Substance abuse among nurses

The prevalence of substance abuse among nurses is rising and continues to rise. The American Nurses' Association (ANA, 2002) estimates that six to eight percent of nurses use alcohol or other drugs to the extent that they impair their professional performance (ANA, 2002). Because of the incidence of drug abuse among nurses, it is important all nurses to be aware that drug abuse exists among nurses and should know the proper steps to assist their co-worker get the support they need.

Some startling recent statistics show that in the United States, the problems in productivity and employment among individuals with substance abuse problems cost the American economy $80.9 billion. Of this, $66.7 billion was attributed to alcohol and $14.2 billion to other drugs (NIH, 2007). Of course, this does not include the emotional costs to families and individuals such as divorce, alcohol, and drug-related domestic and child abuse, automobile injuries, etc. One out of every ten nurses has engaged in substance abuse and this is a defiant problem for the nursing community. A great strategy for combating substance abuse is being aware of the signs of drug abuse; new nurses can be better equipped to take action against an ever growing issue. An additional strategy is knowledge of factors that contribute to drug abuse among nurses. Finally, learning early on how to manage one’s own stress level can greatly decrease the pervasiveness of drug abuse in the nursing community.
The majority of nurses who receive treatment for problems related to chemical abuse became addicted as students, and were academically in the top third of their class. A majority also hold advanced degrees. It has been estimated that approximately ten percent of nurses are chemically impaired and most disciplinary problems that are addressed by Boards of Nursing are related to nurses in this ten percent (Uris, 2002). Nurses should be educated on the signs and symptoms of substance abuse among their peers. It is important for all nurses to be aware of signs and symptoms of substance abuse, such as, mood swings, diminished alertness, increasing forgetfulness, defensiveness, decreased concentration. Additionally signs of withdrawal, impaired cognition, isolation or withdrawal from colleagues. Substance abuse issues in nursing usually are first noted by staff members. Whether a staff nurse acts on his or her knowledge or chooses to remain silent, directly affects patient care, safety and the reputation of the institution. It also ultimately affects the impaired colleague's level of functioning (Dunn, 2005). By the time a nurse demonstrates negative or inappropriate work habits, the problem already has reached a serious stage. It is advantageous for institutions to create systems that allow for reporting and tracking substance-abuse incidents and provide education and support to help nurses participate in rehabilitation and avoid placing patients in harm's way (Blair, 2003).
Being aware of signs and symptoms is important; however being aware of factors that contribute to substance abuse is another important step in understanding its prevalence. Some of the factors that have been identified as contributing to substance abuse are: psychological or physical pain, emotional problems, a demanding high-pressure and stressful work environment, and family problems. Additional factors that have been known to contribute are previous emotional or mental health problems, family members with chemical dependency, depression, anxiety, or mental, emotional, or sexual abuse (George, 2003). Some recent studies have shown that nurses who work in oncology have overall high substance use rates. One theory for this behavior is that controlled substances serve as a coping mechanism to help nurses distance themselves from the emotional pain they may experience while working with dying patients (Dunn, 2005). Psychiatric nurses also experience high levels of substance use. Nurses working in psychiatric areas may consider self-medication more acceptable because they work in a culture that accepts using psychotropic medications to cope with life (Anderson, 2004). Additionally, psychiatric nurses may be more willing to report their use of substances than other specialty nurses because they perceive this as an acceptable form of treatment. Pediatric and women's health nurses report the lowest use of addictive substances. This could be due to the lack of availability of these substances on their units, or it could be that this population of nurses is emotionally expressive (NIH, 2003). People who are able to express their feelings may have less need for substance use.
Learning about the signs and symptoms and knowledge about contributing factors are great ways to decrease the prevalence of substance abuse Furthermore, increasing education about management of stress levels is another strategy that can help reduces substance abuse in the workplace. Stress provides another explanation for why some nurses abuse substances. Increased workloads, decreased staffing, double shifts, mandatory overtime, rotating shifts, and floating to unfamiliar units all contribute to feelings of isolation, fatigue, and, ultimately, stress (Ponech, 2005). Each person feels stress and handles it in different ways; learning early on how to effectively manage stress can be extremely beneficial in finding alternative ways to decrease stress. Chronic stress can result in increased sensitivity to stress and cause more susceptible to the effects of stress. Research indicates that increased sensitivity to stress actually alters physical patterns in our brain, thus if stress is uncontrolled it can lead to emergency measure to decrease it, and thus leading to the use of substance abuse (Anderson, 2004). To aid in learning how to decrease stress here are a few strategies for decreasing stress: learning to take time out for self care, regular exercise, good communication with family, friends and co-workers, planning productive solutions to problems, ask for support when feeling stressed out, and learning to set clear limits.
To actively combat this issue of substance abuse that imperils patients and gives rise to a bad reputation toward nurses, all nurses should be aware of the signs and symptoms of substance abuse; to strive for better communication in their homes and within the work place. To find out what helps them manage their stress levels and to fervently practice self care that will aid in the decrease of physical, emotional, and psychological stress. By being aware of the signs and symptoms nurses’ know what signs may point to the need for intervention for their co-worker. By being knowledgeable about factors that contribute to substance abuse nurse can identify those factors if present in their own lives and can get help before those issues become uncontrolled. Understanding how stress correlates with substance abuse nurses’ can utilize alternative means to reduce stress in their life, ultimately reducing the prevalence of substance among the nursing community.

“Helping the impaired nurse is difficult, but not impossible. The choices for action are varied. The only choice that is clearly wrong is to do nothing.”
National Council of State Board of Nursing








Intervention # 1 Being aware of signs & symptoms of substance abuse.
Intervention # 2 Knowledge of factors that contribute.

Intervention #1
~ Disadvantages
a.) If nurses are aware of signs and symptoms they may be better able to hide there problem. Nurses may become more capable of masking there substance abuse by being more cautions not to exhibit the signs and symptoms that they were taught are associated with substance abuse in the workplace (Dunn). Examples of signs and symptoms that are taught are as follows, and being aware of these can contribute to the ability to facade the issue in a nurse set on not getting caught. Attendance. Look for sporadic absences, a day at a time and usually on a Friday or Monday. Appearance. Take note of a nurse who shows a sudden dramatic change in her personal grooming. Affect. Watch for disturbing shifts in a nurse's personal traits-her facial expressions, voice, posture, and gestures. For example, an outgoing nurse may suddenly become stone-faced and uncommunicative. Attitude. Pay attention to any changes in a nurse's attitude toward work. A staff member noted for her efficiency may suddenly begin taking longer to complete tasks. And listen closely to patients' complaints: A neglectful nurse may have a drug or alcohol problem.

b.) While researching this paper it became unambiguous to see all the many different, well thought out, techniques nurses use to steal medications. It is outlined in many different articles step-by-step how nurses go about obtaining controlled substances. By merely researching the signs and symptoms it could potential lead to an open door for someone who might be interested in obtaining medication to be aware of techniques that others have tried (NIH). Below is an example of how knowledgeable impaired nurses are about their addiction habits.

More than 15 years of my life are a blur I remember only a few landmarks through the fog of alcohol, cocaine. Dilaudid, Demerol, heroin, and other drugs. I was in and out of psychiatric units and drug treatment programs. I cycled through a dozen or so boyfriends. For extra money, I waited on tables or tended bar. But mostly I worked in hospitals-as a nurse. Yes, I took vital signs, changed dressings, gave medications, charted-the same things you do
every day. Many of the drugs I used came from the medication cabinets of some very well run hospitals.
But no one ever confronted me about my addiction. It's easy for an impaired nurse to "hide." I preferred to work the night shift, when staffing was minimal and there were no supervisors or visitors around. I also liked neurosurgery units; patients with head or spinal cord injuries were less likely to complain about taking a p.r,n medication. The final turn of events came one night when I told a patient with a spinal cord injury he needed medication he didn't want, I gave myself the Demerol, and then tried to give him sterile water. He refused it, so I put the syringe back in the drawer. Apparently, my nurse-manager suspected me because as soon as I put the syringe in the drawer, she confiscated it. I knew she'd fire me once she found out it contained only water, so I quit. I participated in group meetings with other recovering doctors and nurses. That was one of the toughest parts of treatment. I told them I felt good about the work I'd done as a nurse. Immediately, they confronted me, pointing out that 1 couldn't be an addicted nurse and a good nurse at the same time. I was surprised by their frankness. They knew about lying to yourself. And they knew that only friends who cared enough to be tough and honest could break through that denial. My recovery hasn't been easy. I haven't made it without stumbling but I wanted to live my life without taking drugs-and I've reached that goal. Today, I counsel adolescents at the treatment center that helped me recover. It's the best job I've ever had. Now I'm grateful that I have the chance to give back some of what I've been given. That's one reason I'm telling my story. If you have a problem with drugs or alcohol, you can get help. Recovery isn't easy, but it's worth the price.
(Alexander).


Intervention # 2
~ Disadvantages
a) By being aware of the all the contributing factors, nurses might tend to think that anyone that has some of these factors are suspicious of substance abuse. Therefore, being untrusting of their colleague, and constantly watching over there back, which in turn may bring down the units trust and moral (Ponech). Nurses are at risk for drug abuse because of the availability of medications in the workplace and the cultural acceptance within nursing that pharmacologie agents provide a desirable method to cure one's ills. Health care provides a permissible climate in which to use exogenous substances to correct internal feelings or illnesses. Nurses have been taught that medications solve problems. They have seen medications alleviate pain, cure infections, and diminish anxiety. Not only are prescription medications accessible, but nurses also have a mistaken belief about their personal skills and level of knowledge to self-medicate without becoming addicted. Self-medicating behaviors may only be viewed as inappropriate when the magnitude and regularity of these behaviors increases. Access creates a familiarity with controlled substances that can increase the likelihood that nurses will use them on their own. Nurses may erroneously believe that they have the ability to control and monitor their own use of medications because of their experience with administering medications and observing their effects on patients Some nurses "believe that they are immune to the negative consequences of drug use because they are so familiar with drugs." (Dunn).


b.) Nurses that may have contributing factors, or who are at high risk for substance abuse may feel that they are being targeted or looked down on by their nursing peers. Thereby, discouraging them form asking for help if needed, or feel un-apart of the team because they don’t feel comfortable discussing their personal life with any of their co-workers; which may lead to depression and feelings of inadequacy in their careers (ANA). Recognizing that substance abuse is a medical illness that requires treatment is the first step in removing the stigma associated with it. Current philosophies of the ANA and boards of nursing support helping addicted nurses seek treatment and rehabilitation to become productive members of society and nurses again. Certainly, communication and information sharing are paramount for this process to be effective.
It is only logical that a nurse who is suspected of abusing substances should be reported. It is the emotional aspect that undermines the reporting process. Being fearful that a colleague may lose his or her job or terminate a friendship are powerful motivators to withhold or dismiss anecdotal or subjective information. As social beings, people are motivated by emotions; the ability of nurses to report a colleague would be less hampered, however, if one of their loved ones was being cared for by a nurse who was impaired. As patient advocates, this is the level of nursing at which all nurses should practice.


