-RN: An evidence-based approach using the ACE star model of knowledge transformation. Nursing Education Perspectives. 28(2), 82-87.

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Authors Josh Mefford Thomas Williams Jordan Coghill Ashley Duwell Claudia Magaña Tara Neel

Childhood Obesity

One of the most alarming public health concerns today is the prevalence of obesity in children and adolescents. Nurses have the opportunity to provide awareness and education to families on this subject. One of the main ways nurses can help identify childhood obesity is by maintaining accurate body mass index-for-age percentile growth charts. Obesity in children, identified as a BMI percentile equal to or greater than 95%, currently affects 11% of children and adolescents in the United States.8 When broadened to include those "at risk" for greater than or equal to the 85th percentile, 25% of U.S. children and adolescents are affected.8 Obesity is the leading cause of preventable death in the United States.3 However, there are many factors that contribute to the overall problem of childhood obesity. Evidence has shown that the highest rates of obesity are found in the poorest families. Access to healthy foods is limited in lowincome neighborhoods where fast food restaurants dominate.7 Themes such as the high cost of fresh foods and time constraints of parents working fulltime outside the home also contribute to obesity in children. The health of our children is indicative of the quality of health these children will have when they become adults. Evidence based research shows that an estimated 70% of overweight children will become obese adults, leaving them susceptible to a variety of co-morbidities such as diabetes and other metabolic disorders.5 Obesity leads to the degradation of blood vessels, making patients vulnerable to cardiovascular disease, stroke, blindness, kidney failure and potential limb amputations. The increasing trend of obesity in children contributes to the development of related medical diseases resulting in increased medical costs. According to the Department of Health and Human Services (2001), "Economic costs associated with obesity have been estimated at $117 billion by the United States Surgeon General".1 Obese children that become obese adults account for $93 billion of medical expenditures which is about 9% of total expenditures in the United States.3 There has been a recent movement towards preventing childhood obesity in order to improve individual health in the U.S. and to avoid the increased medical costs. Early identification and intervention can provide the most positive health outcomes for children. Behavior modification and prevention through education are methods being used to reverse this national trend of obesity in children and adolescents. Recent studies have shown that psychological concepts such as goalsetting strategies; improving self efficacy, and the transtheoretical model of change which assesses the client's readiness for contemplation, preparation, action, and maintenance of weight loss have been effective in obesity prevention.4 Application of these interventions must be used effectively in order to bring about positive change related to childhood obesity. Nurses are often the first to identify a child with overweight

"...experts fear that this generation of American kids may be the first ever to have a shorter life span than their parents do" Time Magazine

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tendencies and are poised to lead child weight management.2 In addition to identifying obesity in children and adolescents, nurses must recognize that parental involvement is an essential part to overcoming childhood obesity.6 Providing awareness by teaching in a family-centered manner and implementing an individualized care plan that encourages self efficacy, nurses will be able to develop a care plan that is inclusive and meaningful to the family of an overweight child. " Only 33% of

gies. Journal of Advanced Nursing, 52(1), 6-13. Retrieved October 20, 2008, from CINAHL Plus with Full Text database. 6. Jain, A., Sherman, S., Chamberlin, L., Carter, Y., Powers, S., & Whitaker, R. (2001, May). Why don't low-income mothers worry about their preschoolers being overweight?. Pediatrics, 107(5), 1138-1146. Retrieved September 26, 2008, from CINAHL Plus with Full Text database. Kelly, L., & Patterson, B. (2006, December). Childhood nutrition: perceptions of caretakers in a low-income urban setting. Journal of School Nursing, 22(6), 345351. Retrieved September 26, 2008, from CINAHL Plus with Full Text database.

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adults in 200306 were at a healthy weight, half the number who ideally should be and 10% fewer than 1988-94." - Time Magazine

References 1. U.S. Department of Health and Human Services, (2001). U.S. Department of Health and Human Services, The Surgeon General's call to action to prevent and decrease overweight and obesity, U.S. Department of Health and Human Services; Public Health Service; Office of the Surgeon General, Rockville, Md. Edmunds, L. (2008, July). Social implications of overweight and obesity in children. Journal for Specialists in Pediatric Nursing, 13(3), 191-200. Retrieved September 26, 2008, from CINAHL Plus with Full Text database. Evans, W., Renaud, J., Finkelstein, E., Kamerow, D., & Brown, D. (2006, March). Changing perceptions of the childhood obesity epidemic. American Journal of Health Behavior, 30(2), 167176. Retrieved October 5, 2008, from CINAHL Plus with Full Text database. Hawley, S., Beckman, H., & Bishop, T. (2006, June). Development of an obesity prevention and management program for children and adolescents in a rural setting. Journal of Community Health Nursing, 23 (2), 69-80. Retrieved October 5, 2008, from CINAHL Plus with Full Text database. Jackson, D., Mannix, J., Faga, P., & McDonald, G. (2005, October). Overweight and obese children: mothers' strate-

