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A Mental Health Nurse’s Perspective on Newtown and Its Aftermath

December 19, 2012
Mary Magdalene Crying statue/Wikimedia Commons

Mary Magdalene Crying statue/Wikimedia Commons

By Donna Sabella, MEd, MSN, PhD, RN, mental health nurse, AJN contributing editor, and coordinator of the monthly Mental Health Matters column

As we all know by now, last Friday, December 14, our nation was forced to bear witness to another act of unconscionable violence, as 20 children and six adults were gunned down inside their elementary school on a morning that began with the murder of the  gunman’s mother.

As the country ponders why and how this could have happened, we know that there are no easy answers. Those answers that we do arrive at will undoubtedly involve much thought and soul-searching. How could one human being, one lone gunman barely an adult himself, wreak such devastation on so many?

The pain and grief of Friday hangs heavy over Newtown, and only those who lost a child or loved one that day can begin to imagine the sorrow they are experiencing. But the sorrow and grief do not stop there. As President Obama stated on Sunday night in his remarks to the Newtown community, the nation collectively shares their sorrow, disbelief, and pain.

As we know, one need not be directly involved in an event to be affected by it. This horrible event forces us all to confront the notion that while we are the land of the brave and the home of the free, we share our land with evil, with senseless violence, and with concerns about our safety. If a child cannot be safe in school, what must we as a nation do to correct that situation?

As we all struggle to come to grips with the events of December 14, there will undoubtedly be challenges to the psychological well-being and mental health of first responders who were exposed to scenes most cannot imagine, of those directly affected by the shooting, and even of those of us miles away. Under the circumstances, it’s normal to feel pain, grief, anger, fear, and a number of other emotions and feelings. It’s normal to empathize with those closest to the epicenter of tragedy. At times like this, we need to be good to ourselves and find ways to acknowledge and process our pain.

Below are a number of things we can do to take care of ourselves at such times, as well as a few resources that may be useful:

  • Acknowledge and honor what you are feeling instead of trying to ignore or cover up what you are experiencing.
  • Know that we all grieve differently, so don’t worry if your feelings don’t match those of others. And contrary to popular opinion, not everyone needs to talk about things, especially right after a traumatic event.
  • Find and do what gives you peace during trying times. For some, comfort is found in religion and spirituality; for others, talking to a trusted friend, doing volunteer work, or spending time with friends and family provides solace and comfort.
  • Take care of yourself physically, making sure to get enough sleep, eat right, and exercise; don’t rely on drugs and alcohol for solace or stress relief.
  • A major concern is what to tell our children, should they have questions. Base your responses on the child’s age and the questions she or he asks, and let them talk about how they’re feeling.
  • Focus on the here and now. We can’t undo the past or control the future. Living in the present helps keep us grounded.
  • Know that you’re not alone and that many others are experiencing similar feelings. For most, recovery will come in time. However, should you begin to feel overwhelmed, seek mental health help. Depending on your situation, you may want to consider grief counseling as well as trauma-based counseling.

Resources and Information

Grief: http://www.helpguide.org/mental/grief_loss.htm

National Alliance on Mental Illness (NAMI): http://www.nami.org/

PTSD: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/

Trauma-Focused Cognitive Behavioral Therapy: http://www.goodtherapy.org/trauma-focused-cognitive-behavioral-therapy.html

On December 14, Adam Lanza joined the list of those whose names are seared into our collective memory: Eric Harris, Dylan Klebold, Seung-Hui Cho, Jared Lee Loughner, and James Eagan Holmes. Would that getting each of these young men the mental health services they could have used were as easy as their getting guns. Maybe then we would see less of this type of thing and fewer names on the list. I believe that gun control is important, but we also need to do more about making  mental health treatment more accessible and less stigmatizing and improving society’s understanding of mental health matters as well. In the next Mental Health Matters column, I will share in more detail what we might do to better recognize and intervene before someone crosses the line.

