Phone 334-262-8321 alabamanurses.org

Nurse March, April, May 2018 • Volume 45 • Issue 1

Provided to Alabama’s Nursing Community and Funded by the Alabama State Nurses Association.

Quarterly publication direct mailed to more than 84,000 Registered Nurses and Licensed Practical Nurses in Alabama Alabama State Nurses Association • 360 North Hull Street • Montgomery, AL 36104

Inside Alabama Nurse SAVE THE DATE ASNA 2018 ANNUAL CONVENTION

October 4-6, 2018 Leadership Grand National, Opelika, AL Academy 2018 Page 8 Plan for the 2018 ASNA Convention at the Auburn/Opelika Marriott Grand National Resort as part of a Family Vacation!

More info at alabamanurses.org Elizabeth A. Morris Clinical Education Sessions – FACES ‘18 Pages 9-12

IndexNurse Alabama Nurses Foundation...... 5 Clinical News ...... 16-19 Continuing Education ...... 13 ED’s Notes...... 3 Elizabeth A . Morris Clinical Education Sessions – FACES ‘18...... 9-12 Happy Nurses Week!...... 5 Leadership Academy 2018...... 8 Nurse Helps Centenarian Patient’s Legal Corner...... 4 LPN Corner...... 4 Dreams Come True Membership News...... 6-7 Centenarian Frank Calloway’s in 2014. In the 1970’s patients at trip to the opening of his Bryce were no longer allowed President’s Message...... 2 art exhibit, at the American to “work in the fields / farms” Visionary Art Museum in that had provided food for the Baltimore, could not have hospital since the Civil War. happened without his nurse. It Rather, they stayed indoors Non-Profit Org. could not have happened, in fact, and did “arts and crafts.” Mr. U.S. Postage Paid without a long line of nurses Frank began drawing scenes he Princeton, MN that assisted him over the years. remembered from his childhood Permit No. 14 current resident or “Mr. Frank” (as he liked to be on long rolls of butcher paper called) has passed on now, but with pencil, pens and crayons this incredible story you are about (the art supplies for the patients). to read lives on through his art Mr. Calloway and his Nurse This became his daily pass-time and through those who knew for many years. In 2008, his him. (The story was publicly disclosed...so no HIPPA works of art came to the attention of a museum curator violations). in Baltimore. They decided to dedicate an entire wing Frank Calloway was admitted into Bryce Hospital of the museum to display Mr. Frank’s work. He was in Tuscaloosa in 1952. He lived at the state psychiatric hospital, or one of the campus facilities, until his death Centenarian Patient’s Dreams continued on page 4 Page 2 • The Alabama Nurse March, April, May 2018 The President’s Alabama message nurse