 

References:


Alexander, D. (2005). When nurses are addicted to drugs. Nursing. (2) 50-58 Retrieved for Proquest February 29th 2008.

American Nurses Association (2002). ANA code of ethics for nurses. Washington DC.


Anderson, J. (2004). Treatment considerations for the addicted nurse. Behavioral Health Management. (14) 22-26. Retrieved from Proquest September 30, 2007


Blair, P. (2003). Report impaired practice-stat. Nursing management. (33) 23-25. Retrieved from Proquest October 12, 2007


Dunn, D. (2005). Substance abuse among nurses-defining the issue. Association of operating room nurses. (82) 592-596. Retrieved from Proquest October 1, 2007.


George, M. (2003). Substance abuse among healthcare professionals. Nursing Ethics. (14) 843-849. Retrieved from Proquest October 9, 2007


National Institute of Health (2007) www.drugabuse.gov/infofacts/costs.html


Ponech, S. (2005). Telltale signs. Nursing Management. (31) 32-37. Retrieved from Proquest October 12, 2007


Uris, P. (2002). Chemical dependency handbook for nurse managers. National Council of State
Boards of Nursing. Retrieved from www.dora.state.co.us/nursing October 12, 2007

Click Here to Read More..

Autoethnography and Mental Health Nursing

It is no secret that it takes a special kind of person to be a mental health nurse. Qualities and abilities such as well-developed self-awareness, acceptance of self and others’ feelings, an understanding of the complexity of the human experience, an ability to accept ambiguity and uncertainty, willingness to take responsibility for self, and provision of trust and respect are crucial for the effective psychiatric mental health nurse (Foster, McAllister & O’Brien, 2006).

But how does one integrate all these qualities effectively in practice? How does one become an effective mental health nurse? Foster, McAllister & O’Brien, 2006, state that autoethnography is the answer. According to them, autoethnography, the study of "self" should be an integral part of every mental health nurse's practice to ensure the highest level of care.

There has been little research, and little literature has been written on the topic of autoethnography, and its use. Foster, McAllister & O’Brien, 2006, in their article “Extending the Boundaries: Autoethnography as an Emergent Method in Mental Health Research”, talk about the use of autoethnography as a new approach to caring for the mentally ill, as well as a research method, with the emphasis on mental health nursing research.

The same authors, in an article published in December 2006, talk about the experiences of a doctoral student whose mother is mentally ill, and the process through which she used autoethnography to generate new research in the field, and relate to other mentally ill patients.

Other articles such as “Nursing Student Attitudes to Psychiatric Nursing and Psychiatric Disorders in New Zealand” (Surgenor, Dunn & Horn, 2005) and “A Survey of Mental Health Nurses’ Experiences of Stalking” (Ashmore, Jones & Jackson, 2006) talk about the different experiences that nurses have with mental health patients. These articles show how different interactions with mental health patients change nurses’ attitudes, and the way that they interact with their patients thereafter.

It is a well known fact that attitudes, beliefs, values, life experiences and even religious practices greatly impact nurses’ ability to care. In most areas of nursing practice, attitudes and beliefs are mostly positive. When it comes to mental health however, nurses attitudes and beliefs may be less positive. This in turn, may negatively impact the level of care that mental health patients receive.

Research by Reed & Fitzgerald, 2005, found that attitudes were found to be linked to issues that influence nurses’ ability to provide care. Dislike was also apparent from nurses who suggested mental health care was not their role. One of the most prevailing feelings however was fear, which caused avoidance. James & Cowman, 2007, identified attitudes towards clients with bipolar disorder to be less then favorable. The authors recognize that mental health patients are more difficult to care for than other patients. As a result, these patients receive care that is inadequate.

Autoethnography has been defined as “the study of self” (Foster, McAllister & O’Brien, 2006). A process through which a nurse looks at herself and identifies her own attitudes, beliefs and values about mental health, and issues that are involved in mental health nursing in order to improve their care of the mentally ill. This way, psychiatric mental health nursing is seen as being directed by the nurse’s own characteristics, who is working together with the client to create a therapeutic relationship and to improve or maintain the client’s health.

In order for the nurse to effectively interact with the client, the nurse needs to first be able to understand that her character has been constructed by a set of experiences that is different from the patient’s. Social constructivism is a perspective that maintains that people develop a sense of what is real through conversation with, and observations of others (Foster, McAllister & O’Brien, 2006). This means that whatever the nurse holds to be real, might not be real for the patient, because his experiences have been different. Thus a nurse cannot impose her perception of reality onto the patient because of her different experiences. A nurse cannot be therapeutic until she realizes that what is real, and what makes sense to her, might not be real, or not make sense to a patient. Autoethnography works by having the nurse look at what her reality is, takes note of what the patients’ reality is, and only then, can the nurse make a final judgment.

“Psychiatric mental health nursing research literature also recognizes the importance of the quality of engagement between nurse and the client as being integral to the nurses effective use of self” (Foster, McAllister & O’Brien, 2006). The way that a nurse interacts with the patient, and the quality of their relationship, is crucial for a therapeutic environment. Foster, McAllister & O’Brien, 2006, also state that clients themselves have reported that provision of respect, security, confirmation, and companionship are some of the most valuable aspects of the nurse-client relationship. How can nurses provide these to the patients, when the nurses are afraid of patients, avoid patients and or believe that it is not their role to take care of these patients? It is impossible for the nurse to provide security for these patients when they themselves are scared. It is impossible for the nurse to provide companionship to these patients when the nurse avoids them. If the nurse cannot effectively talk to, listen to, and empathize with the patient, there is no therapeutic relationship.

Using autoethnography, the nurse first needs to understand that she dislikes these patients, is afraid of these patients, and avoids these patients. The nurse than must think and identify the reasons for these behaviors. Why is it that the nurse fears and avoids these patients? Then she must remedy the problem By doing so, the nurse just went from a nurse who fears and avoids a patient, to a caring nurse who can develop a healthy therapeutic relationship with the patient. By doing so, the nurse becomes a caring nurse who can develop a healthy therapeutic relationship with the patient.

Autoethnography is the process through which nurses evaluate their own attitudes and beliefs towards mental health. This way they can correct any misconceptions or false beliefs about mental health patients they might have. In this manner they can provide the best care possible. It is a process which should be applied by every nurse that has a mental health patient in her care.

INTERVENTION 1

The nurse will identify her own thoughts, feelings and perceptions about the mentally ill client and the disease process that can interfere with the quality of care provided and set them aside while caring for the mentally ill client.

Disadvantage 1

Knowledge deficit

Knowledge deficit is a big problem in mental health nursing. Many research studies have concluded that most nurses are undereducated about how to care for mentally ill patients. Because of the limited amount of education, nurses rely on their own beliefs, perceptions and values when setting standards in their care for the mentally ill clients (Reed & Fitzgerald, 2005). A lot of nurses have their preset beliefs that mentally ill patients are difficult to take care of, assaultive and non cooperative and simply hard to take care of. A lot of times nurses attribute these qualities to all mentally ill patients (Reed & Fitzgerald, 2005). It is hard for them to understand that this is not necessarily true and that she needs to set these feelings aside. Because of the lack of education in caring for these clients, these nurses make further mistakes in their care which in turn reinforces their false beliefs. The nurse goes on attribute these qualities to the patient’s condition and does not perceive them as their own beliefs and perceptions. This makes it even harder for the nurse to implement this nursing intervention while caring for the mentally ill client.

Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database.

Disadvantage 2

Pt. discrimination/dislike.

Dislike and discrimination of mentally ill clients has been thoroughly studied and documented. Most of the time, this attitude stems as a result of the choices the patients make. Choices which make it more difficult for the nurse to provide care (Reed & Fitzgerald, 2005). Mentally ill clients can become easily agitated, non cooperative, resistive and paranoid (Reed & Fitzgerald, 2005). They also make poor choices and judgment calls. In most cased hygiene standards are usually very low also. This leads the nurse to develop a sense of dislike towards these patients. This attitude makes the nurse more reluctant to identify her own attitude as a barrier in quality care. As a result, there is a further increase in the nurses' anxiety, dislike and avoidance of the patients. This type of attitude also increases the use of medical and mechanical restraints which can be very detrimental to the patient.

Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database.

INTERVENTION 2

The nurse will sit with the mentally ill pt. for at least 20 minutes to listen to the pt’s “story”, identify the pt’s belief system, thoughts, perceptions and degree of cooperativeness to help nurse better understand patient and increase comfort level with patient.

Disadvantage 1

NEGATIVE PAST EXPERIENCES.

Past experiences with mentally ill clients can either strengthen or ruin the perception of these clients to the nurse. Negative experiences heavily influence the nurses’ perception of these patients, the care they deserve, and even the nurses own perspective on her ability to provide care for these patients (Ashmore, Jones & Jackson, 2006). Nurses who had negative experiences with mentally ill clients experienced an increase in their level of anxiety, increased feelings of unhappiness and anger. They also said they felt less relaxed, outgoing, happy and competent in their care (Ashmore, Jones & Jackson, 2006). The same article stated that 37.5 percent of nurses who had a stalking experience ignored the patient afterwards, 14.3 percent of nurses yelled at the person, and 19.6 percent pleaded the person to stop (Ashmore, Jones & Jackson, 2006). Experiences as such, can make the nurse avoid a situation where she has to sit and talk with the mentally ill client. She will also be reluctant to develop nursing interventions in which the nurse has to spend time with the patient. This can make the relationship even worse and have a negative outcome on the plan of care.

Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database

Disadvantage 2

FEAR.

Fear is the biggest barrier in providing quality care for the mentally ill patient. The nurses are worried about their physical safety and the safety of other coworkers on the ward. They also feel vulnerable professionally, ethically and legally about the action they might have to take to avoid harm if such action should be necessary (Reed & Fitzgerald, 2005). This can cause a gap in between the nurse and the patient. As a result, the nurse can end up avoiding the patient, keep their distance and take shortcuts when interviewing them. For communication to be effective in the nurse/mentally ill client relationship, the nurse has to show empathy, warmth, respect, patience and trustworthiness (Foster, McAllister & O’Brien, 2006). When the nurse fears these patients, she can’t show any of these qualities to these patients, thus making it hard to implement this intervention.

Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database

References:

Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database.

Surgenor, L., Dunn, J. & Horn, J. (2005, June). Nursing student attitudes to psychiatric nursing and psychiatric disorders in New Zealand. International Journal of Mental Health Nursing, 14, 103-108. Retrieved October 20, 2007 from CINAHL database.

Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database.

Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database.

James P. & Cowman S. (2007 October). Psychiatric nurses' knowledge, experience and attitudes towards clients with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 14, 670-678. Retrieved November 1, 2007 from CINAHL database.

Foster K., McAllister M. & O’Brien L. (2005 December). Coming to Autoethnography: A mental health nurse’s experience. International Journal of Qualitative Methods, 1-13. Retrieved November 1, 2007 from CINAHL database.

Click on the Edit HTML tab. Paste the first two sentences of your old paper over these words, with your name. Leave the following text intact.

Paste the rest of your old paper plus the new part and all the references over these words. Leave the following text intact.

Click Here to Read More..

Nurses and Breastfeeding

The American Dietetic Association [ADA] (2005) recommends that all infants be breastfed for the first 12 months of life with the addition of complimentary foods after 6 months of age (Spear, 2005). Yet in the United States, the percent of infants being breastfed for the first 12 months is only 17% to 20%. (ADA, 2005).

Nurses are often the people entrusted to provide lactation education and support to new mothers. Despite this, lactation education can be and often is lacking. More thorough breastfeeding education in nursing schools can help to better equip nurses for providing effective breastfeeding counsel and support (Spear, 2005). Nurses employed in hospitals should advocate for the development of a hospital wide policy regarding breastfeeding (Wallis & Harper, 2007). In addition, nurses involved in caring for new mothers should receive continual training on breastfeeding counseling and lactation through continuing education coursework, clinical experiences and in-service training (US Department of Health and Human Services [USDHHS], 2000). When these strategies are implemented, the nurse, as a client educator, will be effective in increasing exclusivity and duration of breastfeeding, thereby promoting wellness in both mother and infant.

Breastfeeding provides many benefits to both mother and child. Maternal benefits can include reduced postpartum bleeding, decreased uterine involution time, improved bone density and reduced risk of breast and ovarian cancer. Some of the numerous benefits for the child are protection against infectious and non-infectious diseases, decreased risk of childhood obesity, reduced risk for heart disease, enhanced immune system, and decreased risk of diarrhea and respiratory infections (ADA, 2005). Breastfeeding also offers an economic way to provide optimal nutrition to the baby (ADA, 2005). Notwithstanding, there are many barriers to breastfeeding among all populations. Many women do not breastfeed because they lack a full understanding of its benefits. Others refrain because of embarrassment and social disapproval, especially when it comes to breastfeeding in public. Some feel that breastfeeding will make them less attractive, and others feel they cannot breastfeed due to work or school responsibilities (ADA, 2005).

A nurse who has been prepared can help a woman overcome these barriers with information, resources and counsel on breastfeeding. Unfortunately, many nurses do not have the education necessary to be able to educate others on breastfeeding. This is evidenced by a survey done on students who had successfully completed their obstetric nursing courses. Only 22% of surveyed students knew that breast milk has antibacterial properties, 85% did not know that breastfeeding is recommended for the first year of life. Forty-one percent thought that formula and breast milk were nutritionally equivalent (Spear, 2005). In order to correct this educational deficit, students interested in working in obstetrics or pediatrics can be offered breastfeeding and human lactation seminars. These seminars can help students learn to identify and overcome barriers to breastfeeding. Possible seminar supplements include a maternal breastfeeding panel to help students see the mother’s perspective on breastfeeding initiation, and participating in clinical experiences with lactation specialists (Spatz, 2005).

After thorough education on lactation in nursing school, a nurse in the hospital setting can continue to improve breastfeeding success rates by advocating for the development of an effective hospital policy on breastfeeding. All staff should be aware of and follow this breastfeeding policy (Wallis & Harper, 2007). Appropriate policies should address a number of topics including, staff training in the skills needed to implement the policy, early initiation of breastfeeding, education of pregnant women about the benefits of breastfeeding, education of mothers on how to breastfeed and maintain lactation, limited use of any food or drink other than human breast milk, rooming-in, breastfeeding on demand, limited use of pacifiers and artificial nipples, and fostering of breastfeeding support groups and services (USDHHS, 2000).

Once a breastfeeding policy is in place, all involved staff members should receive the necessary training to enable them to follow that policy. Many nurses on staff in maternal and newborn units lack experience, and therefore confidence, in helping a new mother breastfeed. This anxiety can inadvertently be communicated to the mother and be detrimental to the breastfeeding process (Wallis & Harper 2007). One option for this training is through the requirement of continuing education coursework on human lactation and breastfeeding (USDHHS, 2000). Wallis and Harper (2007) reference a hospital that holds three breastfeeding workshops a year; which all employees are encouraged to attend. These workshops focus on practical management of breastfeeding, advantages of breastfeeding, and initiating and maintaining lactation. In addition, a new mother always attends to share her experience with breastfeeding. New staff should receive immediate training on breastfeeding and human lactation as well as on the hospital breastfeeding policy (Wallis & Harper, 2007). This will allow for hospital staff to provide continuity of care to the woman and child.

Breastfeeding is not “popular” in the United States. The nurse, as a client educator, can increase exclusivity and duration of breastfeeding, thus reversing this trend. This will result in improved wellness in both mothers and infants. When nurses receive adequate education on lactation in nursing schools, help develop hospital policy on breastfeeding, and participate in continuous on-the-job training to improve their skill and knowledge in helping women breastfeed, they become more effective at their role in helping mothers initiate and maintain breastfeeding.


a. Intervention 1 -More thorough breastfeeding education in nursing schools.


i. Disadvantage 1 - Offering extra classes will not provide enough education to change the current trends.
Providing extra courses and seminars for those students who plan on going into fields that involve mother and baby will be beneficial to these particular students, if they choose to take them. However, many nurses do not have a specific are of nursing in mind while still in school, but later on will switch to maternal and newborn nursing. Breastfeeding information and training must become a larger part of basic nursing curricula (Spear, 2005). This will help to provide all nurses with the skills and current information to provide support to the breastfeeding mother. If the general nurse is prepared to support mothers in breastfeeding, outcomes for exclusivity and duration will likely improve.

Spear, H. J., (2005). Baccalaureate nursing students’ breastfeeding knowledge: A descriptive survey. Nurse Education Today, 26, 332-337. Retrieved January 3, 2007 from Expanded Academic ASAP database.


ii. Disadvantage 2 - Incorporating more breastfeeding education into the basic curricula will be ineffective with the current general nursing textbooks.
Nursing students have several textbooks that might contain information on breastfeeding such as a maternal and child or nursing fundamentals textbook. Trying to improve students’ knowledge of breastfeeding best practices could be very ineffective with these texts. Phillipp, McMahon, Davies, Santos and Jean-Marie (2007) discovered upon analyzing the breastfeeding information in six maternal newborn nursing textbooks, that many textbooks are deficient in the area of breastfeeding. All of the books that were reviewed had important breastfeeding information that was inaccurate, inconsistent, or omitted. In order for incorporating breastfeeding education in to the basic curricula to be effective, new textbooks with accurate and complete information will need to be used.

Phillipp, B.L., McMahon, M.J., Davies, S., Santos, T., & Jean-Marie, S. (2007). Breastfeeding information in nursing textbooks needs improvement. Journal of Human Lactation, 23(4), 345-349.


b. Intervention 2 –Nurses in hospitals should advocate for a hospital-wide breastfeeding policy.


i. Disadvantage 1 –A policy to give no other food and drinks to newborns besides human milk unless medically necessary is discriminatory.
Contemporary evidence has shown that initiating breastfeeding within the first hour of birth is beneficial to both mother and child. The first days of life for the newborn is when many babies receive colostrum from their mothers. This colostrum is the source of maternal antibodies for the babies and is beneficial to them in many other ways as well. Conversely, in many Asian cultures, colostrums is viewed as old milk and not good for the babies health (Kaeswarn, Moyle, & Creedy, 2003). This cultural conflict can cause difficulty for both the nurse and the new mother who share these cultural beliefs about colostrums. The nurse must put her beliefs aside and do as the hospital policy states. The new mother can be put in a vary uncomfortable situation where she can choose to confirm to hospital rules or defy them and stay true to her beliefs and perhaps be labeled as a difficult patient (Kaeswarm et al., 2003). An effective policy would also need to address the cultural issues surrounding breastfeeding.

Kaeswarn, P., Moyle, W., & Creedy, D. (2003). Thai nurses’ beliefs about breastfeeding and postpartum practices. Journal of Clinical Nursing, 12, 467-475. Retrieved January 31, 2008 from Expanded Academic ASAP database.


ii. Disadvantage 2 –Mothers who choose not to breastfeed can be labeled as poor mothers.
There is much research stating that breast milk is the optimal food for a newborn. Despite this, there are many reasons for which a mother might choose to not breastfeed her child. Even though breastfeeding is best for the child in most cases, the mother still has the right to choose whether she will breastfeed the child. Strict policy against using formula in hospitals can alienated the mothers who do not want to breastfeed. Nurses and doctors, in some instances, have tried to convince the mother to change her mind using tactics that border on coercion. These mothers can be made to think that death will be eminent for her child if she does not breastfeed. All mothers should be educated on the benefits of breastfeeding, but if they choose to use formula they should be provided with information on how to choose formula and successfully nourish her baby. Not providing any type of formula education could actually cause harm to some children (Kent, 2006).