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Posted in mental health, nursing perspective, public health nursing | Tagged , , , , , , , | 1 Comment »

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Post-Sandy Emotional Self-Care for Nurses and Others

November 19, 2012

Hurricane Sandy, from International Space Station at 16:55:32 GMT on Oct. 29, 2012 / NASA

By Donna Sabella, MEd, MSN, PhD, RN, mental health nurse, AJN contributing editor, and coordinator of the monthly Mental Health Matters column

With the recent devastation caused by Sandy in the mid-Atlantic and New England areas we need to be mindful that the harm done in such events goes beyond property and the physical domains. Many exposed to Sandy’s wrath may be suffering from varying degrees of stress and psychological trauma. It is important to remember that, along with taking care of our physical needs, in the process of getting back to normal we also need to be mindful of our emotional needs and reach out for help as necessary.

As health care providers we nurses pride ourselves on being able to handle anything that comes our way as we strive to give patients the best care possible, but it is important for us to be aware of our own emotional needs during times of crisis and disaster. Sandy is considered a disaster—for those affected by the storm, either directly or indirectly, the experience can lead to thoughts, feelings, and behaviors that are outside our usual range, and which may indicate it’s time to seek help. Below, I offer some information that provides tips on how to take psychological care of ourselves after Sandy :

  • Know that your responses to the situation are in most cases a normal reaction to an abnormal situation and that things do improve over time.
  • Give yourself time to heal and be good to yourself emotionally. Be patient with yourself and find ways, no matter how small, to do something nice for yourself or do something you enjoy. Make sure you take care of your emotional needs before addressing everyone else’s.
  • Take care of yourself physically as well. As much as possible in your situation and circumstances get plenty of rest, eat well, and avoid using alcohol or drugs to make yourself feel better. While drinking or using drugs, even prescribed medications, may result in temporary relief of stress and anxiety, over time doing so could lead to serious problems.
  • Realize that symptoms do not always occur immediately after a crisis or disaster and that there are several psychological stages we go through after a disaster. For some, symptoms can take months or years to manifest themselves; we each proceed through these stages at our own pace.
  • Should you experience such symptoms as mood swings, “re-experiencing” particular events, hyperarousal, avoidance, depression, trouble sleeping, or  cognitive difficulties, consider seeking help, especially if any symptoms prevent you from feeling like yourself and interfere with your normal routines and normal level of functioning.

Below are some resources and information regarding postdisaster mental health issues that I hope you will find helpful. Just because we are nurses does not mean that we have to go it alone during these trying times. For anyone experiencing severe symptoms and a psychiatric emergency, help can be found in your local emergency department or by calling 911. Your local Red Cross is also available to provide help and support. Otherwise, to find out more, please visit the Web sites listed below:

“Mental Health and Hurricane Sandy: What Can We Expect, and What Can We Do?”

MedlinePlus Resource Page on Coping with Disasters

U.S. Dept. of Health and Human Services: Hurricane Sandy Response and Recovery in the Mid-Atlantic Region (scroll down to list of mental health resources on page)

For those in the New York area:

New York State Office of Mental Health: Hurricane Sandy Resources

For those in the New Jersey area:

Mental Health Association in New Jersey: Mental Health Resources Following Sandy

New Jersey State Hurricane Sandy Resources page

If you have questions or would like more information, please feel free to contact me at sabellad@arcadia.edu. My best to you and yours for a peaceful Thanksgiving.

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Posted in disaster care, nursing perspective, public health nursing | Tagged , , , , , | Leave a Comment »

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Behind Our Ambivalence About Flu Vaccines

November 9, 2012

By Amy M. Collins, editor

Influenza virus particle/CDC

Tis the season to start thinking about getting the flu vaccination. Every year I consider doing so, but due to my own personal vaccine angst I usually decide to just take my chances (while simultaneously lecturing elderly family members to make sure they get theirs, of course).  Working in Manhattan, with the vaccine available at most pharmacies and even vaccine access through work, gives me very little reason to forgo vaccination. And my theory that I am young and strong and can brave illness gets weaker as I pass the point of being able to comfortably claim youth. Riding the subway every day amid a festival of germs reminds me that I should know better.