Are You a Member? ASNA Board of Directors President Rebecca Huie, DNP, ACNP Rebecca Huie, RN, DNP, ACNP as the President for ASNA. This experience took a lot President-elect Sarah Wilkinson, DNP, RN ASNA President out of me with the exhausting emotional days and nights Vice President Linda Gibson-Young, PhD, CRNP, at her bedside wondering what her outcome was going FAANP Greetings Alabama Nurses! to be, whether for the better or worse. Balancing my Secretary Lindsey Harris, DNP, FNP-BC I hope you are all having a time between my mom, work, and family was definitely great 2018! ASNA has already a challenging experience. But, the things that made it Treasurer Wanda Spillers, DNP, RN, CCM started planning a busy and bearable was my faith in God, prayer, family, and the District 1 Donna Everett, MSN, BS, RN productive year. We began wonderful nurses who cared so diligently for her when I District 2 Jackie Williams, DNP,MSN, RN the New Year by planning was there and when I had to be away. There were definitely District 3 Wanda Spillers, DNP, RN, CCM for Nurses Day at the Capitol some very special nurses who went above and beyond to District 4 Bridget Moore, DNP, MSN, MBA on February 28, 2018. By the make my mom feel at ease, kept me informed of what District 5 Wade Forehand, DNP, RN-BC time you read this article, was going on, and provided me with comfort when I had this event has already taken to be away during the day to go to the office. I remember Commission on Professional Issues: place. I sincerely hope you one day, I was napping in the chair beside my Mother’s Sarah Owens Watts, PhD, RN, Chair were there to enjoy the robust ICU bed, when a nurse (Brandon) who was not even Parlimentarian: Sue Morgan, PhD, RN speakers and the Rally on the assigned to my mother brought a blanket into the room Capitol steps in Montgomery, and draped it over me as I was sleeping in the chair. This Alabama. This event is so memorable, and you just have to small gesture of caring and compassion meant so much ASNA Staff be there to feel the energy in the air, as hundreds of nurses to me. It made me so proud to be a nurse. Many of the and future nurse’s rally together. This is truly a prominent nurses on my mother’s care team displayed such kindness, Executive Director, Dr. John C. Ziegler, MA, D. MIN demonstration to show the influence of the nursing thoughtfulness, and concern for her and for me. The nurses Director Leadership Services, profession to State Representatives and Senators when we from the floor who stand out to me the most are Ashley, Charlene Roberson, MEd, RN, BC all come together as one profession, one voice. The energy Titiana, DuYoung, Andrea, Jennifer, and Fallon. However, ASNA Attorney, Don Eddins, JD from being present among hundreds of nurses rallying all of the nurses were amazing, as well as her entire Programs Coordinator, April Bishop, BS, ASIT at the Capitol is profound. If you have never experienced healthcare team. Andrew, the Nurse Practitioner also went Continuing Education Coordinator, this, I encourage you to plan to attend in 2019! This above and beyond to stop by several times during his shift event is organized by the Alabama Coalition of Nursing to check on my mother and discuss her medical condition Katie Drake-Speer, MSN RN Professions that encompasses many professional nursing with me. Thank you to UAB Highlands ICU nursing staff organizations. So, regardless of your nursing specialty, and healthcare team for caring not only for my mother Our Mission plan to be a part of this in the future. through this scary ordeal, but for me as well. ASNA also held the Board of Directors retreat in The Alabama Nurse goes out to over 95,000 nurses in ASNA is committed to promoting excellence in nursing. February and the Board members gathered to review the state of Alabama, but ARE YOU A MEMBER OF the 2017-2018 strategic plans, assess our progress, ASNA? I asked this question to several of the nurses who Our Vision and incorporate new initiatives into the plan for this were caring for my mom, and most of the responses were upcoming year. In 2017, the ASNA BOD developed “no.” The reasons varied and included responses such as; ASNA is the professional voice of all registered nurses the two year plan that included increasing visibility, they just haven’t taken the time to join, didn’t know the in Alabama. collaboration, membership and service. ASNA has made benefits of joining, or used to be a member years ago. huge