8. Speroni, K., Tea, C., Earley, C., Niehoff, V., & Atherton, M. (2008, July). Evaluation of a pilot hospital-based community program implementing fitness and nutrition education for overweight children. Journal for Specialists in Pediatric Nursing, 13(3), 144-153. Retrieved October 10, 2008, from CINAHL Plus with Full Text database. 9. Park A. (2008, December). America's Health Checkup. Time Magazine.December 11, 2008 issue.

2.

3.

" Since 1980 the obesity rate has doubled in children and tripled in adolescents."Kelly Spatterson (2006)

4.

5.

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Authors Lisa Haehnichen Brigitte Hanlon Jessi Allen Rebecca Caswell Zacharias Miller Dulce Ziegler

Stress Management

The nursing profession can be very stressful! Nurses often work with the sick and dying which can be physically, mentally, and emotionally exhausting. The necessary stresses of nursing are often compounded by troubles in the workplace such as administrative challenges and understaffing1. Additionally, nurses may be adversely affected by stressors in their personal lives, such as caring for young children or aging parents4. The negative effects that stress has on one's mental and physical health are well known and documented. In order to adequately care for others, manage stress, and avoid burnout; nurses must first care for themselves. Stress reduction techniques can be implemented both on a personal level and on an institutional level. It is important for nurses to learn methods to mitigate the effects of stress, both at home and in the workplace. Health care institutions also play a critical role in the development of environments which address the stress of their employees. Therefore, the responsibility of managing stress rests both on the individual as well as on the institution. Individuals will have the most control over their stress if they utilize personal stress reduction methods. Such methods to decrease stress include mindfulness-based stress reduction programs, meditation, yoga, and breath-awareness. These methods have been proven to significantly lower the stress levels of participating nurses4. Nurses who utilize frequent mantra repetition and other practices which increase self-awareness also reported a greater sense of well-being7, 12. Several studies indicated that nurses and nursing-students alike benefit from programs designed to enhance their self-care abilities4, 12, 14. External factors, such as institutional policies and managerial style, have been shown to have a significant impact on nurse burnout and subsequent migration from the nursing profession10. These external factors, however, are seldom under the nurse's direct control. According to research, there is a negative correlation between perceived coworker social support and perceived stress levels2. Researchers found that when nurse managers give recognition and reward for performance, they can greatly reduce nurses' perceived stress and job retention; thereby increasing satisfaction and reducing turnover3. When nurses are able to effectively manage their stress, the people that they care for also benefit. Successful stress reduction has a positive correlation with increased empathy among nurses5. Consequently, increased empathy has been linked with improved patient satisfaction, fewer ER visits, and better overall patient outcomes5. Among patients surveyed, those who were cared for by nurses experiencing burnout reported more dissatisfaction with the care they received4. Employers play an important

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"Health care institutions also play a critical role in the development of environments which address the stress of their employees"

MANTRAS........

ss" l pa shal s too Thi

role in creating environment for employees and can reduce the stress levels of their nurses by creating a supportive work environment. In order to face the many uncontrollable stressors of nursing, nurses can learn and commit to practicing one, or several, beneficial stress-reduction techniques. Nursing education plays a vital role in preparing nursing students to cope with the stress of their upcoming careers. Inclusion of a stress-reduction course in nursing curricula would help to lay the foundation for a lifetime of healthy and effective stress management.

References 1. AbuAlRub, R.F. (2003). Job stress, job performance, and social support among hospital nurses. Journal of Nursing Scholarship, 36(1), 73-78. AbuAlRub, R.F. (2006). Replication and examination of research data on job stress and coworker social support with internet and traditional samples. Journal of Nursing Scholarship, 38(2), 200-204.

81-87. 7. Bormann, J.E., Becker, S., Gershwin, M., Gifford, A.L., Kelly, A., Pada, L., & Smith, T.L. (2006). Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers. The Journal of Continuing Education in Nursing, 37 (5), 218-224. Deppoliti, D. (2008). Exploring how new registered nurses construct professional identity in hospital settings. The Journal of Continuing Education in Nursing, 39, 255-262. Dickenson, T., & Wright, K.M. (2008). Stress and burnout in forensic mentalhealth nursing: a literature review. British Journal of Nursing, 17, 82-87.