The vaccine has caused a stir over the past few years: during the 2009 H1N1 pandemic, people worried about whether or not to get the new combined vaccine, and the question of mandatory vaccination for health care workers remains a hot topic even now.

But a new report, The Compelling Need For Game-Changing Influenza Vaccines, released by scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota, suggests that the flu vaccine may not be as effective as it is touted to be. According to the report, influenza vaccinations provide only modest protection for healthy young and middle-aged adults, and little if any protection for those 65 and older—those who are most likely to contract the illness and suffer its complications. In addition, the report’s authors concluded that federal vaccination recommendations are based on inadequate evidence and poorly executed studies.

With as many as 49,000 Americans dying from influenza each year, approximately 90% of them elderly, should the report matter to those on the fence about getting vaccinated? Not according to Dr. Joseph Bresee, chief of epidemiology and prevention in the CDC’s influenza division, who was quoted in the New York Times as saying, “Does it work as well as the measles vaccine? No, and it’s not likely to. But the vaccine works.” And the risk of being on the safe side and getting the vaccination appears to be quite low—the report acknowledges that currently licensed influenza vaccines in the United States are among the safest of all available vaccines.

The report ends by issuing an urgent call for improved vaccines: “novel-antigen game-changing seasonal and pandemic influenza vaccines that have superior efficacy and effectiveness compared with current vaccines are urgently needed.” These game-changing vaccines, says the report, must demonstrate increased efficacy and effectiveness for populations at increased risk for severe influenza morbidity and mortality.

So, will the report make a difference to nurses’ recommendations to patients this season, or affect their own decision about whether or not to get vaccinated? Will it influence the ongoing debate about mandatory vaccination for health care workers? For the record, it didn’t for me. At my yearly check-up, the flu vaccine was strongly recommended. The American Nurses Association continues to urge people to get vaccinated as part of their Unite to Fight the Flu initiative.

The report is not saying not to get vaccinated, just that it may not work as well as we’d hoped, and knowing this isn’t a deal breaker for me. So now I just have to get over my vaccine angst and take the plunge!

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Posted in H1N1 virus (swine flu), patient perspective, patient safety, public health nursing | Tagged , , , , | 3 Comments »

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In Sandy’s Wake, Emerging Nurse Stories and Some Resources for Now and Next Time

November 2, 2012

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

Whether the National Weather Service officially categorized Sandy as a tropical cyclone or a hurricane, the damage it caused was unprecedented as it made its way through the mid-Atlantic area and up through the Hudson Valley and New England.

I’m one of millions without power, but consider myself lucky, given the horrific damage sustained by many in neighboring areas. The severity of the storm really hit home as I learned about hospital closings—as any nurse or physician will tell you, it’s not something done without a great deal of deliberation, as moving severely ill patients carries its own significant risks.

In Brooklyn, Coney Island Hospital, a city-owned facility, was closed. In Manhattan, New York Downtown Hospital and the Manhattan VA Medical Center moved or discharged patients before the storm hit. And because of storm damage, New York University Langone Medical Center and more recently, Bellevue Hospital Center, the 275-year-old flagship hospital of New York’s municipal hospital system, were evacuated.

Stories are emerging about the heroic efforts of hospital staff who worked through the storm, evacuating patients down many flights of stairs, using plastic sleds as they slid patients down as many as 17 flights in some instances. The stories reminded me of those I heard from nurses at Charity Hospital in New Orleans after Hurricane Katrina, and from nurses from St John’s Medical Center in Joplin, Missouri, which was hit by a tornado, or even following the attacks of 9/11. And of course, there are the home health nurses, who had elderly and ill patients depending on their visits—see this article for stories of visiting nurses who have been braving arduous travel in the city to see to patients.

All such stories have the familiar theme of care providers who prioritized finding a way to keep patients safe during the disaster. We hope to bring you some personal accounts—they deserve to be highlighted and the professionals involved should be applauded. And we should also give kudos to staff at the hospitals who received the evacuees. On short notice, these clinicians had to absorb new patients, many of whom were frightened and perhaps confused. And then, of course, there were families who needed to be notified. All in all, there were herculean efforts on all sides.