progress in each of these areas during the past Many of these nurses told me that they have been in the Our Values year. For detailed information on our 2017 progress, visit nursing field for less than three years and some less than a www.alabamanurses.org and read “A Look Back at Our year. However, there were nurses that have been nurses for • Modeling professional nursing practices to other Amazing Year” under the news tab. many years that were not members. This informal survey nurses On a personal note, I would like to share a firsthand continues to perplex me. Why would a nurse NOT be a • Adhering to the Code of Ethics for Nurses experience of the compassion and dedication from nurses. member of ASNA, their very own nursing professional • Becoming more recognizably influential as an My mother was recently hospitalized for 22 days. She organization that represents over 95,000 nurses in their association spent 18 of those days in ICU. This was a challenging home state? Hopefully, it is just because they do not realize • Unifying nurses experience for me, as I am an only child and her primary the benefits of being a member. So, I will share another • Advocating for nurses caregiver. My Dad passed away many years ago, so she personal perspective on my ASNA membership and how • Promoting cultural diversity only has me to care for her when she is sick. I have a busy being a member has helped me, both personally and • Promoting health parity job with a huge amount of responsibility and an obligation professionally. I think the most meaningful and cherished • Advancing professional competence benefit that ASNA has given me are the friendships that I • Promoting the ethical care and the human dignity of have developed with nurses in various locations across the every person state of Alabama. A true friendship is a valuable gift, and • Maintaining integrity in all nursing careers to have nurse friends I can rely on who live hundreds of miles away is a pretty impressive benefit of ASNA. This is all a result of the networking that ASNA offers through Advertising various venues and events that are held during the year. There is also the benefit of, “It looks good on a resume,” For advertising rates and information, please contact Arthur L. but that is just a small perk compared to the leadership Davis Publishing Agency, Inc., 517 Washington Street, PO Box knowledge and skills you obtain by being involved in CE 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub. events, Leadership Academy, and/or serving on ASNA com. ASNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for committees. Another important aspect of ASNA that errors in advertising is limited to corrections in the next issue benefits me personally, are the many service projects or refund of price of advertisement. that I can be involved in throughout the year. When I • 3-11 Charge Nurse help someone else, I feel rewarded, fulfilled, and happier. Acceptance of advertising does not imply endorsement • 7-3 Quality Assurance Performance Don’t you? Mentorship is another huge benefit to add to or approval by the Alabama State Nurses Association the “why be an ASNA member” list, which hits both the of products advertised, the advertisers, or the claims Improvement Nurse made. Rejection of an advertisement does not imply a President’s Message continued on page 3 product offered for advertising is without merit, or that Benefits Include: the manufacturer lacks integrity, or that this association • Blue Cross/Blue Shield and disapproves of the product or its use. ASNA and the Arthur supplemental companies L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an (health, dental, vision secondary) advertiser’s product. Articles appearing in this publication • Paid Vacation/Sick Days www.alabamanurses.org express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of ASNA or • Educational Credits those of the national or local associations. • PRN scheduling for nurses The Alabama Nurse is published quarterly every March, attending college June, September and December for the Alabama State Nurses Association, 360 North Hull Street, Montgomery, AL 36104 4401 Narrow Lane Road, Montgomery, AL 36116 Published by: © Copyright by the Alabama State Nurses Association. 334-281-6336 Arthur L. Davis Alabama State Nurses Association is a constituent member of the American Nurses Association. www.johnknoxmanor.com Publishing Agency, Inc. March, April, May 2018 The Alabama Nurse • Page 3