Gerorge, K. (2006). Child feeding and human rights. International Breastfeeding Journal, 1(27).


References
American Dietetic Association. Promoting and supporting breastfeeding (2005). Journal of the American Dietetic Association, 105, 810-818.
Spatz, D.L. (2005) The breastfeeding case study: a model for educating nursing students. Journal of Nursing Education 44(9), 432-437. Retrieved September 24, 2007 from Proquest database.
Spear, H. J., (2005). Baccalaureate nursing students’ breastfeeding knowledge: A descriptive survey. Nurse Education Today, 26, 332-337. Retrieved January 3, 2007 from Expanded Academic ASAP database.
US Department of Health and Human Services. (2000). HSS blueprint for action on breastfeeding. Washington, DC: Author. Retrieved January 19, 2007 from www.4women.gov/breastfeeding/bluprntbk2.pdf
Wallis, M. & Harper, M. (2007) Supporting breastfeeding mothers in hospital: part 1. Paediatric Nursing. 19(7), 48-52. Retrieved September24, 2007 from EBSCO Host database.

Click Here to Read More..

Family Centered Care in the NICU

Roughly 12.5% of all babies born in the United States each year are premature (Archibald, 2006). That is a about half a million children being born before the 37th week of gestation is complete.

While in the hospital, new parents need an advocate. That advocate can be the registered nurse. The role of the RN is that of a care provider for the neonate. However, it is also one of an educator and facilitator of communication for the needs of the family. Too often families are made to feel like visitors in special areas of the hospital like the NICU (neonatal intensive care unit). By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
When a newborn and parents are separated, the necessary bonding time is greatly diminished. According to Wong (2006), infants begin to develop a sense of trust as they learn the feel, sound, and smell of their parents. When their parents are gone, the neonate must learn to trust the nurses. However, the nurse is also associated with pain as well as comfort. It is important for the parents to be enveloped in the care of their child so that the neonate does not begin to associate pain with their care provider. During this time, the parents also discover the personality of their infant and how to recognize their needs by the behavioral cues displayed. When their time is limited in the NICU, the personalities go undiscovered and these cues go unlearned. When the previously mentioned strategies are put into practice, these developmental tasks can be completed successfully.
The first strategy is to create a family centered care plan (FCC). By incorporating family centered care into the unit, those stresses can be alleviated tremendously. FCC is creating a partnership between the parents and the hospital staff. There are four main concepts to FCC. They are dignity and respect, information sharing, family participation, and family collaboration (Cisneros, 2003). Though implementing family centered care can be difficult, it brings positive outcomes for both the family and the child. There is not a single way that all neonatal units must operate their family centered care. Each location is different depending on the needs of the staff and patients. The facility begins with a vision and a philosophy. It is suggested that the staff in the neonatal unit participate in developing these documents. Sharing of ideas and reviewing all feedback allows for a clear and well developed vision to emerge. Families are also an integral part of developing FCC. Those who have the experience of having a child in the neonatal intensive care unit are a valuable resource to consult when making changes to the program.
The second strategy is finding ways to involve parents in the care of their child. Parents are no longer seen as visitors but as critical components in the care plan of the child. Unlimited access to their baby at any time of the day is essential. It is important for the parents to be able to be there to comfort their child and learn ways to ease their tensions and pain. The nurse is the educator for the parents. He or she provides the information and guidance to help the parents through this difficult time. Two important areas that the nurse needs to help the mother in are kangaroo holding and breastfeeding. Kangaroo holding is skin to skin contact between mother and baby. These things are necessary, not only for the development of the infant, but also as a way for the mother and child to bond. Parents are encouraged to participate in the care of their child while they are in the NICU. Physical contact, especially kangaroo holding, has been shown to help the baby thrive as well as promote bonding between child and parent (Johnson, 2005). They show the parents how to take part in the infants care so that they may spend as much time as they wish with their baby. Many infants in the NICU have feeding problems or are unable to digest properly. The NICU nurse aids the mothers in breast and bottle feeding. The nurse takes time to show the parents how to read monitors, adjust equipment, and explain difficult medical jargon so that they are comfortable and understand clearly. Parents leave the NICU with a bond to the staff that cared for their child. Some even bring the baby back to show that they are thriving. “It’s a great reminder that the NICU isn’t a horrible place. Most babies leave here and grow into happy, healthy kids. You’d never know that they ever had a health problem” (American Baby, 2007).
The third strategy is developing good communication with the families. The largest contribution to family-centered care is the participation of the families. The NICU nurse is not only a caregiver and educator, but he or she must be an excellent communicator. As a result of being informed of every detail, the parents feel a sense of involvement and control in their decision making. By providing explanations and honest answers, the nurse helps the parents to build confidence in their abilities. Being this close allows the parents to make better decisions regarding the care of their baby and gives them the opportunity to become more connected to the child. Daily communication between the nurse, the other hospital staff, and the parents keeps the flow of family centered care moving. If the parents do not feel included in their infants care plan, then family centered care has not been achieved. “To support the philosophy of FCC, attention must be paid to teaching and supporting nurses’ communication skills, and relationship building with self, peers, and families” (Griffin, 2006).
While taking care of the half a million children born prematurely each year, the role of the RN is that of a care provider for the neonate and an educator and facilitator of communication for the needs of the family. The purpose of FCC is to provide the parents with a greater role in the care of their infant. By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
Archibald, C. (2006, Mar-Apr) Job satisfaction among neonatal nurses.
Pediatric Nursing. Pitman: Vol. 32, Iss. 2, p. 162, 176-179.

Cisneros-Moore, K., Coker, K., DuBuisson, A. & Swett, B. (2003, April) Implementing potentially better practices for improving family-centered care in neonatal intensive care units: success and challenges. Pediatrics 111. Retrieved Apr. 22, 2007 from www.pediatrics.org.

Griffin, T. (2006, Jan-Mar) Family-centered care in the NICU. Journal of Perinatal & Neonatal Nursing 20. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.

Johnson-Nagorski, A. (2005, Jan-Feb) Kangaroo holding beyond the NICU. (Updates & Kidbits)(neonatal intensive care unit). Pediatric Nursing 31. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.

Special babies, special care. American Baby. Retrieved April 13th, 2007 from http://www.americanbaby.com.

Wong, D., Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D. Maternal Child Nursing Care. St. Louis: Mosby, 2006.
a. Intervention 1 –Incorporating a family-centered care plan
i. Disadvantage 1 – The family-centered care plan that the facility has adopted may not fulfill the needs of each individual family.
Unrestricted access to their infant and treatment participation only may not fulfill the emotional and psychiatric needs of the family. It takes more than just family-centered care to assist the parents. Hospitals that offered a combination of formats for support services: group support, one-to-one support, and telephone support were more effective at meeting the needs of the infant’s parents. (Hurst, 2006). The family-centered care ideology is all too often “cookie-cutter” and not adaptable to the individual family needs.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252. Retrieved February 3, 2008 from ProQuest database.
ii. Disadvantage 2 – Support groups are more effective than family-centered care.
Parents often become frustrated when they have a child in the NICU. The unknown environment and language can be overwhelming. Though family-centered care tries to alleviate these issues, it has several hang-ups. It does not leave the parents with an outlet for frustrations. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care (Hurst, 2006). By having others to talk with who are going through the same experiences, the families can become more connected and have a place to discuss their fears and concerns.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252-255. Retrieved February 3, 2008 from ProQuest database.
b. Intervention 2 –NICU nurses need to develop good communication skills and fully share care information with the family.
i. Disadvantage 1 – Years of experience and clinical work setting influenced both perceptions and practices of family-centered care.
A recent study of sixty-two licensed registered nurses looked at the level of implementation of family-centered care. It covered the necessity of family-centered care and current nurse practices. According to Peterson, Cohen, and Parsons, 2004, scores representing current nursing practice of family-centered care were significantly lower than those representing its necessity (p = .000). Nurses with 10 years or fewer of neonatal or pediatric experience scored significantly higher on both the total Necessary Scale (p = .02) and total Current Scale (p = .017) than did those with 11 years or more. Nurses who work in the NICU scored significantly lower on the total Necessary Scale (p = .013) than did nurses who work in pediatrics or PICU. Although nurses agree the identified elements of family-centered care are necessary, they do not consistently apply those elements in their everyday practice.
Peterson, M., Cohen, J., & Parsons, V. (2004). Family-centered care: do we practice what we preach?. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN., 4, 421-424. Retrieved January 31, 2008 from ProQuest database.
ii. Disadvantage 2 – The fear of the unknown and a lack in trust of the healthcare provider can lead the mother to feel trapped. Heermann, Wilson, and Wilhelm (2005) reported that mothers "struggled to mother" because nursing interactions pushed the mothers to the sidelines and left the mothers feeling unimportant in the life of their child. The power struggles between the mothers and the nurses with each trying to position herself as the 'expert' on the infant. Heermann, Wilson, and Wilhelm (2005) found that mothers attempted to negotiate partnership relationships with professional caregivers but that their actions were frequently misunderstood or unrecognized. Thus, the primary focus in this study was the mother's developing relationship with the infant and ways in which that relationship was affected by interactions with the nurses.
Heermann,J., Wilson,M., Wilhelm, P. (2005). Mothers in the NICU: outsider to partner Pediatric Nursing, 3, 176-183. Retrieved January 31, 2008 from ProQuest database.

Click Here to Read More..

Preventing Heart Disease

Travis Cox

As of 2007, heart disease is the leading cause of death in the United States and it includes a variety of diseases relating to the heart (AHA, 2007). Heart disease is very costly and creates quite a burden for the patients affected as well as their families.