No doubt there are many people who are, or in the coming days will be, severely stressed or perhaps in crisis, and that includes health professionals. Here are some resources we hope will be helpful now as you react or in the future as we take stock of these events and our readiness:

The following AJN articles are available as open access. There are others, too, in our Responding to Disasters collection.

“The  Impact of Event Scale–Revised: A Quick Measure of a Patient’s Response to Trauma” (November, 2008)

“Disaster Care: Public Health Emergencies and Children” (December, 2009)

“Crisis Standards of Care—A Framework for Responding to Catastrophic Disasters” (October, 2012)

And from the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Kit (this includes materials for helping the public as well as for dealing with personal stress):

“Psychosocial Issues for Children and Adolescents in Disasters” (this and following are large PDF; may take time to load)

“Psychological First Aid for First Responders”

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Posted in continuing education, disaster care, public health nursing | Tagged , , , , , , , | 1 Comment »

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Calling All Hurricane Sandy Nursing Stories

October 31, 2012

Hurricane Sandy, October 28/ NASA photo

AJN‘s offices in Manhattan remain closed today, with no subway service and various continuing power outages in many areas where the staff live in New Jersey, Manhattan, and other surrounding areas. We’re all keeping up as well as we can with our production and editing processes. Meanwhile the presidential election, sure to have a substantial impact on health care in the U.S., creeps ever closer. Please let us know in the comments section any stories you have of nurses and their experiences during Hurricane Sandy and its aftermath. Or share photos. We’d love to get a sense of how it went for nurses out there who were affected by the storm, and we hope to provide open access to some of our disaster care and preparedness articles in the next couple days.

AJN Oct. cover, detail

The editors

Posted in disaster care, patient perspective, public health nursing | Tagged , , , , | 3 Comments »

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Nursing Research: Alive and Well

September 17, 2012

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

Last week I spent two-and-a-half days in Washington, DC, where there are LOTS of campaign collectibles. My favorite: coffee mugs proclaiming “Friends Don’t Let Friends Vote [insert Democratic or Republican).” Also noteworthy: “Hot for Mitt” and “Hot for Barack” hot sauce (see photos). I was there attending the meeting of the Council for the Advancement of Nursing Science (CANS), where close to 1,000 nursing researchers met to share their work. It wasn’t too long ago that one would have been hard-pressed to find that many nurses doing research. The National Institute of Nursing Research (NINR) only celebrated its 25th anniversary in 2010 (see our 2010 article about their many accomplishments).

Creativity and innovation. Kathi Mooney, PhD, RN, FAAN, from the University of Utah College of Nursing, gave the keynote—and it was perfectly suited to this group, many of whose members are immersed in analytical thought and scientific methodology. Mooney talked about the importance of creativity and innovation in moving research forward—yes, applying scientific rigor to identifying knowledge gaps and building on known research is critical, but she urged attendees to step back occasionally and be open to other ways of thinking.

To do that, she said, one must create time for reflection and thinking. She also encouraged deans and faculty to foster environments that support creativity, where there’s freedom to explore non-mainstream thinking, risk taking is encouraged, and there’s time for social interaction and informal encounters.

Posters and symposiums and podium presentations filled the rest of the schedule. The presentations were akin to speed dating—researchers had less than 15 minutes to present the highlights of their work. I’m sure for those presenting and those involved in the particular area of research, it might have been frustrating, but for someone like me seeking what’s new and compelling across many areas, it was an ideal format. As one presenter said, “It’s like being a detective on Dragnet, that old TV show, where the lead detective would say, ‘Just give me the facts, please.’”

Some takeaways for me:

Creative thinking involves reframing problems and tasks (one example from Mooney: does the stone cutter see his job as cutting large chunks of stone, or as being part of a team that’s building a cathedral).

Read the rest of this entry ?

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A Nurse and Mother on Dialing Back the Risk in Football

September 14, 2012

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

One Monday afternoon when my son Bryan was a senior in high school I got a call from him. He had hurt his back during football practice and was in so much pain he couldn’t move to get into his car. I rushed over to the field and found him standing, tense and still. When I lifted his shirt to look at his back, I gasped. The entire lumbar area was rounded and swollen out to the size of a grapefruit. At the hospital tests revealed he had a large hematoma, no critical damage done. The first question Bryan had for the doctor—“Can I play on Saturday?”

