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Old Friends Among the Devastation: A Red Cross Volunteer in the Oklahoma Tornado Zone

June 19, 2013

In 2011, after devastating tornadoes struck Alabama, we ran a series of blog posts, “Dispatches from the Alabama Tornado Zone,” by Susan Hassmiller, the senior adviser for nursing at the Robert Wood Johnson Foundation. Hassmiller went to Alabama as a Red Cross volunteer, and reported back to us with a number of moving and inspiring posts and photos. The recent tornadoes in Oklahoma are the occasion for a new series we are initiating today.


Eleanor Guzik, NP, RN, a volunteer disaster health services manager with the Red Cross, describes herself as a 74-year-old wife, mother, grandmother, great-grandmother, traveler, serial volunteer, and a late-in-life RN who worked in critical care for 10 years, was an NP for 10, and retired in 1995. This piece by Eleanor Guzik describes her deployment and arrival in Oklahoma; subsequent posts by Guzik and other Red Cross volunteer nurses will give us glimpses of the day to day work of volunteers in Oklahoma and the people and situations they encounter.

Deployment and Arrival

May 25, 2013. Oklahoma City, Oklahoma. An American Red Cross emergency response vehicle tours through an Oklahoma City neighborhood to ensure that each residence is provided with resources. Photo by Talia Frenkel/American Red Cross

May 25, 2013. Oklahoma City, Oklahoma. An American Red Cross emergency response vehicle tours through an Oklahoma City neighborhood to ensure that each residence is provided with resources. Photo by Talia Frenkel/American Red Cross

I am proud to say that I am a Red Cross Nurse. My history with the Red Cross goes back to Hurricane Katrina. I have since fallen down the rabbit hole of volunteerism and am having the time of my life, working harder than I ever did for a paycheck.

In May I was in beautiful southern California, retired, without a worry, counting my blessings and trying to keep my head above water in my busy volunteer schedule with my favorite hospice and the American Red Cross.

I’d made myself available during the month of May to deploy to any national disaster for the Red Cross, if needed, but I wasn’t summoned into action until May 21. “Can you come?” they asked. “Yes, for 10 days,” I answered. “I’ll get a flight out tonight.” Read the rest of this entry »

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Evidence-Based Interventions That Improve Maternal and Child Nutrition

June 17, 2013

On June 8, in London, presidents, prime ministers, businesspeople, and philanthropists came together to sign the Global Nutrition for Growth Compact. The event, hosted by the governments of Brazil and the U.K. and the Children’s Investment Fund Foundation, resulted in commitments to accelerate progress toward improving nutrition for children and mothers around the globe.

In London's Hyde Park, activists laid a carpet of flower petals to represent the lives of children lost each year through malnutrition. Photo by Ismar Badzic via Flickr.

In London’s Hyde Park, activists laid a carpet of flower petals to represent the lives of children lost each year through malnutrition. Photo by Ismar Badzic via Flickr.

Simultaneously, the Lancet published its second paper in a series on maternal and child nutrition. The authors of the study estimate that poor nutrition is the root cause of 45% of child deaths (3.1 million deaths among children under age five each year). 

The report builds on a similar report from 2008 and highlights the progress achieved since then. For example, the number of the world’s children who never grow to their potential height has dropped steadily over the past two decades, from more than 253 million in 1990 to 167 million in 2010.

But according to the new report, far more can still be done. The authors estimate that close to 15% of all deaths in children under five can be prevented, and at least a fifth of all stunting avoided, if 10 nutrition-specific interventions are scaled up to 90% coverage in the 34 countries most affected by malnutrition.

These evidence-based interventions include

  • providing periconceptual folic acid supplements, balanced energy protein supplements, calcium supplements, and micronutrient supplements to pregnant women.
  • promoting breastfeeding and delivering appropriate complementary feeding to infants.
  • providing vitamin A and zinc supplements to children up to the age of five.
  • implementing strategies to manage moderate and severe acute malnutrition.

To read the executive summary of the full report (available to download for free), go to:
http://download.thelancet.com/flatcontentassets/pdfs/nutrition-eng.pdf.
Amy M. Collins, editor

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Incomplete Combustion: Crohn’s, Motherhood, a New Normal

June 14, 2013

April Gibson is an essayist, poet, and ostomate. She holds an MFA in creative writing from Chicago State University. In her writing she seeks to address and renegotiate societal beliefs about motherhood, illness as alienation, beauty as a shell. Her work is published or forthcoming in Tidal Basin Review, Reverie, The New Sound, Aunt Chloe, AsUs and elsewhere. She lives in Chicago with her two sons. 

AprilGibsonTwenty-one days pass. I am a 90-pound bag of skin. Legs like peanut butter drapes thrown over femur bones, no muscle, no pronounced curve. A lover would look past me quickly in the street. I do not want these scars, or this strange body. I want to wear a red bikini. I want a kiss on my belly.