As of 2007, heart disease is the leading cause of death in the United States and it includes a variety of diseases relating to the heart (AHA, 2007). Heart disease is very costly and creates quite a burden for the patients affected as well as their families. With nursing education, heart disease can be reduced. It can also help maintain the health of patients at risk or those who have been diagnosed with heart disease. Nurses have the proper training and are more cost effective than using physicians for educational means. With proper nurse education and intervention through nurse led clinics, clients who either have heart disease or are at risk for heart disease will have significantly better quality of life. Heart disease targets people who are with hypercholesterolemia, have hypertension, hyperglycemia, which are smokers or, TABP (Type A Behavior Patterns) which has been recently added to the list (AHA, 2007). Because these problems are very prominently found in today’s society, heart disease is common and hard to avoid. In 2005, it was estimated that the cost of heart disease in America was $394 billion (CDC, 2005). This ever-increasing problem can be avoided or managed by maintaining basic day to day activities which include: decreasing cholesterol in daily diet, avoiding obesity by regular exercise, avoiding a sedentary lifestyle, smoking cessation, controlling diabetes and having regular check ups and health screenings. (CDC, 2005) As a nurse, strategies such as education, screenings in outpatient clinics and community screening can lead to a decrease in heart disease and better lives for those with heart disease.

There are many techniques that a nurse can utilize when educating people on the importance of preventing heart disease. Diet, exercise and smoking are three main categories that ought to be addressed. The American Heart Association has many pamphlets and brochures that talk about strategies and methods to prevent this disease (AHA, 2007). Education should focus on the methods used to prevent heart disease such as reducing cholesterol, lowering salt intake and avoiding obesity. Avoiding foods high in saturated and trans fat can help reduce cholesterol. One of the biggest obstacles for this issue is educating those in poverty who find it easier and cheaper to eat a ninety-nine cent high fat cheeseburger then to buy fresh fruits and vegetables from the grocery store (Wright, 2007). Preventative diets include ones high in vegetables and fruits as well as avoiding large quantities of red meat and foods high in Omega-3 fatty acids (found in many seafood products). One of the most common preventative diets is the Mediterranean style diet which consists mainly of olive oil, bread, abundant fruit and vegetables, a moderate amount of wine, and animal products such as lamb, sausage and goat cheese (Wright, 2007). Exercising regularly can also help to reduce the risk of heart disease. It is recommended that the average adult get 30 minutes of moderate exercise 5 times a week (AHA, 2007). Nurses should also promote smoking cessation programs or products that can help people to stop smoking such as nicotine gum or patches. There are nearly 135,000 smoking-related cardiovascular disease deaths per year (AHA, 2007). Education on this matter can be the first step to promoting a healthy lifestyle and reducing the occurrence of heart disease.

Along with education, people screened early and screened often have a better chance of avoiding or fighting heart disease. Nurse led clinics have been a proven resource in reducing the number of people with heart disease as well as improving the lifestyle of those with heart disease (CDC, 2005). Studies involving three different styles of outpatient teaching methods and screenings were done and compared in 2001. These studies showed that people responded to and were more apt to attending nurse led clinics. The study compared hospital screening, physician run clinics and nurse led clinics. The results showed that the nurse run clinics had more visitors with a better rate of identifying patients at risk. They also had better follow up care and better education retention with an overall 85% success rate and a 33% better overall experience according to patients (Campbell, 2005). Nurse led clinics also were more cost effective per patient with better success rates according to a 2005 study which showed that nurse led clinics can thrive financially in a community while serving a valuable purpose (Berg, 2007). Clients at these clinics receive advanced screenings based on their predisposition to heart disease. They will receive proper education, screening for blood pressure and cholesterol and monitoring for patients with heart disease to help them get on track (Berg, 2007).

Besides nurse led clinics, nurses can help educate and screen in the community. Mobile operation centers such as school and office screenings can be set up with correspondence to the American Heart Association (AHA, 2007). These mobile screenings can have a significant impact in catching people pre disposed or those who may have early signs of heart disease but have not yet been diagnosed. These early tests (education, cholesterol and blood pressure screening) can save a life as well as start someone down the right path in getting well. These early warning stations can also be a very helpful resource for preventative education.

Strategies such as education and early detection are the absolute key to preventing heart disease. Nurses can be a valuable tool in all these venues. Nurses can help people pre disposed to heart disease to stay healthy and treat people with heart disease so that the quality of life for these people becomes better rather then declining into a state where the disease process takes over and eventually ends in death. Overall nurses can educate, prevent and sustain people’s health regarding heart disease. Nurses are cost effective, properly trained and caring enough to get the job done.

INTERVENTION DISADVANTAGES:

Disadvantage A)
Mobile operation centers such as school and office screenings can be set up with correspondence to the American Heart Association (AHA, 2007). These mobile screenings can have a significant impact in catching people pre disposed or those who may have early signs of heart disease but have not yet been diagnosed.

Reason Number 1:
The cost of running and maintaining these mobile operation centers would be to costly to justify their use.

To make this option work well, the city would be required to make an investment to a fleet of vehicles, man power to operate and maintaining those vehicles, man power to work out of those vehicles and screen patients, the cost of supplies, advertising the location of screening clinics and possible paying for temporary housing for the vehicles. According to an article from Children’s Advocate, the cost of running a mobile health center can be over $500,000 in the first year and then $250,000 every year after that to maintain the program. This money would need to come from taxes, fund raisers or private funding which is not practical (Santana, 2005).



Reason Number 2:
Pre screening of patients does not determine that those people at risk or currently living with heart disease will have the motivation or means to seek out regular professional medical help.

The range of people who would be screened in this system is to vague to guarantee that people would follow up with primary care providers or seek out providers if they currently do not receive care. With our current health care system those uninsured would not benefit from this except by gaining some understanding of a disease that they may have. They do not have the insurance or money to seek out routine care to guarantee their future health. Those with insurance or means to seek out care may not follow up with their doctors. We can not be sure that the costs will not out way the benefits. In a research article published in PHN, who screened 222 people for ongoing visits to the mobile centers and follow up exams 3 in 10 people screened did not seek further medical expertise. 8 in 10 of these people could not afford the cost of medical exams, further treatment or transportation to medical facilities (Betty, 1998).

Disavantage B)
Nurse led clinics have been a proven resource in reducing the number of people with heart disease as well as improving the lifestyle of those with heart disease

Reasons number 1:
Nurse led clinics cost more per individual then medical facilities that can meet all of their needs.

The cost of running a nurse lead clinic is astronomical, without MD support the services provided are limited and patients still have to be referred to other medical facilities. Although they may be able to screen and educate they can not do numerous treatments needed to help patients. Patients would much rather be seen in an all encompassing site where all there needs can be met. In a study of 19 nurse led clinics that dissected the willingness of patients to pay for the amount of services rendered for heart disease the cost was (on average) $254 higher in the nurse clinics providing intervention then in just assessing and educating. This extra cost per individual would make it very hard for a nurse led clinic to compete with other medical centers (Campbell, 2005).

Reason number 2:
Nurse led clinics do not have the resources to effectively treat and manage people with heart disease.

Nurse led clinics lack the resources available to treat heart disease patients. They must be referred to treatment centers and hospitals for continuous care. Although nurse led clinics can help educate and prevent heart disease they still lack this essential tool to treat people with heart disease. In my research for this article I found that a majority of clinics that were nurse led failed because of the feeling that they were not giving adequate care to their patients (Campbell, 2005).

References

American Heart Association (AHA). (2007). Exercise and Fitness. Retrieved October.
17, 2007 from http://www.americanheart.org/presenter.jhtml?identifier=1200013

Berg, S., Hertz, P.. (2007). Outpatient Nursing Clinic for Congenital Heart Disease Patients: Copenhagen Transition Program. Journal of Cardiovascular Nursing, 22, 488-492. Retrieved November. 17, 2007 from http://www.jcnjournal.com.

Betty, A., Elnitsky, C. (1998). Rural Mobile Health Units: Outcomes. Public Health Nursing. Vol. 15 (1), 3-11. Retrieved January. 31, 2008 from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1525-1446.1998.tb00314.x?cookieSet=1&journalCode=phn

Campbell, N.C., Murchie, P., Ritchie, L.D., & Thain. J. (2005). Running nurse-led secondary prevention clinics for coronary heart disease in primary clinics: Qualitative study of health professionals’ perspectives. British Journal of General Practice, 55, 522-528. Retrieved April. 12, 2007 from PubMed Central database.

Campbell, N., Murchie, P., Raferty, J. (2005) Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial. BMJ, 707. Retrieved January. 31, 2008 from http://www.bmj.com/cgi/content/full/330/7493/707

National Center for Chronic Disease Prevention and Health Promotion (CDC). (2005). Preventing Heart Disease and Stroke. Retrieved October. 17, 2007 from http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/cvh.htm

Santana, J. (2005). Going Out to the Community, Mobile Clinics Bring Health Care to Families. Childrens Advocate, 12, 96 – 100. Retrieved January. 31, 2008 from http://www.mobilehealthclinicsnetwork.org/featured.html

Wright, J. (2007). Nutritional Spices of Life. Journal of Community Nursing, Vol. 21 (10), 10-16. Retrieved November. 21, 2007 from http://www.jcn.co.uk/index.html


Travis Cox

Click Here to Read More..

Adolescent HIV Prevention and Education

Sexually active young people in the United States are at persistent risk for HIV infection. This risk is especially notable for youth of minority races and ethnicities.

Continual prevention outreach and education efforts are required in order for adolescents to receive clear and accurate information. Approximately 4,842cases of HIV are diagnosed yearly among people ages 15-24 years (Eaton et al., 2006). With this rate of HIV infections among adolescents it is clear that additional efforts are required as new generations replace the generations that benefited from earlier prevention strategies. Adolescents are receiving mixed messages regarding HIV due to the medications that are now available and longer life expectancy of those living with the disease. Nurses working with adolescents can be pivotal in reaching youth before high-risk behaviors are established by identifying high risk adolescent populations, promoting education, and eliminating barriers to testing.