8.

9.

"

"Namaste"

2.

"Be

I am

still and k no Go d w th " at

10. Garrosa, E., Moreno-Jiménez, B., Liang, Y., & Gonzáles, J.L. (2008). The relationship between socio-demographic variables, job stressors, burnout, and hardy personality in nurses: An exploratory study. International Journal of Nursing Studies, 45, 418-427. 11. Palfi, I., Nemeth, K., Kerekes, Z., Kallai, J., & Betlehem, J. (2008). The role of burnout among Hungarian nurses. International Journal of Nursing Practice, 14, 19-25. 12. Sharts-Hopko, N.C. (2007). Personal and professional impact of a course on contemplative practices in health and illness. Holistic Nursing Practice, 21 (1), 3-9. 13. Sheldon, L.K., Barrett, R., & Ellington, L. (2006). Difficult communication in nursing. Journal of Nursing Scholarship, 38(2), 141-146. 14. Stark, M.A., Manning-Walsh, J., & Vliem, S. (2005). Caring for self while learning to care for others: A challenge for nursing students. Journal of Nursing Education, 44(7), 266-270.

"Om mane padme hum"

"Ju st B rea

the

3. AbuAlRub, R.F. & Al-Zaru, I.M. (2008). Job stress, recognition, job performance, and intention to stay at work among Jordanian hospital nurses. Journal of Nursing Management, 16, 227-236. 4. Baker, D. M., Capuano, T., CohenKatz, J., Deitrick, L., Shapiro, S., & Wiley, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout. Holistic Nursing Practice, 19(2), 78-82. Beddoe, A.E., & Murphy, S.O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(6), 305311. Blackwell, J. (2004). The health styles of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 16,

"

"I am a being of light and love"

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Authors Margaret Boehme Perry Brubaker Heather Hansen Helena Class Mika Frazzetta

Mental Health in the University Setting

All too often, mental health issues are dismissed by individuals and society while more acute physical issues are given priority. This marginalization is particularly obvious in the university setting where counseling services are often minimal or nonexistent. Non-university health clinics often receive the benefits of larger staff and funding allocations. 6 Furthermore, students with physical issues are often able to visit health clinics with relative frequency whereas those with mental health issues are limited to a few intermittent visits per semester. 5,6 The focus for this research was to first determine whether there is a need for increased counseling and psychiatric services in the university setting and, if so, how mental health needs can realistically be met considering the constraints of university budgets. young adults in the United States. 4 Additionally, recent research has revealed a positive correlation between mental illnesses, such as mental exhaustion and depression, and physical illnesses such as bronchitis, otitis media, sinus infections, and strep throat. 1

"more than twothirds of university level students either enter college with a moderate to severe mental illness, or will develop some form of illness during their university tenure"

Researchers in both countries have concluded that due to the amount of students with the need for mental health services, the next step is determining how to offer effective services considering the budget constraints of both students and universities. Students surveyed in both the United States and the United Kingdom ranked relationships, financial problems, and excessive study assignments as the primary causes for their mental health issues. 2,5,6 These studies also report that there are only minor disparities for mental health services when considerResearchers in the United Kingdom ing sex, ethnicity, and socio-economic have determined that mental health is- status. Furthermore, no major disparisues in their universities are on the rise ties between these groups were found and therefore merit more funding for among those who were actually using diagnosis and treatment. 6 A longitudi- university offered counseling and psynal study performed in the United chiatric services and those who were not. 6,7 According to recent studies of States from the mid-1980's through early 2000 has shown that mental university students in both countries, health issues have remained constant the major barriers to receiving care inthrough this period. 8 Regardless of clude: (a) not recognizing that they are this difference, studies from both coun- in need of services, (b) not knowing tries consistently confirm that more where to receive help, (c) not realizing than two-thirds of university level stu- that there are often simple and effecdents either enter college with a modtive methods for handling their particuerate to severe mental illness, or will lar problem, and (d) the social stigma develop some form of illness during associated with having any form of their university tenure. Depression mental illness. 4,5,7,9,10 ranking at the top of the list. 2,4,5,8 The Several plausible solutions have seriousness of depression can hardly been offered to address the mental be overstated considering that suicide health needs of students. First, technois the third leading cause of death for logical assessment tools have been