President’s Message continued from page 2

personal and professional column. I have benefited and The E.D.’s Notes actually owe my professional nursing journey to some amazing mentors who guided, developed, supported, and encouraged me along the way, and still do to this day. ASNA provides nurses with an excellent opportunity to find a professional mentor. Finding the right mentor If You’re Living in a Bubble…ASNA is For U or several mentors will help nurses take charge of their careers and broaden their knowledge and skills. It doesn’t John C. Ziegler, MA. D. MIN exhausted. Maybe that was just their “charting” face… matter where you are in your nursing career; I believe that ASNA Executive Director At any rate, it was obvious that they were fixated on every professional nurse needs to have a mentor. We are the immediate task (and that’s how it should be). I lifelong learners, therefore, we never stop learning and Have you seen pictures thought I would be cool and introduced myself, during growing in this profession. ASNA’s mission is to promote of those wild big bubble-like what appeared to be a lull in activity, as the Executive excellence in nursing, but also to be an advocate for safe things with a person inside? Director of their Alabama State Nurses Association! practice for nurses and patients. This is why ASNA has They can run and turn the My “cool factor” was quickly deflated by a number of a fulltime lobbyist who keeps us informed of legislative bubble in any direction…roll blank stares… issues that may impact our nursing profession. Some down a hill and do all sorts “ASN… What?” I answered; “ASNA! For 104 years examples of legislative issues include, workplace bullying, of crazy “recreational” stuff ASNA has been THE professional nursing association safe staffing and safe patient handling. Therefore, ASNA from inside the bubble. Looks that gave nurses a voice in expanding their scope of provides nurses with opportunities to be involved with like fun for a while…but you practice and setting high standards for patient care.’ policy development that impacts the nursing scope wouldn’t want to be stuck in Blank stares… ‘We provide networking opportunities of practice and helps shape healthcare in the state of the bubble. “Living in a bubble” where you can meet nursing executives outside of the Alabama. During my ASNA membership, I have had the has been a sad cliché for a long workplace, benefits that save you money and a way opportunity to visit Washington D.C. many times and time. It describes someone to add your voice to support or defeat policies that participate in Lobby Day at the Capitol and attend the with a very limited awareness determine what you can do or can’t do as a nurse!’ American Nurses Association Membership Assembly. of things outside of their immediate surroundings Blank stares… Then finally, someone said: “Oh, the This has allowed me the opportunity to network with and daily routines. It can also describe someone who Alabama State Nurses Association…that’s where we nurses across the nation and be involved in several has allowed “the tyranny of the urgent” to pull them go to keep our license active – or if someone gets in national workgroups to develop strategies to improve our through life. Getting the kids up, dressed and off to trouble.” I politely answered, “No, that’s the Alabama nursing profession and healthcare delivery. ASNA also school…a nurse arriving at work 30 minutes early to Board of Nursing (ABN). ASNA exists to protect benefits the nursing profession by awarding scholarships get the transitional info from the previous shift…and nurses and their profession. The ABN/Board of to nurses pursuing a higher education. The ASNA so on. Sound familiar? Nursing, primarily exists to protect the public from scholarship award benefitted me when I was pursuing my Recently, I was asked by someone on the Alabama nurses who may not be competent or who may have Master of Science Degree in Nursing. I am also honored State Nurses Association membership team to give committed an offense or crime. Hallelujah! Rays of to serve as the President of ASNA and I would never have them three bullets / reasons why someone should join light flooded the hospital hallways! The blank stares gotten this opportunity, if I was not a member. My hope ASNA. They wanted to have that in hand, when they had changed to expressions filled with enlightenment! is that by reading this, you will consider joining ASNA. talked to friends and associates about joining. “A Then the sharp sound of a buzzer interrupted the We need to come together as one nursing profession, one reasonable question from an enthusiastic recruiter,” I joyous revelatory moment and two nurses quickly voice! Join ASNA today! thought. ASNA has so many benefits and does so much darted toward room 302. I was left alone at the nurses’ for the profession – no problem. Three reasons… station with one nurse…and a blank stare. All this is to say…I understand the bubble thing. 1. Networking and professional career development Nurses have the second hardest job in the world (the hardest job is being a parent). If you live in a bubble… 2. Benefits that far exceed the cost of dues it’s OK. ASNA is a warm, friendly, professional place where you can bump into other “bubble people” 3. Supporting and protecting the profession through (networking), get some outside air (personal benefits), legislative and policy advocacy and be assured that membership amplifies your voice (advocacy) about things that matter to you and your I put some of these out on a Facebook post and patients. Oh! I just gave you three reasons to join. By received a lot of positive comments. BUT, I also had the way, many young professionals and peers have a few skeptical comments like: “I don’t have time to already joined. We’ve grown by over 40% in the last network” – “ASNA hasn’t done anything to help my few years! So, for only $15 a month, you can have the job” – “I’m safe because I work for a big company” dignity of state and national membership. Although – “All ASNA wants is my money” – OMG! I realized your life may be very full, you can tap into benefits that coming up with three generic reasons to join at will and have the satisfaction of standing with 104 might not be as easy as I thought. Then I went to a years of advocates who have worked to make your hospital to visit a sick relative…and I watched the profession what it is today. Right now – pick up your nurses work. They were kind to patients and families… phone, go to alabamanurses.org and tap the red join but when they returned to their stations – the smiles button. I promise…we won’t burst your bubble. disappeared and most of them looked either bored or Page 4 • The Alabama Nurse March, April, May 2018