The Centers for Disease Control and Prevention (CDC) has conducted biennial Youth Risk Behavior Surveillance (YRBS) studies since 1991 in order to identify priority risk behaviors among youth. The results for the YRBS are obtained from students in grades 9-12 who participate in national, state, or local surveys. Of the students surveyed, 46.8% had engaged in sexual intercourse at least once in their life (Eaton et al., 2006). Male students were consistently ranked higher in risk taking behaviors than female students. Minority students (African American and Hispanic) predominately had more risk behaviors than Caucasian males or Caucasian females. These behaviors included multiple sexual partners, unprotected intercourse, and injection drug use (Eaton et al., 2006). Although most students receive some form of preventative health care annually, few discuss STD, HIV, or pregnancy prevention at those visits (Burstein, Lowry, Klein, & Santelli, 2003).

Understanding and identifying adolescent populations that are statistically at higher risk for HIV is a key strategy for nurses. Beedy-Morrison, Nelson, and Volpe (2005) provide evidence that Caucasian adolescent girls engage in higher HIV risk behaviors and receive less HIV testing compared with African American adolescent girls. Although HIV prevalence is higher among African American adolescents, the authors emphasize the implications the result of this study has on health care professionals. According to the findings, if Caucasian girls are more likely to engage in risky sexual behaviors and yet are less likely to be tested, there may be many undiagnosed HIV cases. In addition to the undetected HIV cases, the information health care professionals utilize to identify high risk groups may be inaccurate. Authors Goodenow, Netherland, and Szalacha (2002) found significantly high rates of HIV risk behaviors among bisexual adolescents. A study conducted in Seattle and British Columbia supports the previous research but also found a higher likelihood of HIV risk behaviors among sexually abused students in all sexual orientation categories (Saewyc et al., 2006). Nurses must promote greater community awareness of at-risk adolescents and seek to educate those populations. Education can occur through street outreach, pamphlets with referrals, posters, and classes where youth are located such as the YMCA or Boys and Girls Clubs of America.

Another key strategy for nursing professionals is to provide reality based education. HIV education should include “skills in negotiation, conflict resolution, critical thinking, decision-making and communication, which improves their self-confidence and ability to make informed choices such as postponing sex until they are mature enough to protect themselves from HIV, other STIs and unwanted pregnancies” (Unicef, 2002, p.26). Rew, Whittaker, Taylor-Seehafer, and Smith (2005) suggest that nurses must make sure confidentiality boundaries are established in order to build trust. Adolescents are more receptive to nurses that are open and direct and move from less sensitive topics to more sensitive topics during an assessment. Nurses must assist youth in establishing clear goals for preventing HIV and focus on specific health behaviors related to those goals. Adolescents need to be encouraged to talk with their parents and delay sexual intercourse. If delaying sexual intercourse is not an option adolescents must be taught about the risks and effective contraception methods that will protect against pregnancy, STD’s, and HIV.

An additional strategy nurses need to utilize is to eliminate barriers to sexual health promotion in order to provide effective HIV education. Barriers such as embarrassment, worries about confidentiality, previously bad experiences, and access problems can prevent an adolescent from seeking care. Lindberg, Lewis-Spruill, and Crownover (2006) found that African American adolescents “viewed available healthcare systems as formidable and unwelcoming and healthcare providers as judgmental and disrespectful” (p.85). The adolescents pointed to lack of privacy, having to discuss the problem with multiple personnel including the receptionists, and long waiting times as major barriers. In order to target adolescents, they need a place where they can receive competent care in a relaxing, private, and adolescent focused environment. A teen health clinic with a non-medical environment and open staff is one solution to this problem. Other options include private entrances for teens or a prescribing nurse available at schools.

Currently, we do not yet have a cure or vaccine to prevent HIV. This disease is still winning the war but there is an arsenal of weapons at our command. Nurses must have the know-how and the ability to utilize the resources available. The key to making a difference for adolescents is the adoption of successful HIV prevention interventions, paired with ongoing evaluation of their effectiveness in reducing risky behaviors or increasing safer behaviors. The key strategies addressed provide a foundation to prevent adolescent HIV infection rates. However, many more strategies will be required in order to find success. Young people need the tools to protect themselves from HIV infection and it is going to require a community collaborative effort.

Intervention I- Provide Reality Based Education

Disadvantage I- Limited and Inconsistent HIV Education

HIV prevention work cannot take place without certain ‘tools’ – things that can be used by those at risk of HIV to prevent infection. Ongoing discrimination against HIV positive people and a high number of annual infections suggest that AIDS education in the US is not as effective or as widespread as it could be. A 2006 survey for example found that 10% of Americans thought that there were drugs that could cure HIV, and 29% thought HIV could be transmitted through kissing. Although comprehensive sex education in schools is generally considered the best context in which to teach about AIDS, only around 60% of teachers report using a comprehensive (or abstinence-plus) system. About 34% teach strict abstinence-only programs, while at least 6% teach absolutely nothing at all. The exact content of what is taught can also vary considerably, and many have reported that even in schools where comprehensive education is theoretically taught, a lot of important information can be missed out or glossed over.

UNICEF (2002). Young people and HIV/AIDS: Opportunity in crisis. New York, NY: Author. Retrieved October 2, 2007, from http://www.unicef.org/publications/files/pub_youngpeople_hivaids_en.pdf

Disadvantage II – Outside Variables Can Affect HIV Curriculum Success

Important factors other than curriculum characteristics may dramatically affect their success. In general, at least three groups of factors may affect whether a curriculum-based program produce behavior change: 1) the characteristics of the curriculum and its implementation; 2) the needs, deficits (and assets) of the youth being served by the program; and 3) the characteristics of the youths’ environment, especially the prominence of AIDS, other STDs or teen pregnancy. In some communities in the United States where few young people hear messages to delay sex until older and where HIV is a salient issue, programs that encourage young people to delay sex in order to avoid HIV may be effective, whereas they might not be effective in other communities where youth already hear those messages or where HIV is not a salient issue.

Kirby, D., Laris, B.A., & Rolleri, L. (2006). Sex and HIV education programs for youth: Their impact and important characteristics. Family Health International, 1-76. Retrieved from www.etr.org on January 28, 2008

Intervention II – Eliminating Barriers to HIV Prevention Education

Disadvantage I – Health Care Access and Poverty Prevent Youth From Seeking Care

Studies have found that young people face a host of barriers to health care, including limited access to transportation, lack of confidentiality and youth-friendly service delivery environments, fear about seeking care, and lack of information about services available. Nearly 1 in 4 African Americans and 1 in 5 Hispanics live in poverty. The socioeconomic problems associated with poverty, including lack of access to high-quality health care, can directly or indirectly increase the risk for HIV infection.

Burstein, G.R., Lowry, R., Klein, J.D., & Santelli, J.S. (2003). Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits. Pediatrics, 111(5), 996-1002. Retrieved January 3, 2007, from Expanded Academic ASAP database.

Disadvantage II- Less Effort to Reaching “Other” At-Risk Populations

There is a need to pay more attention to the needs of specific groups of young people like young parents, young lesbian, gay and bisexual people, as well as those who may be out of touch with services and schools and socially vulnerable, like young refugees and asylum-seekers, young people in care, young people in prisons, and also those living on the street. Young people who drop out of school are more likely to become sexually active at younger ages and to fail to use contraception.

Rew, L., Whittaker, T.A., Taylor-Seehafer, M.A., & Smith, L.R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing, 10(1), 11-19. Retrieved October 2, 2007, from EBSCO Research database.

References

Beedy-Morrison, D., Nelson, L.E., & Volpe, E. (2005). HIV risk behaviors and testing rates in adolescent girls: Evidence to guide clinical practice. Pediatric Nursing, 31(6), 508-513. Retrieved January 14, 2007 from Expanded Academic ASAP database.

Burstein, G.R., Lowry, R., Klein, J.D., & Santelli, J.S. (2003). Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits. Pediatrics, 111(5), 996-1002. Retrieved January 3, 2007, from Expanded Academic ASAP database.

Eaton, D.K., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Harris, W.A., & et al. (2006). Youth risk behavior surveillance-United States 2005. Morbidity and Mortality Weekly Report, 55(SS-5), 1-112. Retrieved January 31, 2007, from http://www.cdc.gov/mmwr

Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey. American Journal of Public Health, 92(2), 203-210. Retrieved January 9, 2007, from PubMed central database.

Kirby, D., Laris, B.A., & Rolleri, L. (2006). Sex and HIV education programs for youth:Their impact and important characteristics. Family Health International, 1-76Retrieved from www.etr.org on January 28, 2008.

Lindberg, C., Lewis-Spruill, C., Crownover, R. (2006). Barriers to sexual and reproductive health care: Urban male adolescents speak out. Issues in Comprehensive Pediatric Nursing, 29(2), 73-88. Retrieved October 2, 2007, from EBSCO Research database.

Rew, L., Whittaker, T.A., Taylor-Seehafer, M.A., & Smith, L.R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing, 10(1), 11-19. Retrieved October 2, 2007, from EBSCO Research database.

Saewyc, E., Pooh, C., Murphy, A., Skay, C., Richens, K., Reis, E. (2006). Sexual orientation, sexual abuse, and HIV risk behaviors among adolescents in the pacific northwest. American Journal of Public Health, 96(6), 1104-1110. Retrieved October 2, 2007, from EBSCO Research database.

UNICEF (2002). Young people and HIV/AIDS: Opportunity in crisis. New York, NY: Author. Retrieved October 2, 2007, from http://www.unicef.org/publications/files/pub_youngpeople_hivaids_en.pdf

Click Here to Read More..

Smoking Cessation and the Role of the Nurse

Habitual smoking is a worldwide health crisis that can shorten life expectancies by over 20 years and create fatal illnesses such as lung cancer, emphysema and heart disease (Whyte,2007).Because smoking can lead to chronic and acute illnesses, nurses can have and impact on their clients health by educationg them on the importance of smoking cessation.