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""...most importantly, there needs to be an increase in student awareness of available resources on college cam-

found useful for immediate triage of students with suspected mental health issues. 5 This tool is able to categorize students using formulated questions to place them into tiers of critical importance. Second, brief therapy sessions have shown to be useful for those experiencing acute mental health symptoms.5,9 Third, the use of selective serotonin reuptake inhibitors versus traditional tricyclic anti-depressants has shown to be effective in the treatment of mental illness in college students. Finally, and most importantly, there needs to be an increase in student awareness of available resources on college campuses.

matched primary care sample. British Journal of Guidance & Counselling. 2007; 35(1): 41-57 4. Garlow, SJ, Rosenberg J, Moore JD, Haas AP, Koestner B, Hendin H. Depression, desperation, and suicidal ideation in college students: results from the American foundation for suicide prevention college screening project at Emory University. Depression and Anxiety. 2008; 25: 482-488 Haas AP, Koestner B, Rosenberg J, Moore D, Garlow S, Sedway J. An interactive web-based method of outreach to college students at risk for suicide. Journal of American College Health. 2008; 57: 15-22 Monk EM, Mahmood Z. Student mental health: a pilot study. Counselling Psychology Quarterly. 1999; 12(2): 199-210

5.

6.

Nurses are essential in the education and support of their clients. There7. Rosenthal B, Wilson CW. Mental health fore, it is critical that they be aware of services: use and disparity among diverse available mental health resources for college students. Journal of American both themselves and others. In a high College Health. 2008; 57(1): 61-67 stress career such as healthcare, nurses 8. Schwartz AJ. Are college students more need to take particular care in order to disturbed today? Stability in the acuity ensure their own mental and physical and qualitative character of psychopathology of college counseling center clihealth. Otherwise, client care will dients: 1992-1993 through 2001-2002. Jourminish and nursing burnout may occur nal of American College Health. 2006; 54 from the combination of stress and ex(6): 327-37 haustion that comes with the job.

9. References 1. Adams TB, Wharton CM, Quilter L, Hirsch T. The association between mental health and acute infectious illness among a national sample of 18- to 24-year-old college students. Journal of American College Health. 2008; 56(6): 657-663 Andrews B, Wilding JM. The relation of depression and anxiety to life-stress and achievement in students. British Journal of Psychology. 2004; 95: 509-521 Connell J, Barkham M, Mellor-Clark J. CORE-OM mental health norms of students attending university counseling services benchmarked against an ageTinklin T, Riddell S, Wilson A. Support for students with mental health difficulties in higher education: the students' perspective. British Journal of Guidance & Counselling. 2005; 33(4): 495-512

puses."

2.

10. Yorgason JB, Linville D, Zitzman B. Mental health among college students: do those who need services know about and use them?. Journal of American College Health. 2008; 57(2): 173-180

3.

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Cultural Competence

It is projected that by 2050 approximately 50% of the U.S. population will consist of ethnic minorities such as Asians, African Americans, Hispanic Americans, Native Americans, and Pacific Islanders.9 Nurses work with communities, families, groups, and individuals whose lives are enriched and challenged by cultural diversity. Therefore, as nurses, we must be culturally aware and be able to demonstrate cultural competence.7 Cultural competency is a set of congruent behaviors, attitudes, polices and structures that come together in a system, agency, or among professionals to work effectively in cross culture situations.3 There is an association between providing culturally competent care and improved provider-client communication, compliance with medical regimes, and satisfaction with care and health outcomes.8 Unfortunately, research shows that nursing curriculum lacks effective teaching on cultural competency in health care.5 Here in the United States the motto "e pluribus unum" meaning "one from many" is indicative of a U.S. society derived from many cultures to become one culture. Positive intergroup relations and participation are sought, while maintaining the culture and heritage of diverse groups is not desired.7 Culturally diverse populations, including minorities whose health practices differ from westernized medicine, often experience a disregard of their healthcare practices and beliefs.7 This is not necessarily from a lack of respect, but due to cultural blindness stemming from a lack of cultural competency among healthcare workers. Cultural blindness is the philosophy of viewing and treating people as the same and encourages assimilations but ignores cultural strengths.7 Examples in medical history, such as the case of Lia Lee, daughter of Hmong immigrants; show that expecting assimilation to western ideas on healthcare does not work. 4 Many nurses believe that they have received little or no cultural awareness education in their nurse training programs. The few that have received educational training in cultural competency generally agree this education was so limited that is was meaningless in their integration of knowledge and knowledge into practice.5 Becoming a culturally competent care provider entails a sequential process of (a) being aware of one's values, demonstrating knowledge and understanding of another's culture, (b) accepting and respecting another's diversity, and then providing culturally relevant interventions.2 Cultural competency must be learned, especially given the focus on assimilation in this country. Culturally competent curricula can guide nurses towards providing care that addresses other cultures' beliefs, practices, and ideas in regards to medicine, health, and overall welfare. Providers with diversity training and higher levels of education attain significantly higher scores on cultural awareness, cultural sensitivity, and cultural competence behaviors than those with less training.4 Case studies, journaling, threaded discussions, and care plans that illustrate ethical dilemmas are all strategies that allow students to rehearse and refine future professional actions.2 One such case study used The