All week he insisted he could play and I insisted he couldn’t. His arguments never let up—he was quarterback and Saturday’s game was with an archrival. There wasn’t time for the backup quarterback to learn the plays, his team depended on him. Finally I made a bargain. We would go see his physician, whose judgment I trusted, and we would both respect his opinion, whichever way it went.

He played. One of the coaches wrapped his back in layers of padding with an ACE bandage and out he went. It was a brutal game. As determined as he was, the pain still slowed him down and he got tossed around like a rag doll. Finally in the last quarter they took him out.

I was reminded of all this when reading a New York Times editorial this week, “Dying to Play,” about the dangers of football and the growing body of evidence about the devastating long-term consequences of the repeated head trauma that football players endure. It talked about the decision a father, who was a pro football player, made with his son after his son got “his bell rung” in a game. They decided that the son, determined to follow his father into the pros someday, would “keep his mouth shut and his options open” rather than see the physician and wait for the okay to play.

Many parents will have their own version of these stories, the kid who insists on playing in spite of injuries or risk. They hide their injuries, downplay their pain, pop more ibuprofen than you know about. I watched Bryan’s best friend get knocked unconscious in a tackle, spectators standing silenced, watching, waiting for him to move as the coaches and the team doctor bent over him. Finally his legs started moving and people began to clap in relief and support, but I could tell by the erratic movement that he was actually seizing. An ambulance took him off to the hospital and next Saturday he was on the sidelines, impatiently waiting to get back in the game. Read the rest of this entry ?

Posted in Karen Roush, nursing perspective, public health nursing, school nurses | Tagged , , , | 1 Comment »

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Domestic Violence Screening: Why the Rush to Dismiss It?

August 24, 2012

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

All rights reserved. Photos by author.

A recent study reported in JAMA, “The Effect of Screening for Partner Violence on Women’s Quality of Life” (abstract only), is being touted in overly simplistic headlines across the Web (the word “debunks” has been getting a lot of use) as further evidence that domestic violence screening doesn’t improve outcomes for women.

Don’t believe it.

The problem doesn’t lie with the researchers or with JAMA; they accurately reported just what they found. The problem lies with how it is being interpreted by others as further proof of the overall ineffectiveness of screening for intimate partner violence (IPV).

What the study actually found was that there was no difference in health outcomes between women who received computerized screening and a resource list and women who just received the resource list or women who received neither.

This is how it worked:

Women in primary care settings who agreed to participate and who were randomized to the screening group were seated in front of a computer and responded to the three questions in the partner violence screening (for example, “have you ever been hit, kicked, punched or otherwise hurt by someone within the past year?”) on the monitor. If they checked yes for any question, the computer played a short video of an IPV advocate who “provided support and information about the hospital-based IPV advocacy program and encouraged [them] to attend.”

All rights reserved.

So what’s wrong with this? True, this particular “screening” and “intervention” didn’t make a difference in the participants’ quality of life. The problem lies in the claims being made that this study proves that IPV screening doesn’t work. The reason this is a problem is not with the screening component. Research supports computer screening to improve disclosure rates—it’s one way to address the time burden that is often cited as a major barrier to screening, as well as the stigma attached to disclosure. So yes, further testing of this possible approach to screening is warranted.

The problem, as I see it, is with the approach taken with women who disclosed abuse. We know that women will disclose abuse and accept help if there is trust, the belief that you actually care about them, a nonjudgmental attitude and consideration for their safety. None of these things are present in this approach. In fact, it is the antithesis. What this approach tells women is that we cannot be bothered to actually talk to you in person—that would take more time, money, and actual empathy than we care to spend on you.

We also have evidence that a well-planned advocacy program with follow-up can work. This “intervention” doesn’t take into consideration the complexity of IPV. There are social, cultural, psychologic, economic, and physical factors involved. I don’t know what this computer-presented advocate says to the women watching. But even if it’s all the right things, she or he is still just an image on the screen.