Paste the rest of your old paper plus the new part and all the references over these words. Leave the following text intact.Nursing strategies for this are to act as role models by not smoking themselves, promoting smoking cessation in the adult clients, and educating children and adolescents on the dangers of taking up smoking.
The International Council of Nurses believes that nurses can be very helpful in the prevention of smoking and smoking cessation. Nurses can help to reinforce this influence on their client’s by not smoking themselves since they are regarded by the public as important health role models. Just as important, or even more so is to provide a good example for their own children in order to safeguard the nurses health and that of their family. Children of smokers have an increased risk of sudden infant death syndrome, respiratory infections, lung cancer and ear infections (Kellogg, 2002).
Smoking and the willingness to try a smoking cessation program should be assessed with clients. Nurses working in Dr’s offices who see the same clients on a regular basis are in an optimal position to do this. Cost should not be a deterrent since the clients’ employer may offer programs or their insurance benefits may cover the cost of smoking cessation programs. While some clients may not be ready to quit, the nurse may follow an approach called the “transtheorhetical model of change.” This method is a way to help clients move through stages such as: precontemplation, contemplation, preparation, action and maintenance in order to prepare them for smoking cessation. During precontemplation, the client has no intent on quitting smoking in the next six months. The contemplation stage is the time that the client has an intention to quit during the next six months time. Preparation is the stage that the client has planned to quit in the next 30 days and has taken behavioral action toward action. The stage that follows preparation is the action stage which includes clients who have quit for less than six months. Lastly, is the maintenance stage in which the client has remained free of smoking for more than six months.
Another approach for the nurse to use with smoking cessation is the intervention steps known as the five A’s which include: ask, assess, advise, assist and arrange (Whyte, 2007). Asking clients about their smoking is always the first step. For the younger person asking about what their friends do is also important. Assessing includes whether or not the client is ready to make a change within the next 30 days. Advising pertains to providing help and motivation for the smoker to quit. Assisting the client could include many options such as: setting a quit date, recommending smoking cessation pharmacotherapy, removing all tobacco items from the clients’ environment, individual or group therapy, expecting challenges and enlisting help from friends and family. Lastly, arranging follow up contact by either in-person or telephone conversations to keep track of the client and continue with support.
Nurses can also help support their clients by educating them on the available pharmacotherapy treatments for smoking cessation. There are six currently available treatments approved by the Food and Drug Administration (FDA) for smoking cessation: one nonnicotine treatment and five nicotine replacement products that differ based on delivery mechanism (Ford, 2006). The nicotine replacement products include the nicotine inhaler and nasal spray which are available by prescription and the nicotine gum, lozenge and patch which are available over the counter. Clients should be advised to completely stop smoking before using nicotine replacement product to increase their chance of success. Sustained-release bupropion (bupropion SR) is approved by the FDA for smoking cessation, is available by prescription in tablet form and should be started before the client stops smoking. It is believed to ad smoking cessation through the inhibition of various neuro chemicals normally activated in the brain by smoking (Scanlon, 2006). Bupropion SR Bupropion SR and the nicotine patch can be combined for another alternative.
While interventions and pharmacotherapy’s can be effective in smoking cessation with the adult population, smoking prevention among children and adolescents is better than the cure. The younger a person begins to smoke, the greater their risk of smoking-induced diseases such as cancer or heart disease (Whyte, 2002). For this age group, peer lead prevention programs can be very effective. These can include videos or films which highlight the social consequences such as: smelly clothing, bad breath, financial cost and decreased athletic ability. Nurses working in schools can help by promoting smoke-free environments and reinforce the dangers of smoking.
Smoking has many adverse effects on health and contributes greatly to morbidity and mortality. Because smoking can lead to chronic and acute illness, nurses can have an impact on their clients’ health by educating them on the importance of smoking cessation and the avoidance of smoking in children and adolescents. Nurses can also set a healthy example by not smoking themselves. These strategies can help to increase abstinence rates and decrease tobacco-related mortality and morbidity which can help to improve their client’s lives.
Intervention #1- Promoting smoking cessation in adult clients.
Disadvantage #1- The high addictiveness of cigarettes.
Due to the high addictiveness of tobacco, clients participating in smoking cessation treatments do not always respond as readily as many healthcare professionals would like. It is the complex neurobiology of tobacco that is likely to be responsible for the development of tobacco dependence. The nicotine is the principal addictive component of tobacco smoke and shares many of the pharmacological characteristics of a psychostimulant drug such as amphetamine and cocaine.
Balfour, D., (2002). The Neurobiology of Tobacco Dependence: A Commentary. Respiration. 69, (1). 7-11. Retrieved February 4, 2008, from Proquest database (677604631).
Disadvantage #2- The financial costs of smoking cessation treatments.
Smoking cessation medications can range in price from $3.50 to $11.00 per day. Medicare does not cover smoking cessation treatments and private insurers have been reluctant to cover these costs as well. Their lack of coverage comes even as the healthcare savings has been estimated to be $1,623 a year for each person that quits smoking. Fortunately, tobacco cessation treatments are available and effective, and more medications are being developed to treat tobacco dependence. However, the inability of tobacco users to afford these treatments remains a barrier to reducing smoking cessation.
Solberg, L., (2005, June). Impact of insurance coverage on the use and effects of smoking cessation medications. Disease and Management Health Outcomes. (3). 151-58. Retrieved February 5, 2008, from EBSCO database (1173-8790).

Intervention #2-Educating children and adolescents on the dangers of taking up smoking.
Disadvantage #1-Peer pressure and the smoking behavior of their closest friends.
Research findings show that adolescent peer relationships contribute to adolescent cigarette smoking. Youth who are friends with smokers have been found to be more likely to smoke themselves than those with only nonsmokers as friends. Best friends, romantic partners, peer groups and social crowds all have been found to contribute to the smoking or non-smoking behavior of teenagers. Rather than coercive pressures, the decision to smoke has been found to be more about trying to fit in, social approval and popularity.
Castrucci, B.C., Gerlach, K.K., Kaufman, N.J., Orleans, C.T., (2002, September). The association among adolescents’ tobacco use, their beliefs and attitudes, and friends’ and parents’ opinions of smoking. Maternal and Child Health Journal. 6(3). 159-67. Retrieved from EBSCO database February 5, 2008.
Disadvantage #2- Advertising and promotion of smoking that appeal to adolescents.
Despite tobacco industry claims, researchers have consistently implicated cigarette marketing activities as an important catalyst in the initiation of smoking in adolescents. Due to advertising, studies show and increase in smoking rates among population subgroups specifically targeted by marketing campaigns.
Biener, L., (2000, March). Tobacco marketing and adolescent smoking: more support for a casual inference. American Journal of Public Health, 90(3). 407-11. Retrieved February 5, 2008, from EBSCO database (0090-0036).


References

Kellogg, John Harvey, (2002, June). Tobaccoism. American Journal of Public Health, 92 (6). 932-934. Retrieved October 12, 2007, from EBSCO database (0090-0036).

Potts, Lisa A., (2007, August 15). Emerging psychotherapies for smoking cessation. American Journal of Health-System Pharmacy, 64 (16). 1693-1698. Retrieved October 12, 2007 from EBSCO database (1079-2082).

Saarman, L., Daugherty, J, & Riegel, B. (2002, June). Teaching staff cognitive-behavioral intervention. MedSurg Nursing, 11(3). 144-151. Retrieved January 7, 2007, from Expanded Academic ASAP database (A87509029).

Scanlon, A. (2006, November). “Nursing and the 5A’s guideline to smoking cessation interventions”. Australian Nursing Journal, 25(4), 14- . Retrieved January 7, 2007, from Expanded Academic ASAP database (A154562471).

Whyte, F., & Kearney, N. (n.d.). Enhancing the nurse’s role in tobacco control. Retrieved February 4, 2007, from http://www.tobacco-control.org/tcrc_Web_Site/Pages_tcrc/Resources/Factsheets/enhancenursesrole.pdf

Click Here to Read More..

Anaphylaxis

Anaphylaxis and its treatment
Gary Darley

Anaphylaxis is a rising threat to the lives of many people. Recent increases in the number of serious reactions seen in emergency rooms, have led to the need for an increased awareness of the causes and treatment of anaphylaxis (Sampson, 1601). The intent of this paper is to explain what is happening during an anaphylactic reaction and what the protocol is to correct it. The science of treating anaphylaxis is relatively well understood, and when established protocols are followed, treatment of anaphylaxis is highly successful.

