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Gym Class, or Physical Education?

May 23, 2012

Photo by Krossbow, via Flickr

By Michael Fergenson, AJN senior editorial coordinator

Gym class. Some of us may have memories of a brusque man tossing a ball into the middle of the gym, telling us to play and occasionally blowing a whistle. Popular culture certainly portrays the “gym teacher” in this way—or worse, sometimes they’re cast as the villain. I put gym teacher in quotes in the last sentence because my dad would get angry with me if he heard that term, or “gym class” for that matter. My father considers himself a physical educator. When people call him a gym teacher, which is most of the time, he replies with the quip: “The gymnasium is the room that I teach in, but I am a physical education teacher.”

There’s something more important going on here than mere semantics. Is this pop cultural view of the gym teacher causing harm to students? I believe so.

My father has been a physical educator for a little more than 20 years. For a long time I had the same negative view of gym teachers as most people. That was until I began to study education myself. I definitely wasn’t going to be a gym teacher—oh no, it was literature for me. I would be a high school English teacher, but that didn’t sound quite right. It reminded me of my dad’s quips. I wasn’t going to teach English, I was going to teach literature. That thought stayed in the back of my mind until, for a class assignment, I went to watch my dad teach. That’s when I finally realized the difference between a gym teacher and a physical education teacher.

My dad didn’t just toss a ball and tell the kids to go play. He was teaching these kids how to be physically fit. He taught them proper nutrition, how the different muscle groups work, the types of exercises that one could do to achieve results—and that was just the beginning. He taught the difference between exercises for muscle strength, muscle endurance, and elasticity. He showed them the proper way to stretch and the proper way to cool down. In short, he was teaching his elementary school class how to be physically fit.

More importantly, he was instilling a love of his subject in his students. That is the goal of any good teacher, because it means the students will continue to learn that subject and delight it in long after they have left school.

Unfortunately, not everyone has seen real physical education. More unfortunately, those making education policy don’t seem to have either. We all know that physical education budgets are being cut around the country, because it’s seen as unnecessary. However, studies such as this one, which was recently published in the American Heart Journal, show that proper physical education can help reduce the current obesity epidemic among American children. Read the rest of this entry ?

Posted in children's health, public health nursing | Tagged , , , , , , | 1 Comment »

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How Good Are Your CPR Skills? Research Shows Monthly Practice Is Crucial

May 11, 2012

A nurse practices CPR on a voice advisory manikin. Photo courtesy of Laerdal Medical.

By Maureen Shawn Kennedy, AJN editor-in-chief

Most of you are probably aware of the AHA’s revised CPR guidelines that were issued in 2010. They include a major change in the resuscitation sequence—which now begins with chest compressions rather than ventilation—and emphasize the importance of achieving adequate compression of the chest—“at least two inches (5 cm)”—to achieve adequate blood flow. (You can see a video by the AHA demonstrating the new guidelines here.)  This change is especially important in light of recent research on CPR skills.

In 2011, Marilyn H. Oermann and colleagues conducted research with nursing students to determine how often one needs to practice CPR skills to maintain competence. 

As she explains in an article in the May issue of AJN, students who practiced briefly each month not only maintained their skills, but improved them significantly by the end of 12 months.

In comparison, the skills of those who only  had an initial training session deteriorated after three months; by 12 months, few could perform CPR adequately, especially in terms of achieving adequate depth for chest compressions. And although these were students, Oermann describes studies showing similar results with paramedics, non-ICU nurses, and nurse anesthetists. 

Most hospitals and agencies only require an annual review or demonstration of skills to be recertified in CPR; few, I bet, measure the depth of compressions. Sounds like it’s time to revisit this practice.

You can hear Oermann discuss her article in a podcast with Jo Haag, director of global training, ECC Programs, AHA, and Vanderbilt nursing professor Mary Fran Hazinski, a clinical specialist in pediatric critical care at Monroe Carell Jr. Children’s Hospital at Vanderbilt and a senior science editor at the AHA.

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Posted in nurses, patient safety, practice tips, public health nursing, Shawn Kennedy, AJN editor-in-chief, Uncategorized, videos | Tagged , , | 1 Comment »

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E-Cigarettes: Positive Smoking Substitute or a New Problem Replacing the Old?