Authors Chelsea Adams Mary Egan Amy Chamberlin Lisa Dove Rachel McCoy Thuy Nguyen

"Becoming a culturally competent care provider entails a sequential process..."

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"It is incumbent on nurse educators to strengthen the ethical commitment of students and their understanding of effective ways to provide health care to diverse populations"

1, 2008, from CINAHL Plus with Full Text Spirit Catches You and You Fall database. Down as a way to instruct cultural competence as an exemplar from 6. Ndiwane, A., Miller, K., Bonner, A., Imliterary journalism.1 Regardless of perio, K., Matzo, M., McNeal, G., et al. the method, nurse educators need to (2004). Enhancing cultural competencies of advanced practice nurses: health care chalwork with students to ensure that lenges in the twenty-first century. Journal of students possess cultural awareness, Cultural Diversity, 11(3), 118-121. Reknowledge, and cultural skills nectrieved October1, 2008, from CINAHL Plus essary to apply in the clinical setwith Full Text database. ting.6 To be effective nurses we need 7. Racher, Frances E. RN, PhD, Annis, Robert PhD, (2007). Respecting Culture to be culturally competent. It is inand Honoring Diversity in Community Praccumbent on nurse educators to tice. Research and Theory for Nursing Pracstrengthen the ethical commitment of tice: An International Journal. 21 (4). 255students and their understanding of 268. Retrieved October 11, 2008, from CINAHL Plus with Full Text database. effective ways to provide health care to diverse populations. Cultural diversity 8. Schim, S. M., Doorenbos, A. Z., & Borse, in our nation is a fact. Culturally conN. N. (2005). Cultural Competence Among gruent nursing care occurs when Ontario and Michigan Healthcare Providers. Journal of Nursing Scholarship, 37, 354nurses and clients come together with 360. Retrieved October 1, 2008, from CIan attitude of cultural humanity and NAHL Plus with Full Text database. respect.8 References 1. Anderson, K. L. (2004). Teaching Cultural Competence Using an Exemplar from Literary Journalism. Journal of Nursing Education, 43, 253-259. Retrieved October 2, 2008, from CINAHL Plus with Full Text database. 2. Cagle, C. (2006). Student understanding of culturally and ethically responsive care: implications for nursing curricula. Nursing Education Perspectives, 27(6), 308-314. Retrieved October 2, 2008, from CINAHL Plus with Full Text database. 3. Evans, B. (2006). The multicultural research process. Journal of Nursing Education, 45(7), 275-279. Retrieved October 1, 2008, from CINAHL Plus with Full Text database. 4. Fadiman, A. (1997). The Spirit Catches You and You Fall Down. New York, NY: Farrar, Straus and Giroux. 5. Leishman, J. (2004). Perspectives of cultural competence in health care. Nursing Standard, 19(11), 33-33. Retrieved October 9. Stanhope, M., & Lancaster, J. (2008). Public Health Nursing Population Centered Health Care in the Community (7th ed.). St. Louis, Mo: Mosby.

Photo By Marlon Sherman with special thanks to the Ogalala Lakota College Nursing Graduating Class of 2008

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Authors Rebecca Morris Sarah Johnson Nikki Mahouski Sheri Creekmore