Three weeks felt like spans of small forevers. I didn’t believe my legs and arms were mine. My abdomen sunk to a cave, save for the rustling bag. My aunt hurled the word “unconscionable” on each visit, until the hospital knew her voice. My mother, grandmother, aunts, they stayed in mornings, my little brother stayed through late nights, nodding off once the drugs snatched my eyes to sleep. So many people, one could’ve mistaken my bed for a box. I can’t remember them all, or even all the days.

The nurses were there everyday, same ones. This is their wing. The doctors came in swarms, always hanging heads to pens unless speaking. I wore lipstick when we passed the vomit days, gave laughs to friends. My big sister gave me big twists in my hair.

A disease that had already stolen my youth, at 27 I lost my colon to Crohn’s. When they removed the sick parts, cut away the damaged pieces, they also took the one feeling my body understood. Pain is a tricky thing, illness a confusion of sense. A piercing touch, the sight of blood, a smell can make you puke. A sound can make your head bang. The metallic taste of medication can make you want to quit. I never knew what healthy felt like. It was all so strange.

The functions of me were foreign. I would never work the same.

At first I looked for clothes with ruffles and flares. I cried at the sight of a middriff top I’d purchased the summer before. I would never again wear low-rise jeans, or bikinis, or mesh articles of any kind. I would never undress myself with pride. There were vows to celibacy, thoughts of a hermit life—all sorts of ridiculous ideas. My best friend reminded me I never really wore middriffs much, anyhow. Old pictures reminded me a decade had passed since I’d worn a two-piece swimsuit, then there was the recollection that I couldn’t actually swim. A small step to recovery.

The same Band-aid stuck to my body for a lifetime. This is what permanency feels like. On the right side of belly, I carry the burden of desperation, the things we humans do to stay alive. My caramel skin sticky with adhesive and the color of someone else’s nude. The beige bag flattened under all that I wear, who could ever guess my unbalanced geometry. No one ever had to see the off parts of me, unless there was a man to love me despite, and still, there are ways to hide from the world. Wraps and lace, pockets of all kind. I can never truly be a naked girl. I live in a time warp of constant repair, fixing. Never fixed. My body working its way around the darkness that knows to fill a space. Read the rest of this entry »

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Science and Suffering: My Two Months Battling the Aliens

June 12, 2013

By Ronald Pies, MD, professor of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University, Syracuse, New York; clinical professor of psychiatry, Tufts University School of Medicine, Boston; editor-in-chief emeritus of Psychiatric Times. Dr. Pies is also the author, most recently of, The Three-Petaled Rose, an exploration of the synthesis of Judaism, Buddhism, and Stoicism (iUniverse).

Doyle Alphabet by fdecomite, via Flickr

Doyle Alphabet by fdecomite, via Flickr

It all started suddenly: weird, creeping sensations in my forehead and between my eyes, especially when I lay on my back or bent my head forward. The expression “my skin is crawling” quickly came to mind. Over the next few days, I began to experience intense pressure in my forehead and a weird sensation on the bridge of my nose—as if a large clothespin had been clipped onto it. Within a few days, it felt like someone had poured a sack of concrete into my head.

My self-diagnosis was sinusitis—a term that covers many etiologies. But most cases of sinusitis begin with head or facial pain and nasal discharge—not the strange sensations my wife and I soon started calling “the aliens.”

Nevertheless, I began an aggressive self-treatment program: decongestants, aspirin, and something called a Neti pot—an ancient form of nasal irrigation using a vessel resembling a small, plastic teapot.

After a couple of days, my symptoms were considerably milder—but by no means gone. I saw my primary care doctor a few days later, and—despite the “alien” sensations—he concurred with my diagnosis. Antibiotics are notoriously overprescribed for sinusitis, and my very conservative PCP was not about to do so. Steroid nasal sprays are also used, and I asked Dr. G. if he’d consider a trial.

“Nope!” he replied, “I’d like you to see an ENT. If you have a nasal polyp, I don’t want to shrink it with steroids and miss the diagnosis.”

I nodded in agreement, but I was disappointed. My doctor was talking the language of science—“Don’t introduce extraneous variables into your investigations”—and I was wagging the tongue of misery. Read the rest of this entry »

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Sexual Assaults: Is the Military Finally Starting to Get It?

June 10, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

March 26, 2010: A poster supporting the Sexual Assault Prevention and Response (SAPR) program. (U.S. Navy photo illustration/Released)

March 26, 2010: A poster supporting the Sexual Assault Prevention and Response (SAPR) program. (U.S. Navy photo illustration/Wikimedia Commons)

On June 7, the U.S. Air Force command named Maj. Gen. Margaret H. Woodward director of its Sexual Assault Prevention and Response Office. She replaces her predecessor, Lt. Col. Jeffrey Krusinski, who was charged with sexual assault in early May.

Announcement of his arrest came the day before the Department of Defense was to hold a press briefing to tout changes intended to improve the handling of sexual assaults. Also on June 7, the U.S. Army command suspended Major General Michael T. Harrison, the commanding general of the U.S. Army in Japan for failing to “to report or properly investigate an allegation of sexual assault.”