Centenarian Patient’s Dreams continued from page 1 Frank’s story, age, illness and art REMEMBERED…96 “That’s were worth, in themselves, museum how many bricks I’ll need for the invited to a gala given in his honor at the opening of the notoriety – there is one more steps.” She counted the bricks in the exhibit. Because of his age and multiple health issues, fascinating piece that attracted steps – 96! The medical staff at the an RN was required to be with him 24/7. After legal additional international media state’s psychiatric hospital began and medical clearance, plans were finalized to fly Mr. attention. After many years of to examine Mr. Frank’s “library” Frank and a medical team to Baltimore for the opening drawing his 20 – 30’ murals on long of drawings and found that he was ceremonies of his exhibit. rolls of butcher paper and dozens of a mathematical savant! For many Remember, he had been a patient at Bryce since staff attending him on a daily basis, years, he had begun each of his 1952. He had never flown before, never seen the ocean a NURSE NOTICED a feature of drawings with a grid filled with, not and never been out of the state of Alabama! Thanks to his art that aroused her curiosity. random numbers…but an inventory the professional care of the nurses who non-intrusively Before he began each landscape… list. How many pieces of lumber… checked vitals and blood sugar 6 M r . F r a n k Julian Bond, John Ziegler and spokes for wagon wheels, bricks for times a day...Mr. Frank was able created a grid Frank Calloway steps, shingles for roofs and so on… to enjoy the spotlight. And what a of squares He saw his drawing in his mind and spotlight it was! filled with numbers. She asked calculated the exact quantity of supplies he would need to Julian Bond and other famous him, “Mr. Frank what does the “construct” the image! dignitaries attended the gala (friends number 96 mean to you? (Picture This story would not be complete without this closing of Oprah, etc.). But, the part of the a grid of several hundred squares point. Thank you nurses for what you do every day. celebration that left no dry eye in the with different numbers written You save lives by noticing, assessing and investigating place was the children’s choir. They in each square) She picked “96” details…one patient at a time. And you make life better sang songs in an African language at random in the top third of the for your patients by catching “little things” that may have and one by one came and kneeled grid. He answered, “That’s how previously been overlooked. You connect and personally before Mr. Frank - a symbol of honor many bricks I’ll need for the engage patients with detailed questions like; “WHAT to their “elders.” steps.” Steps? A month later, the DOES THE NUMBER 96 MEAN – MR. FRANK?” Frank Calloway Artist Other than the generic interest long scene was completed. It was of this nice story, you may wonder – Why is this a farm scene with a house and animals. The house was To see more pictures of Frank Callaway’s art and RELEVANT TO NURSING? You see…although Mr. wooden. The front porch steps were brick. The NURSE Baltimore celebration go to alabamanurses.org.