MRSA

The media portrays methicillinresistant Staphylococcus aureus (MRSA) as a "new" health problem. However, this commonly feared organism has been lurking about for many decades.9 Over time, this bacterium has adapted to survive when a specific group of antibiotics are used to try to kill it. So the question is: are antibiotics the only weapon against MRSA? There is a growing body of research examining alternative ways to combat this feared "Superbug." Perhaps the simplest and most effective combatant against MRSA is the practice of good hand hygiene. A large amount of research has been done on the efficacy of hand hygiene. Two aspects that have been studied are staff compliance with hand hygiene and the comparison of different types of alcohol based hand rubs. In one study, the introduction of a program officer to facilitate a hand hygiene program and the increased availability of alcohol based hand rub solutions significantly increased hand hygiene compliance rates from 21% to 47% and decreased the rates of MRSA infections by 60%.5 Another study showed that hand hygiene compliance is 9-15% higher when the gel formulation is available for use instead of the liquid.10 This same study showed that easy access to hand rub was a stronger predictor of staff compliance than whether or not the solution was liquid or gel.10 A separate research study questioned the quantity of the alcohol based product that must be used in order to be effective. These results showed that twice as much hand rub than the standard pump provides is more effective at disinfection of the hands than the standard amount.6 Overall, the research showed that consistent use of good hand hygiene practices is the key to controlling infections such as MRSA. Among the many natural substances that are being evaluated for the treatment of wounds infected with antibiotic resistant bacteria, honey has been shown to have excellent results. Honey has potent antibacterial and antiinflammatory properties and has also been shown to aide in the debridement of wounds.3,8 Manuka honey is unique from other honey products in that it has very high antibacterial properties.3,8 Therefore it may be more appropriate for use on wounds infected with MRSA. A four week study comparing the efficacy of Manuka honey with the traditional treatment of hydrogel on venous leg ulcers greatly favored Manuka honey as the more effective treatment, especially regarding MRSA rates.4 Manuka honey also greatly reduced wound pain when compared to hydrogel (52% versus 34% respectively).4 Another readily available product being researched for its effects against MRSA is tea tree oil. Researchers have found that using tea tree oil in concentrations similar to that of commercially available products can reduce MRSA counts in the laboratory setting. The tea tree oils tested in one study were effective in killing Staphylococcus aureus. However it took longer to kill the resistant strain (MRSA) than the non-resistant strain (MSSA).7 In contrast, another study tested the kill time rates for MRSA and MSSA using tea tree oil and did not find a significant difference between the two strains.2 Research on this alternative is limited and more studies are needed to confirm the efficacy of this natural product's future as a treatment against MRSA.

Overall research showed that consistent use of good hand hygiene practices is the key to controlling infections such as MRSA

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A treatment that has long been used for removing necrotic tissue from wound beds is now being evaluated for its ability to eradicate MRSA colonization in wounds. It's not glamorous, but a new study looking at the ability of larval therapy to reduce MRSA in colonized diabetic foot ulcers shows some promising results. In a study of 13 diabetic patients with MRSA colonized foot ulcers, MRSA was eliminated from all but one of the thirteen patients who received a series of larval therapy treatments.1 The larval therapy treatment was found to take significantly less time to complete than the traditional treatment and no adverse effects were found.1 MRSA is not an emerging problem. However, we do have current and emerging ways to reduce its prevalence. MRSA is preventable. Focusing attention on improving hand hygiene can drastically reduce MRSA rates. Alternative methods such as Manuka honey, tea tree oil, and larvae are also gaining attention as effective alternatives in treating MRSA. As nurses, it is our responsibility to maintain current knowledge of all available options in controlling MRSA.

References 1. Bowling, F., Salgami, E., & Boulton, A. (2007). Larval therapy: a novel treatment in eliminating Methicillin-resistant Staphylococcus aureus from diabetic foot ulcers. Diabetes Care, 30(2), 370-1. Retrieved October 19, 2008 from PubMed. 2. Brady, A., Lughlin, R., Gilpin, D., Kearney, P., & Tunney, M. (2006). In vitro activity of tea-tree oil against clinical skin isolates of meticillin-resistant and ­sensitive Staphylococcus aureus and coagulasenegative staphylococci growing planktonically and as biofilms. Journal of Medical Microbiology, 55, 1375-1380. Retrieved October 19, 2008 from PubMed. 3. Cooper, R., Molan, P., & Harding, K. (1999). Antibacterial activity of honey against strains of Staphylococcus aureus