May 4, 2012

Photo by Michael Dorausch, via Flickr

By Michael Fergenson, senior editorial coordinator

The dangers of smoking cigarettes are well documented, from the terrifying commercials about what smoking does to our bodies to the warnings right on the pack. Yet the Centers for Disease Control and Prevention estimates that 45.3 million people in the United States smoke.

Now, a new trend in tobacco products has become the center of much debate. I’m referring to the electronic cigarettes, or e-cigarettes, that are gaining popularity as a smoking alternative and, for many, as a tool to quit.

I personally know two people who are using this device in an attempt to stop smoking. An article published in the New York Times last November reports that the number of Americans trying e-cigarettes “quadrupled from 2009 to 2010.” The article also cites the results of a survey published in Tobacco Control last year, which found that 1.2% of adults, or close to 3 million people, had reported using these products in the previous month. But are e-cigarettes really a positive smoking substitute and aid to quitting?

How they work. Most e-cigarettes are shaped like a real cigarette, but some have a unique look. They work by heating up a liquid—purchased separately from the device—until it turns into an inhalable vapor. These liquids are available in a variety of flavors, scents, and levels of nicotine content. Some have no nicotine in them at all. Even though e-cigarettes don’t emit real smoke, they can’t be used everywhere—local governments can ban their use, as can private owners of buildings or transportation services. Because these products are fairly new, there’s no way to conclusively know whether or not they are healthier than cigarettes.

Proponents say that the vapor produced is as harmless as fog-machine smoke. The liquid usually contains five to 10 ingredients, all of which are licensed for human consumption and considered safe. This is compared to the more than 5,300 ingredients that have been identified in cigarette smoke, most of which are harmful. Most people use e-cigarettes as an aid to help quit cigarettes, but some just use them as an alternative nicotine delivery system.

What the critics say. One of the arguments against e-cigarettes is that it may lead to children smoking. Since the liquid packs come in many different flavors, this may appeal to a younger demographic. It would also be easier for teenagers to hide the fact that they are using e-cigarettes, since they don’t produce the tell-tale odor of tobacco smoke. There’s also a new “smart” cigarette pack, designed for use with e-cigarettes, that sets up a social network between smokers. Also seeming to target the younger demographic, this device connects wirelessly to social networking sites, and even flashes a blue light and vibrates when it detects another smart pack nearby. Read the rest of this entry ?

Posted in patient perspective, public health nursing | Tagged , , , , , , | 11 Comments »

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Got Leftover Prescription Drugs? Here’s a Chance to Toss Them Safely This Weekend

April 27, 2012

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Camp Pendleton, CA - Packing returned meds into boxes during DEA's 1st National Prescription Drug Take-Back Day, 2010. Photo via Flickr Creative Commons/U.S. Pacific Fleet

Each year, vast quantities of unused medications are discarded in household garbage or flushed down toilets, and end up polluting our rivers and oceans. These products and byproducts have been found in water supplies and in fish and wildlife. 

AJN’s 2010 article “Leftover Drugs in the Water Supply: Don’t Flush Those Pills!” discusses the harmful effects of carelessly discarded medications and highlights state “take-back” programs in Delaware and Maine that were organized by nurses.

The federal government also has a “national take-back” initiative under the auspices of the U.S. Department of Justice Drug Enforcement Agency Office of Diversion Control. This Saturday, April 28, between 10am and 2pm, the agency will hold its fourth National Prescription Drug Take-Back Day, and will have collection sites around the country. (Click here to find local collection sites. Just enter your zip code.)

Last year, the program conducted collections at 5,327 sites in all 50 states and territories. In all, 188.5 tons of unwanted or expired medications were collected. 

So, talk it up with colleagues and patients and hospital employers—help protect our environment.

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Posted in public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | Leave a Comment »

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A Face in a Village: Remembering a First Encounter with AIDS in Africa

February 8, 2012

We’d already guessed there was a problem at the health post—we hadn’t received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren’t receiving reports.