LPN Legal Corner Corner

Don Eddins, JD The association is considering ways this year to strengthen the legislation, such as requiring health care The “Me Too” movement facilities to post notices of the law in workplaces. Any The Hands That corresponds with concerns and suggestions on strengthening would be welcomed. a survey the Alabama State Often nurses, along with a law officer, are assigned to Help to Heal Nurses’ Association conducted treat inmates temporarily housed in hospitals and medical concerning workplace violence facilities. When the bill was before the Legislature I “We Are All in This Together” in Alabama medical facilities. remember telling some people that it is ironic that, while the ASNA sent out officer had a gun, mace and a club/flashlight, as they should Gregory Howard, LPN approximately 1,500 surveys, have, if the inmate assaulted the officer, he would face a of which about 1,000 – an felony charge, but would only face a misdemeanor charge for If you work to help the incredible number of responses assaulting an unarmed nurse unless he seriously injured her. sick or disabled, you play an for so few surveys – were Of the biggest concern, however, is not the occasional important part in the healing answered and returned. The inmate housed in the facility, but every day advances, process of others. We all have, huge percentage of returns – touchings, propositioning, bullying and hostile work and play, a part in the care of about 90 percent – indicated the registered nurse had been environment. those who need us. Some may victim of some sort of harassment or violence – though not But make no mistake about it—sexual harassment think that only the licensed necessarily sexual in nature – on the job. is against the law. If you are a victim, report it to your care takers can help, and are ASNA has long been concerned about workplace supervisor immediately. If the supervisor is the harasser, responsible, for the healing violence and bullying – whether from a fellow worker, report it to his supervisor. And/or call a lawyer, but if you process. Not so. Collectively, supervisor, doctor or patient family member or friend. In decide to call an attorney, do it quickly, because timelines licensed or unlicensed, we play fact, your Association pushed through legislation several under Title VII of the 1964 Civil Rights Act are very short. a part in the process. This is years ago that makes it a felony to assault a health care And as we have been made aware by events at the why it is so important that we worker on the job. national level with the “Me Too” movement, no one is all do our part. above the law and even the most powerful can be stopped What happens when someone fails? This means from the illegal behavior. someone else must, or should, take up the proverbial slack. In today’s society, no one should have to sleep with As uncomfortable as it may be, we have an obligation to another to win a promotion or keep his/her job. It is not notice light incompetence or neglect, for the sake of the right and it is against the law. people we serve. When people reach a certain age it becomes even clearer how important it is to receive competent and compassionate care. PUBLICATION We must all be in step on this one, or we will perpetuate mistrust and the downfall of a stellar The Alabama Nurse Publication Schedule for 2018 reputation. Issue Material Due to ASNA Office “We are all in this together” so let’s fight the fight and do We are dedicated to developing and Jun/Jul/Aug April 16, 2018 our part. supporting your career with more Sep/Oct/Nov July 16, 2018 opportunities for advancement. Dec/Jan/Feb. 19 Oct 16, 2018 We are dedicated to developing and supporting your career with more opportunities for advancement. Guidelines for Article Development Registered Nurses The ASNA welcomes articles for publication. There is no • WorkRegistered one-on-one Nurses with patients payment for articles published in The Alabama Nurse. • Work one-on-one with patients 1. Articles should be Microsoft Word using a 12 • Work • Work forfor a acompany company with a team with approach a team approach We are• Enjoy dedicated a better to work/life developing balance and supporting your point font. •career Enjoy with amore better opportunities work/life for advancement. balance Call us today at 2. Article length should not exceed five (5) pages 8 x 11. ASNA extends it’s deepest sympathy to: 3. All references should be cited at the end of the article. Condolences: Registered Nurses 4. Articles should be submitted electronically. Call • Work855-KND-AT-HOME us one-on-one today withat patients Dr. Carol Dabbs, ASNA District 1 on the death of • Work for a company with a team approach (855.563.2846) or visit Submissions should be sent to: her husband James Dabbs. • Enjoywww.kindredathome.com/careers a better work/life balance 855-KND-AT-HOME [email protected] Call us today at EEO or ASNA President-Elect, Dr. Sarah Wilkinson on the (855.563.2846)855-KND-AT-HOME or visit Editor, The Alabama Nurse death of her father. www.kindredathome.com/careers Alabama State Nurses Association (855.563.2846) or visit 360 North Hull Street | Montgomery, AL 36104 ASNA District 5 member Jean Jolly McClain on the www.kindredathome.com/careers death of her husband Joe. © 2016 Kindred at Home CSR 188899-12 AA/EOE M/F/D/V ASNA reserves the right to not publish submissions. encouraged to apply. 3191v1 EEO March, April, May 2018 The Alabama Nurse • Page 5 Alabama Nurses Foundation