And expecting women to take on all the emotional and practical challenges that disclosure and seeking help can entail, merely in response to a disembodied image on a screen, is a disservice to the women. Beyond the significant risk of increased violence and even death, there are so many other variables, such as fear of losing their children to protective services, or the difficulties involved in accessing resources when you are without transportation or funds. Read the rest of this entry ?

Posted in Karen Roush, public health nursing, women's health | Tagged , , , , , , | 1 Comment »

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Women’s Health: Paying Attention to an Invisible Group

July 5, 2012

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

My sister Ellen is getting married in two weeks, so last Sunday I threw a surprise bridal shower. We had all the traditional trappings—flowers and favors and (much to another sister’s chagrin) a shower game and prizes. The only thing not traditional: at this shower there were two brides, my sister and her fiancée, Pat.

After years of standing by invisible while sisters and brothers married, danced with their partners at each other’s weddings, celebrated births and graduations, now it’s their turn. No longer on the periphery, no longer the ‘other,’ at least for this day, these few weeks, they are finally able to celebrate their love and commitment to each other just like the rest of us.

Why am I writing about this in a nursing blog? Because this invisibility, this sidelining of lesbians like my sister and her fiancée, doesn’t only affect their family life—it extends into their health care as well. Neither Ellen nor Pat ever got routine women’s health care—no Pap smears, no clinical breast exams or mammograms, no routine assessment for osteoporosis risk. They were never hooked into the health care system by reproductive health needs, contraception, or pregnancy and childbirth, as my other sisters and I were. They didn’t have a regular gynecologist who followed them through their reproductive years and would now advise them on preventive health care as they approached menopause.

This isn’t unusual among lesbians; according to the CDC, many avoid getting routine health care. And there is evidence that lesbians may be at greater risk for some health problems. For example, it is known that pregnancy and breastfeeding are protective against certain cancers such as ovarian and breast. Many lesbians never go through pregnancy and childbirth, yet they are less likely than other women to get routine Pap tests or mammograms. And they live with the constant stress of social stigma and discrimination, risk factors for depression, anxiety, and heart disease.

There are a number of reasons why lesbians don’t get necessary health care: lack of domestic partner benefits, which prevents them from qualifying for health insurance coverage through their partner’s plan; discomfort talking with their provider about their sexuality; being misinformed about their risks; and lack of knowledge on the part of their health care providers. According to the Institute of Medicine there is an urgent need for research—we know lesbians face unique problems and risks, but we don’t have an evidence-based understanding of exactly what they are or how to address them. Read the rest of this entry ?

Posted in Karen Roush, nursing perspective, public health nursing | Tagged , , , , , , | 3 Comments »

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A Few Quick 4th of July Safety Tips for Kids

July 3, 2012

By Tyler John, via Wikimedia Commons

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

It’s almost the 4th of July—the unofficial beginning of summer! After paying your usual homage to the Declaration of Independence and remembering the Minutemen and women (yes, there were women!) of Lexington, here are a few ideas for all you pediatric nurses out there on how to make this holiday—and every summer day— safer for kids:

  • Start a bicycle helmet collection for your pediatrician office or local clinic so every time a kid says they don’t use a helmet because they don’t have one—voilà! Here you go!
  • Everyone thinks their kid is a star—now’s their chance to prove it! Get your kids or the neighborhood kids to ‘star’ in a homemade video on summer safety. Then showcase it on your waiting room TV screen or at summer camp. 
  • Safety education—along with the usual on water safety, don’t forget to provide information on lawn-mowing safety to adolescents. Don’t leave out the city kids; a lot of them spend part of their summers in the country, so don’t assume they won’t need this information also.
  • Ditto on grilling safety. Talk to parents of kids of all ages and directly to adolescents.
  • And of course, a reminder about the danger of setting off fireworks, the perennial favorite way to endanger ourselves or our kids on the 4th of July. 

Okay—that’s my list. Any creative approaches you want to share? 

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Posted in children's health, clinical managing editor, public health nursing | Tagged , , , , , | Leave a Comment »

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