At the press briefing, Secretary of Defense Chuck Hagel said he was “outraged and disgusted” at the allegations against Krusinki. Hagel also asserted that “[a]ll of our leaders at every level in this institution will be held accountable for preventing and responding to sexual assault in their ranks and under their commands.” But will commanders really be forthcoming? Will they be willing to report crimes that could make them look like they can’t manage troops effectively, thereby potentially endangering their own chances for promotion?

Congress has launched an investigation into how the military is handling sexual assaults. According to the Washington Post, the hearings were precedent setting in that it was the first time the entire Joint Chiefs of Staff had testified together as witnesses; the hearings were also marked by the significant presence of women on the Senate Armed Services Committee—seven in all. Read the rest of this entry »

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What’s Enough? Why It’s Essential for Nurses to Assess Adolescent Sleep

June 7, 2013

By Sylvia Foley, AJN senior editor

Illustration © Anne Horst / http://www.i2iart.com

In her poem “Sleep in the Mohave Desert,” Sylvia Plath wrote about not sleeping, feeling comfortless, tormented by the “heat-cracked crickets . . . [that] fiddle the short night away” in “the blue hour before sunup.” Though Plath was writing as an adult, sleeplessness and other sleep difficulties have troubled humans of all ages for centuries. Until recently, we could only guess at the health consequences. Now there is mounting evidence that inadequate or insufficient sleep has many adverse effects. Adolescents appear to be particularly vulnerable—and it’s not simply because they’re rebelling against bedtime. In this month’s CE, “Assessing Sleep in Adolescents Through a Better Understanding of Sleep Physiology,” authors Nancy George and Jean Davis offer an in-depth look.

Overview: Adolescents need about nine hours of sleep per night, yet most teens get far less. Inadequate sleep has consequences not only for academic performance but also for mental and physical health; it has been linked to lowered resilience and an increased risk of cardiovascular and metabolic diseases. It’s imperative that assessment of sleep become a routine part of adolescent health care. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in this population. Sleep assessment involves evaluating the three main aspects of sleep: amount, quality, and architecture. The authors provide an overview of sleep physiology, describe sleep changes that occur during adolescence, and discuss the influence of these changes on adolescent health. They also provide simple questions that nurses can use to assess sleep and risk factors for disrupted sleep, and discuss patient education and other interventions.

The authors close with detailed suggestions for nurse–patient education, which include teaching adolescents how to

  • unwind from the day’s activities.
  • establish bedtime rituals.
  • create an environment conducive to sleep.
  • avoid activities that might impede sleep.

To learn more, read the article, which is free online. And please share your thoughts and experiences with us in the comments.

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The ACA and Me: A Dispatch From the Trenches

June 5, 2013
Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

 “Reality is the leading cause of stress among those in touch with it.”—Jane Wagner

By 2014, up to 30 million Americans will have gained access to health care insurance under the Affordable Care Act (ACA). As a nurse human being, I support increased access to health care. However, it is naive to believe it can be accomplished without sacrifice.

My job is a casualty of the ACA.

But let’s backtrack:

It’s more accurate (but less dramatic) to say that our country’s need of better health care delivery significantly affects my job. Most hospital nurses are familiar with Medicare tying reimbursement to patient outcomes. Further, built into the ACA is a requirement that hospitals expecting Medicare reimbursement form accountable care organizations (ACOs):

Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with Original Medicare (that is, those who are not in a Medicare Advantage private plan). The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. The ACO would be a patient-centered organization where the patient and providers are true partners in care decisions.

In other words, hospitals are expected to stop competing for Medicare dollars and work together to reduce duplication of services, decreasing costs within their communities. This is not an entirely new idea in health care. Trauma and neonatal tertiary care centers existed before I graduated from nursing school. They provide advanced health care technology to communities unable to afford them.

ACOs go beyond this concept, however, mandating “partnerships or joint ventures arrangements between hospitals and ACO professionals.”

For example, one hospital will purchase the most advanced machine for radiology, while its competitor will invest in the latest laser surgery technology. Patients needing either will be referred to the center in their community providing that service, thereby increasing its number of billable Medicare patients, decreasing cost and duplication of services. This is my understanding of some of the changes taking place in accordance with the ACA. May I remind you, I am a staff oncology nurse, not an economist.

Here’s how ACOs affect me: My job as an oncology infusion nurse is being combined with those of another hospital offering similar patient services. The short version: After 20 years of employment, along with my coworkers I will have a new employer.

I know it’s just business. I go to work, and every two weeks receive a paycheck for my hours. Every two weeks, my employer and I are even. Still, it feels a little like how I imagine if, after 20 years of marriage, your spouse informs you he is leaving for no particular reason: “It’s not you, it’s me.”

Initially, I couldn’t help but feel abandoned.

A person’s reaction to such situations is clouded by sentiment. There are concerns about possible changes to regular work routines. There is worry over potentially commuting to other work sites. The funniest one occurred while I perused the hospital gift shop, lamenting to myself about the loss of my employee discount. Then I remembered: “We don’t have an employee discount, you sentimental fool!” Feelings of rejection play tricks on memory. Read the rest of this entry »

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