The mission of the Alabama Nurses Foundation is to Eligibility Criteria increase public knowledge about the nursing profession Alabama Nurses 1. Must address a current Alabama health issue. and help nurses grow in advancing their education. 2. At least one grantee must be a current ASNA member. Most nurses think about the foundation only in terms of Foundation Community 3. Preferable to leverage resources with other community academic scholarships and yes we will award a number Grants Application organizations and/or other 501c3 agencies. of academic scholarships at FACES on April 17, 2018. 4. Funds may not be earmarked to complete academic However, in this issue we would like to focus on the Purpose work. Community Grants. At least four Community Grants are The purpose of the Alabama Nurses Foundation 5. Priority will be given for projects that support the awarded each year for community-based projects. Past Community Grants is to help Alabama nurses working ASNA Strategic Plan and/or resolutions adopted by recipients have been involved in environmental issues in in the community settings to contribute to the health and the ASNA House of Delegates. the Uniontown and nutritional issues in northern Alabama. welfare of the Alabama Citizens. Grant recipients are 6. The project may be based in either a nurse’s work or We are seeking more grant recipients. encouraged to participate in community-based projects volunteer setting. that can impact a positive change in a current health issue. Apply online at alabamanurses.org/ANF Application and Award The Alabama Nurses Foundation will award the For more information: Community Grants on an ongoing basis throughout the Charlene Roberson, MEd, RN-BC year. Up to four different grants will be awarded each Director of Leadership Services, ASNA Alabama Nurses Foundation fiscal year. Each Community Grant is awarded for $500. 360 North Hull St. | Montgomery, AL 36104 360 North Hull St. ~ Montgomery, AL 36104 Funds may not be used for influencing legislation or to Ph: 334-262-8321 | Fx: 334-262-8578 PH: 334-262-8321 ~ FX: 334-262-8578 lobby government officials. [email protected]

GOT YOURS? HAPPY NURSES WEEK! Celebrate National Nurses Week May 6 – 12, 2018 This year’s theme is Nurses: Inspire, Innovate, Influence.

Send ASNA pictures of how you are inspiring, ASK FOR A “NURSE TAG” innovating, and influencing. AT YOUR LOCAL TAG OFFICE Page 6 • The Alabama Nurse March, April, May 2018

Membership News

Welcome New and Returning Members (October - December 2017)

Candace Abernathy Grimes Cynthia Barrett Deborah Brannon Pamela Chandler-Edwards Shawn Cosper Lindsay Giddiens Marsha Adams Vicki Bartlett Sylvia Britt Janie Chatham Candice Cotton Stacy Glass Roselyne Akines Sharon Bates Amanda Brown Cecile Cherry Latorria Cotton Teresa Glover Anita All Mary Battaglia Jayne Brown Elizabeth Chesley Neiel Covington-Elston Ernesto Gonzalez Kathalyn Allen Judy Bazzell Jeannie Brown Linda Chester Charlotte Cramer Sharon Goodison Laura Allen Katherine Beard-Petrowski Lucy Brown Francetta Childers Anna Crawford Aileene Goodner Gladys Amerson Erin Beasley Robert Brown Gwendolyn Childs Maryann Crow Jaenelle Grace Azita Amiri Geri Beers Wendi Brownlee Margaret Chivington Jennifer Curran Joan Grant Sandra Anderson Betty Bell Alice Brumbach Permellia Clearo Tamara Dale Bonnie Green Sylvia Anderson Beverly Bell Brady Burge Allison Clement Treasa Daly Rebecca Greenwood Meyer Susan Appel Donna Beuk Sarah Burks McPherson Rheta Cobb Norman Damron Joy Griffith Janet Ash McIntosh Ann Bianchi Elizabeth Burns Ellen Cohen Rayanne Daniels Catherine Guthrie Joyce Austin Jan Biasini Doris Bush Kisha Coleman Emma Davidson Holly Guthrie Janet Awtrey Ruth Bischoff Joyce Butler Laura Coleman Deborah Davis Brenda Hall Judith Azok Leslie Black Brenda Bynum Lasondra Coley Ginger Davis Emily Hall Gennifer Baker Tammy Blackmon Sandra Capps Stephanie Collins Jennifer Davis Heather Hall Marianne Baker Allison Bogese Lisa Cargile Kyle Collum Mardell Davis Peggy Hall Marie Bakitas Urla Boggan Angela Carmichael Smith Virginia Collum Mary Davis Celia Hambright Ladarryl Banks Lydia Bonner Cora Carter Jennifer Compton Sandra Day Debbie Hamby Monica Barfield Linore Bouska Mishelle Cartwright Annie Conn Rhett Dean Anna Hamel Keshala Barlow Wanda Bradford Kitty Cathcart Mary Cooper Billie Deason Cheryl Hamilton Joni Barnett Betty Bradley Doris Chandler Cyndi Cortes Mary Degges Pamela Hamilton Velma Denson Jena Hamm Michelle Derrington Vinetta Hammondez-Yow Janet Deutsch Youngshook Han Charlie Dickson Paula Hancock Anne Dillard Lee Hardin Katie Dillard Lattie Hardy Gina Dobbs Sharon Hardy Karen Doulin Ruth Harrell Lauren Doyle Lindsey Harris Kristi Dreyer Martha Ray Harris Kim Driggers Mary Harris Linda Dubois Melissa Hearn Ryne Duren Barbara Helton Shanterrica Eager Kendall Henderson Martha Eason Sandra Henderson Laura Edwards Diana Hendon Jasmine Egbuna Stephani Hernandez Lee Elgin Vicki Herston Britney Elliott Rachel Hester Tracey England Yvonne Higdon Jolena Epps Debra Hildreth Tamela Esham Cynthia Hill Tommy Etherington Lee Hill Cathy Evans Beverly Hogan Emily Evans Lygia Holcomb LaDonna Evans Scherri Holland Tonya Evans Carolyn Holman Julie Facklam Melissa Holman Patricia Faile Lee Bobbie Holt-Ragler Vesta Fairley Rosemary Hoodless Cherie Fancher Cicely Hooten Robin Farrell Laci Hopkins Brenda Ferguson Lindsey Howell Lillian Findlay Lauretta Huff Heather Flores Teresa Hughey Anne Foote Stacy Humphress Christopher Forbes Jennifer Humphries Josephine Ford Audreekia Hunt Judith Ford Carl Ivey Jeffery Forehand Pamela Jackson Linda Forte Suoliver Jackson Loren Fossee David James Traci Fowler Corine January-Union Sarah Franklin Mina Jeffers Kathy Frawley Carthenia Jefferson Jacqueline Frederick Emma Jeffrey Jeanette Free Barbara Jernigan Cindy Freeman Evelyn Jeter Katherine Frey Joyce Jeter Cassandra Frieson Barbara Johnson Glenda Ganus Kimberly Johnson Emily Garrison Sierra Johnson Safiya George Dalmida Bette Jolly Jimel Gibbs Artilya Jones