from infected wounds. Journal of the Royal Society of Medicine, 92, 283-285. Retrieved October 19, 2008 from PubMed. 4. Gethin G. & Cowman S. (2008) Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. Journal of Wound Care, 17(6), 241-4, 246-7. Retrieved September 5, 2008 from CINAHL Plus with Full Text database. 5. Grayson, M., Jarvie, L., Martin, R., Johnson, P., Jodoin, M., McMullan, C., Gregory, R., Bellis, K., Cunnington, K., Wilson, F., Quin, D., & Kelly, A. (2008). Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated wih a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. MJA, 188(11), 633-640. Retrieved August 30, 2008 from CINAHL Plus Full Text Database. 6. MacDonald, D., McKillop, E., Trotter, S., & Gray, A. (2006). One plunge or two?-- hand disinfection with alcohol gel. International Journal for Quality in Health Care, 18(2), 120-122. Retrieved August 30, 2008 from CINAHL Plus with Full Text database. 7. May, J., Chan, C., King, A., Williams, L., & French, G. (2000). Time-kill studies of tea tree oils on clinical isolates. Journal of Antimicrobial Chemotherapy, 45, 639-643. Retrieved October 19, 2008 from PubMed. 8. Molan, P.C. (2001). Honey as a topical antibacterial agent for treatment of infected wounds. Retrieved November 12, 2008 from http://www.worldwidewounds.com/2001/ november/ Molan/honey-as-topicalagent.html 9. Myatt, R. & Langley, S. (2003). Changes in infection control practice to reduce MRSA infection. British Journal of Nursing, 12(11), 675-681. Retrieved September 20, 2008 from CINAHL Plus with Full Text database. 10. Traore, O., Hugonnet, S., Lubbe, J., Griffiths, W., & Pittet, D. (2007). Liquid versus gel handrub formulation: a prospective intervention study. Critical Care, 11, R52. Retrieved August 30, 2008 from CINAHL Plus Full Text Database.

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Authors Lauren Mitchell Kari Schlueter Luis Clark Allina Sorem MaryRuth Stubbs Amanda Wilson " A skin assessment performed every shift and the use of a pressure ulcer risk tool, such as the Braden scale along with the review of laboratory values, may promote early recognition and prevention of pressure ulcers. "

Pressure Ulcers in Geriatric Population

The geriatric population is at high risk for pressure ulcers (PU) due to the physiological changes that occur with the aging process.1 According to Levine, a geriatric physician, "pressure ulcers are often preventable complications of hospitalization for elderly patients and as such, a low pressure ulcer rate is considered to be an indicator of quality of care".2 As of October 2008, Medicare will no longer reimburse hospitals and nursing homes for treatment of preventable complications such as PUs. Therefore, it is imperative for nurses, physicians, and organizations to consider the three P's: the Patient, Professional responsibility, and Payment to the hospital. Nurses must empower their patients through education related to PU risk factors. Teaching should include adequate nutrition, repositioning, and activity promotion. "Patients who received extra nutritional supplementation developed no pressure ulcers or, if they did, healed better than patients without extra nutritional supplements".3 Patients should be encouraged to shift their weight every 15 minutes while seated and every two hours while lying in bed to relieve pressure.1 Nurses should promote activity by encouraging independence with activities of daily living (ADLs) and assisting with movement. Quality of life is invariably affected by the development of a PU. PUs caused some patients to feel depressed or miserable resulting in decreased confidence related to the emotional, physical, social, and/ or mental impact of having an ulcer.4 Nurses have the professional responsibility to adequately assess, document findings, and treat PUs within the geriatric population. A skin assessment performed every shift and the use of a PU risk tool, such as the Braden scale along with the review of laboratory values, may promote early recognition and prevention of PUs. For example, hypoalbuminemia, a decrease in serum albumin, is associated with a two-thirds increase in pressure ulcer risk.5 The PU assessment must be followed by proper written documentation and photography. The treatment options for PUs are numerous, with current research showing that specific dressings are preferred. Thus, it is the nurses' role to keep up to date with current research. Such research has shown that calcium alginate dressings, followed by hydrocolloid dressings, led to faster healing of full-thickness pressure ulcers among older subjects.6 Due to changes with Medicare reimbursement, facilities must meet standards such as proper documentation of thorough assessments. According to Levine, "If a pressure ulcer is not documented within hours of admission, it is possible that the insurer will determine that the facility `owns' the ulcer, and the facility will risk denial of payment".7 The Centers for Medicare & Medicaid Services (CMS) show national costs for the treatment of PUs are estimated between $5 and $8.5 billion, with treatment costing far more than prevention.7 Additionally, PUs remain "the most common entity on the `no-pay' complications list" for CMS.7 The method CMS will utilize in determining a PU as avoidable or un-

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Humboldt State University Student Nurses' Association

avoidable remains unclear, but it will take a multifaceted approach. According to Levine, "even in the presence of preventive measures, pressure ulcers can occur".7

Text database. 5. Anthony, D., Reynolds, T., & Russell, L. (2000, August). An investigation into the use of serum albumin in pressure sore prediction. Journal of Advanced Nursing, 32(2), 359-365. Retrieved September 30, 2008, from CINAHL Plus with Full Text database.