Anaphylaxis and its treatment
Anaphylaxis is a rising threat to the lives of many people. Recent increases in the number of serious reactions seen in emergency rooms, have led to the need for an increased awareness of the causes and treatment of anaphylaxis (Sampson, 1601). The intent of this paper is to explain what is happening during an anaphylactic reaction and what the protocol is to correct it. The science of treating anaphylaxis is relatively well understood, and when established protocols are followed, treatment of anaphylaxis is highly successful.
To start, anaphylaxis is defined by Brown as, a severe, life-threatening generalized or systemic hypersensitivity reaction (157). Finney states that, anaphylaxis is a severe allergic reaction, where the body’s immune system over-reacts to a harmless substance. The reaction becomes so strong that it threatens imminent death through hypotension, bronco-constriction and hypovolemia, if no action is taken to negate the effect (50).
While anaphylaxis can be mistaken for other conditions such as, an asthma attack, arrhythmia, myocardial infarction, pulmonary embolism, insulin reaction or vaso-vagal response, it is important to note, that most anaphylactic reactions occur within minutes of exposure to an antigen (Finney, 52). Signs and symptoms include pallor, hypotension, anxiety, respiratory distress, pulmonary edema, angio-edema, stridor, tachycardia, urticaria, wheezing and tightness of the chest (53).
Among the chief causes of anaphylaxis are food-induced causes, namely peanuts, tree nuts, fish and shellfish (Sampson, 1601). It is important to note that these are the major foods that cause anaphylaxis, but not the only ones. Other causes include exercise induced, venom reactions or reactions to therapeutic drugs (Brown, 158). In 15-32% of reactions according to Brown, no causative agent was identified. This makes preventing reactions from reoccurring more difficult (157).
There are two major parts of the immune system which are responsible for anaphylactic reactions. First are basophils and second are mast cells. Basophils are a type of white blood cell that carries histamine, heparin and other inflammatory factors. They are found in the blood stream. Mast cells are basophils that have left the blood stream for body tissues, such as loose connective tissue, gastrointestinal mucosa, lungs and the area around blood vessels. In addition to histamine, heparin and inflammatory factors, mast cells also carry spasmogens (Bryant, 24). When working properly these two cell types effectively aid your body in combating invading organisms and keep you healthy. They do this by working with lymphocytes and memory cells. As lymphocytes react to an antigen they produce antibodies and memory cells. The antibody attaches to the antigen inactivating it. Memory cells stay in the vascular system, ready to rapidly produce antibodies, so as to put a quick stop to any identical antigens that may invade. The combination of antigen and antibody attaches to the basophil or mast cell, which then releases chemical signals, primarily histamine. The release of these chemicals attracts another type of white blood cell, an eosinophil for phagocytosis (Bryant, 24-25).
In an individual who is prone to anaphylaxis the basophils and mast cells over produce histamine and other inflammatory factors, or degranulate releasing their entire chemical stores (Bryant, 25). This causes a cascade of events to occur. Vessels dilate and become more permeable to fluids, causing third spacing of fluid and edema. A decrease of up to 35% of blood volume can occur in ten minuets or less, resulting in hypotension and hypovolemia. Airway constriction due to direct histamine action on smooth muscle and edema in the airway decrease a patient’s ability to effectively breathe. Without immediate intervention, most patients will asphyxiate or go into cardiac arrest (Brown, 159).
Several factors exist which predispose an individual to having an anaphylactic reaction, a history of asthma, food allergy (especially to nuts and sea food), history of anaphylaxis, pubescent patients and patients on beta-blockers or angiotensin-converting enzyme inhibitors. As the majority of reactions come from a foreign substance entering the body, the keystone to anaphylactic therapy is prevention (Sampson, 1606). On those occasions when a reaction does occur, treatment must be immediate.
Treatment of anaphylaxis follows the airway, breathing and circulation rule. Epinephrine is the cornerstone of initial treatment for anaphylaxis. Formerly called adrenaline, epinephrine counter-acts the anaphylactic reaction by relaxing the smooth muscles of the airway, constricting blood vessels and suppressing the release of histamine (Finney, 54). 0.15mg for children and 0.3mg of epinephrine for adults can be carried in an easy to use auto-injector called an Epi-pen. The longer it takes to treat the patient with epinephrine, the greater the incidence of complications and fatal reactions. Once initial treatment is performed, an assessment of the patient’s oxygen saturation, overall perfusion and cardiac output must be performed (Sampson, 1604-1605). While epinephrine does a good job initially, additional therapy may be needed in the form of oxygen, to maintain adequate blood saturation, and IV fluids to combat circulatory fluid loss (Brown, 161). Oxygen via mask or nasal canula maybe used, or if necessary artificial ventilation can be used (Brown, 164). Albuterol is sometimes employed to aide in opening the airway. While normal saline may be used, the preferred fluid replacement is an isotonic crystalloid such as Lactated Ringers (Bryant, 161). After treatment has been successful, a four hour observation period is recommended. This is to ensure the reaction does not recur after the epinephrine wears off (Brown, 163). The figure on the following page is a step by step process taken from Brown, showing anaphylactic treatment (164).
Once a patient has been diagnosed with an anaphylactic reaction, education on what to do is essential. A trigger needs to be isolated by an allergist, so that avoidance is possible. The patient needs to be taught the signs and symptoms of an anaphylactic reaction. They then need to understand how to use a portable epinephrine injector, such as the Epi-Pen. Once the Epi-Pen has been used, transport to an emergency room needs to follow, even if the patient seems to recover, as they may still have the antigen in their system. A medical bracelet should be worn, advising any emergency personnel of the patient’s allergy. It must be reiterated, especially to young patients and their care givers, that avoidance of the antigen is vital, but that a normal life is possible.
In conclusion, anaphylaxis is a treatable condition that all medical personnel need to be aware of. It is being seen on a more frequent basis throughout the United States. The reactions are primarily caused by severe food allergies, which can be controlled through avoidance. The cornerstone of treatment is epinephrine, with other therapeutic measures taken as needed. While anaphylaxis complicates a patient’s life, it does not have to stop it. Medical personnel everywhere should be prepared to successfully combat anaphylaxis when it comes knocking at the door.

Intervention #1: Epinephrine Use
While epinephrine is often considered a miracle drug in the treatment of anaphylaxis, there are several disadvantages that surround it. Two of these disadvantages will be discussed. The first is education for patients who use Epi-Pens. In an article by Kumar et al, the authors cited a study that found that in 90% of fatal anaphylactic reactions, patients were not carrying their epinephrine injectors (Epi-Pens). Another cited study showed that some patients had prescriptions for Epi-Pens but never carried them, some carried them but didn’t know how to use them and others carried and used expired equipment, which failed to perform when needed (284). These studies show that patient education is at least as valuable as having the needed supplies to treat an anaphylactic reaction.
Kumar, A., Teuber, S., & Gershwin, M. (2005, December). Why do people die of anaphylaxis: A clinical review. Clinical & Developmental Immunology, 12(4), 281-287. Retrieved February 3, 2008, from Academic Search Premier database.

The second problem found was in the availability of trained staff to recognize an anaphylactic reaction and use epinephrine appropriately. Rankin and Sheikh conducted a survey in the UK that found that epinephrine was available in 97% of schools surveyed. Of those schools with an identified at risk child 80% had staff trained to use epinephrine, while only 48% of schools without an at risk child had staff trained to use epinephrine. 59% of all the schools surveyed did not feel confident in their ability to properly treat and manage an anaphylactic reaction. These numbers become significant when you realize that the highest incidence of anaphylaxis occur due to food sensitivity reactions and those reactions become known when a person is in the primary to high school levels of schooling (1429).
Rankin, K., & Sheikh, A. (2006, August). Serious Shortcomings in the Management of Children with Anaphylaxis in Scottish Schools. PLoS Medicine, 3(7), e326. Retrieved February 3, 2008, from Academic Search Premier database.

Intervention #2: Allergen Avoidance
Another problem with treating anaphylaxis is avoiding the trigger to a reaction. Two difficulties regarding avoidance will be discussed here as well. The first is in non-patient education. One of the major causes of anaphylaxis is an allergy to peanuts (Munoz-Furlong, 33). It seems like such a harmless thing, a peanut. But to some it is deadly.
The Grecos understand because they saw it almost happen to Colby over Labor Day weekend. The toddler, who had safely eaten peanuts before, got three peanut M&Ms as a potty-training reward. "Within 20 minutes, he was sick to his stomach," his grandmother says. "Then he started swelling up and developing hives." Then Colby started struggling to breathe; his face turned pale and his lips turned blue from lack of oxygen. "They did arrive at the hospital in time to save his life," Maureen Greco says. Doctors said Colby had suffered a severe allergic reaction. It could happen again, they said, if he ever touched or ate something containing peanuts. (Even children who have had mild reactions in the past are at risk for severe incidents.) So, Julie Greco has done what any mother would do: She has asked the parents at Colby's preschool to avoid sending in snacks made with peanuts -- and taken him home from one class birthday party because the cake contained them anyway (Painter).
As people who live in this world with others, education is needed so that we can be good neighbors and citizens. Believing a child when they say, “I can’t have that” maybe the difference between attending that child’s funeral or not (Painter).
Munoz-Furlong, A. (2006, February). Going Nuts Over Allergies. Education Digest, 71(6), 33- 34. Retrieved February 3, 2008, from Academic Search Premier database.

Painter, K. (n.d.). In the shadow of the peanut. USA Today, Retrieved February 3, 2008,from Academic Search Premier database.

The second difficulty lies in patient education. In a world where we eat what comes in a box, we have no idea what may have been used in the manufacturing process for that food. Label reading becomes imperative for someone with a known allergic reaction. The food item in question may not even contain the ingredient needing to be avoided, but the plant where it was made can have a risk for cross contamination with other products that do. Labels contain warnings that need to be headed in order to avoid a reaction (Schmit).
Schmit, J. (n.d.). More food labels take an ominous tone on allergens. USA Today, Retrieved February 3, 2008, from Academic Search Premier database.

In summary, anaphylaxis can be treated successfully, but that success rests largely on education. Epinephrine can save a patients life, when used appropriately or it can also cause death when not used or used inappropriately. Avoidance of an allergen is essential to living a wonderful life. When not avoided, allergens can cause a loss of quality of life in the short term as well as the long term in the form of death. Understanding these things becomes a vital necessity to those of use living here on this blue rock we call Earth.


References


Brown, S. (2006, April). Anaphylaxis: Clinical concepts and research priorities. Emergency Medicine Australasia, 18(2), 155-169. Retrieved November 5, 2007, from CINAHL database.

Bryant, H. (2007, May). Anaphylaxis: Recognition, treatment and education. Emergency Nurse, 15(2), 24-28. Retrieved November 5, 2007, from CINAHL database.

Finney, A., & Rushton, C. (2007, May 23). Recognition and management of patients with anaphylaxis. Nursing Standard, 21(37), 50. Retrieved November 5, 2007, from CINAHL database.

Kumar, A., Teuber, S., & Gershwin, M. (2005, December). Why do people die of anaphylaxis: A clinical review. Clinical & Developmental Immunology, 12(4), 281-287. Retrieved February 3, 2008, from Academic Search Premier database.

Munoz-Furlong, A. (2006, February). Going Nuts Over Allergies. Education Digest, 71(6), 33-34. Retrieved February 3, 2008, from Academic Search Premier database.

Painter, K. (n.d.). In the shadow of the peanut. USA Today, Retrieved February 3, 2008, from Academic Search Premier database.

Rankin, K., & Sheikh, A. (2006, August). Serious Shortcomings in the Management of Children with Anaphylaxis in Scottish Schools. PLoS Medicine, 3(7), e326. Retrieved February 3, 2008, from Academic Search Premier database.

Sampson, H. (2003, June). Anaphylaxis and emergency treatment. Pediatrics, 111(6), 1601-1608. Retrieved November 5, 2007, from CINAHL database.

Schmit, J. (n.d.). More food labels take an ominous tone on allergens. USA Today, Retrieved February 3, 2008, from Academic Search Premier database.

Click Here to Read More..