That’s from “A Face in a Village,” the February Reflections essay in AJN by Susi Wyss, the author of a well-received recent novel, The Civilized World (Henry Holt, 2011). Set in Africa, the novel, like this essay, was inspired by the author’s international health career. In this essay, Wyss recalls a vivid first encounter with the ravages of AIDS and the hopelessness it inspired. (Click through to the PDF version for a cleaner read.)—JM, senior editor

Posted in HIV/AIDS, international nursing, public health nursing | Tagged , , , | 1 Comment »

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Clinic Vision

January 26, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

By Ctd 2005, via Flickr

I’ve begun volunteering at a local free clinic. While it’s been rewarding and satisfying, it’s also been fraught with challenges I didn’t expect; I’ve only worked in an ICU, and the assessment skills specific to critical care don’t translate smoothly to the clinic setting. I’m out of my professional comfort zone, and I feel so inexperienced.

Here’s what I’m used to: By the time a patient is admitted to the ICU, they’ve already been “worked up” in the emergency room. Physicians have been assigned and a preliminary diagnosis is in place. The patients are connected to equipment that displays their vital data continuously, on monitors I can see from almost anywhere, and alarms are triggered by any alterations. I’ve got easy access to radiology reports and films, laboratory values, and microbiology reports. The nursing physical assessment is thorough and paramount; I know what I’m looking for, what I’m listening and feeling for, what certain smells indicate, and I trust my instincts. I’m accustomed to not only the forced intimacy that comes with the in-depth physical assessments of critical care, but the technology and data that supplement my assessments, as well.

At the clinic my nursing role is quite different. I sit at a desk. I am to determine the reason for each patient’s visit and take their vital signs. I ask how they’ve been and what’s changed since their last visit.

One gentleman, when I ask what medications he takes at home, fishes in his pocket and drops pills wrapped in toilet paper on the desk that separates us. I sit across from him, considering how to proceed, itching to take his hand and slide my fingers along his wrist to feel the pulse of his radial artery. I wonder about his breath sounds, what his feet look like, whether I’d be able start an IV on him, and what I’m missing. There are no same-day diagnostic reports to refer to and no dictated medical histories. All I have is the snapshot capture of his vital signs and what he wants me to know.

I’m used to knowing my patients from the inside, out. Here in the clinic, I hardly even touch anyone. I feel blind.

These are the challenges I’ve found: to create a picture of my patient with limited information and subtle clues;  to listen to what someone tells me, hear what they don’t say, and know what to ask; and finally, to not lose my vision because I miss my familiar tools, but instead find a different way to see.

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Posted in nursing perspective, public health nursing, writing and nursing | Tagged , , , | 2 Comments »

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Perspectives on Sebelius Overrule of FDA on Plan B

December 8, 2011

(screenshot from Huffington Post article mentioned below)

Women’s health advocates were quick to cry foul Wednesday when Health and Human Services Secretary Kathleen Sebelius overruled the opinion of the Food and Drug Administration that the popular “morning after” emergency contraceptive “Plan B One Step” should be allowed to be sold without a prescription — and without age restrictions.

That’s from an NPR story on the response of women’s groups to the ruling by HHS head Sebelius. Many others have weighed in via various forums since the ruling. What gives? Is the decision politically motivated? Or was it because Sebelius actually believed in the rightness of her objection enough that she should overrule the FDA, something that’s apparently not at all usual practice?

Here are some quotes from an MSNBC Vitals blog article about the issue, from a major ethicist and from a leader in pediatric care:

“In facing a tough call, HHS has put politics over science when it comes to sex,” said Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and a frequent contributor to msnbc.com.

Dr. Robert Block, president of the American Academy of Pediatrics, called the decision “medically inexplicable,” saying that it defies strong data that shows emergency contraception is safe and effective for girls and women of all ages.

President Obama has come out in support of the decision by Sebelius, as described on The Maddow Blog:

“I think it is important for us to make sure that we apply some  common sense to various rules when it comes to over-the-counter  medicine,” Obama said during an impromptu news conference at the White  House.

He said Sebelius decided 10- and 11-year-olds should not be  able to buy the drug “alongside bubble gum or batteries” because it  could have an adverse effect if not used properly. He said “most  parents” probably feel the same way.

Read the rest of this entry ?

Posted in ethical issues, public health nursing | Tagged , , , , , | 3 Comments »

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World AIDS Day, 30 Years On from That Fateful MMWR

December 1, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.”

So began the MMWR of June 5, 1981—the first herald of what became known as AIDS. Reading that report now, knowing the devastation that would follow, is chilling.