What it means to be in the SNA: The Student Nurses Association provides students with opportunities to develop their professional career. Also you have the opportunity to participate in the community events (i.e. local health and career fairs) and fundraising. From this experience, students gain a partnership with the community outside the university.SNA is a chapter of NSNA, a nonprofit organization that provides leadership roles for students. You can become a member of NSNA, check out www.nsna.org to join. How to join: Please contact SNA board member, come to a meeting, and/or check out our website www.humboldt.edu/ ~nursclub. Students involved say: SNA was a good experience to compliment my first semester in the nursing program. It was helpful to talk with experienced students about classes, clinical, and other school related adventures. Being part of the SNA also helped me think about how I can use my nursing education to help our community. I would like to continue to be a part of this group into the future. ~Nikki Edge "I enjoyed volunteering at the Woofstock and Paddlefest events out in the community this semester. I think it helps just raise awareness of HSU's nursing program and gets us as nursing students out in the community. Hey, see us somewhere fun, not just looming over you in the hospital." ~Rebecca I enjoyed going out into the community and volunteering. It made me realize what a wonderful profession we are in. -Krista Trone

The prevention of PUs is a crucial therapeutic goal for nurses. As re- 6. Belmin, J., Meaume, S., Rabus, M., Bosearch conducted in the UK indicates, hbot, S. (2002, February). Sequential treatPUs "have long been regarded as the ment with calcium alginate dressings and 8 hydrocolloid dressings accelerates pressure emblem of bad nursing". Considering ulcer healing in older subjects: a multicenter the high cost of treating PUs and the randomized trial of sequential versus nonsedenial of payment by Medicare, it is in quential treatment with hydrocolloid dressthe best interest of the nurse, physiings alone. Trial Journal of American Gerician, and the organization to prevent atrics Society, 50 (2), 269-74. Retrieved September 12, 2008, from CINAHL Plus PUs in order to promote positive client with Full Text database. outcomes and decrease overall spending. 7. Levine, J. (2008a). Preparing for the new

References

1. Lueckenotte,

A., & Meiner, S. (2006). Gerontoligcal Nursing. St. Louis: Elseview.

2. Levine, J. (2008b). Preparing for the new Medicare reimbursement guidelines: part II-documentation of altered skin integrity in the 8. Norton, D., McLaren, R., & Exton-Smith, A. (2002). A study of factors concerned in hospital. Clinical geriatrics, 16(7), 17-20. the production of pressure sores and their Retrieved October 2, 2008, from http:// prevention. 194-223. Exemplary research www.clinicalgeriatrics.com/articles/ for nursing and midwifery, 72-99. Retrieved Preparing-NewSeptember 30, 2008, from CINAHL Plus MedicareReimbursementGuidelinesPartII% with Full Text database. E2%80%94Documentation-Altered-SkinIntegrit. 3. Holm, B., Mesch, L., & Ove, H. (2007, September). Importance of nutrition for elderly persons with pressure ulcers or a vulnerability for pressure ulcers: a systematic literature review. Australian Journal of Advanced Nursing, 25(1), 77-84. Retrieved September 30, 2008, from CINAHL Plus with Full Text database. 4. Spilsbury, K., Nelson, A., Cullum, N., Iglesias, C., Nixon, J., & Mason, S. (2007, March). Pressure ulcers and their treatment and effects on quality of life: Hospital inpatient perspectives. Journal of Advanced Nursing, 57(5), 494­504. Retrieved September 23, 2008, from CINAHL Plus with Full

Medicare reimbursement guidelines: part 1-when are pressure ulcers in the hospital avoidable? Clinical Geriatrics, 16(6), 19-24. Retrieved October 2, 2008, from http:// www.clinicalgeriatrics.com/articles/ Preparing-New-Medicare-ReimbursementGuidelines-Part-I-When-Are-PressureUlcers-Hospital-Av.

Instructor:

Piri Barger RN, MSN, CCRN

Editors: Chelsea Adams, Jill Bidwell, Margaret Boehme, Lisa Haehnichen, Martha Meade, Lauren Mitchell, Rebecca Morris, Heidi Mosher, Kelly Pettit Layout: Debra Barrios, Parry Brubaker, Mary Egan, Molly Evenson, Brigitte Hanlon, Thomas Holmes, Sarah Johnson, Kari Schlueter, Sarah Scott

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