Today is World AIDS Day. It has been 30 years.

In some ways, we need this day more than ever, to remind us of the devastating potential of this condition—the Centers for Disease Control and Prevention (CDC) reports that only 28% of people in the U.S. infected with HIV get the treatment they need to suppress the virus. We need it to remind us of the millions who continue to suffer and die from it, mostly in Africa where two thirds of the AIDS cases occur.

We should also take time today to celebrate the victories. We’ve come far in the last 30 years. Effective treatments have been developed. Civil rights protections have been put in place. People with HIV can now live long, joyful, productive lives. Thirty years ago it was a death sentence, one that devastated those it affected—physically, socially, economically. Now it is a manageable illness that appears close to being controlled. Read the rest of this entry ?

Posted in HIV/AIDS, infection control, international nursing, nursing perspective, public health nursing | Tagged , | 5 Comments »

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‘The Worst I’ve Ever Seen’: One Persistent Nurse’s Take on Somalian Refugee Situation

September 20, 2011

By Shawn Kennedy, editor-in-chief

Long-term care: Martone at a refugee camp in Uganda back in 2001

Gerry Martone is a nurse who has traveled to the far reaches of the world in his job as director of humanitarian resources at the International Rescue Committee (IRC). We ran a profile of Gerry in 2001 and also a photo essay. He’s also a skilled photographer and we’ve published his photo essays documenting his travels. (See here for one on assessing poverty in Afghanistan and here for one on Sudan refugees; click through to PDF versions for best viewing.)

So when I spoke with Gerry last week, shortly after he came back from a visit to a refugee camp in Kenya, it scared me when he said the situation in East Africa is the worst thing he’s ever seen. The region is plagued by a severe drought (Martone says it’s had no appreciable rain in two years), and while drought is a cyclical phenomenon there,  a struggling central government, lack of health and response systems, and ongoing  conflicts among local clans have worsened the situation, causing widespread food shortages. The global community is responding with aid, but for many, it will be too late.

He visited a UN camp outside the city of Dadaab, Kenya, to which more than 440,000 displaced people—mostly Somalians, who are the hardest hit—have fled. The IRC runs a hospital at the camp. The situation is dire: the UN estimates that, without intervention, 750,000 Somalians face death within four months. And it doesn’t have to be this way—it’s a matter of making potable water and food available—though even with supplies on hand, it’s hard to get them delivered to those in need. Martone said the area is completely lawless and very dangerous—he traveled with six armed guards—and many organizations fear sending their workers.

Martone said if people want to help, they should donate to an aid agency they feel comfortable with—and there are many doing work in the region, including the IRC, Doctors Without Borders, and the UN Refugee Agency, to name a few.

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Posted in human rights, international nursing, male nurses, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 8 Comments »

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Hurricane Aftermath

August 29, 2011

Hurricane Irene, by D. Fletcher via Flickr

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Well, Hurricane Irene has come and gone in the northeast United States. While it certainly destroyed property, downed power lines, and caused flooding, many are thinking that we escaped the worst, since Irene morphed from a hurricane into a tropical storm when it made landfall in Long Island, New York.

This is not to diminish the tragedy that it caused—in loss of life (CNN reports 25 Irene-related deaths)  and destruction of property.  And I sympathize with those who experienced flooding or lost power. Cooking, showering, and basic daily activities become major challenges and require ingenuity, creativity, and sometimes a touch of genius. While initially this merely seems inconvenient, after a few days it’s exhausting. I’m sure there will be many households without power for weeks, judging from some local news reports.

An important potential health hazard that wasn’t covered in depth on the news is walking or wading in flood waters in shorts and bare feet or flip-flops. Flood waters often contain contaminants from storm drains and sewers, including raw sewage (as one news reporter discovered only after he was covered in it). Debris, sharp objects, and even power lines may be hidden underwater, as well as ditches or drains (47-year-old postal worker Ronald Dawkins, from Orange, New Jersey, was killed when he tried to wade through rising water to a postal facility where he worked and stepped into a hidden drainage creek).

The Centers for Disease Control and Prevention offers a guide to preventing illness after a disaster and also has information for how to stay safe while cleaning up after flooding. Check it out and spread the word.

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Posted in disaster care, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged | Leave a Comment »

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