Welcome Members continued on page 7 March, April, May 2018 The Alabama Nurse • Page 7

Membership News

Welcome Members continued from page 6 Abby Nixon Christine Rembert Carole Smith Melanie Walker Julia Norfleet Eva Reynolds Jennifer Smith Frankie Wallis Loretta Jones Tracy Mason Ramon Norton Rebekah Reynolds Katherine Smith Jacqueline Walls Monairee Jones Mukesha Mbuguje Leah Oakley Christy Rials Mary Smith Martha Walls Virginia Jones Lovie McAboy Phyllis Ogletree Mary Rice Rae Smith Athea Walz Sybil Jordan Karen McCaa Felicia Oji Cindy Richards Rebecca Smith Billie Ward Tonya Judson Kathy McCaleb Parthenia Oliver Hannah Ritter Ruth Smith Cynthia Ward Alishia Keef Lauren McCray Linda Olivet Keshia Rivers Shelia Smith Melissa Ward Mary Kehoe Nannette McDaniel Stephanie Onstine Charlene Roberson Heather Snell Durinda Warren Amy Kelly Sherry McDaniel Concepta Onyatta Sarah Roberts Rhonda Snow Felicia Watkins-Zumstein Elizabeth Kendall Deborah McDonald Michelle Osoinak Cheryl Robinson April Southern Lauren Watson Jeannie Kersey Cindy McGuire Susan Outlaw Gloria Robinson Bernice Spencer Dianne Watts Jill Kilpatrick Keri McLendon Elisabeth Owen Stephanie Rodenberry Yvette Spencer Aegina Weatherly Teresa Kimminau Jenn McLeod Katelynn Owens Theresa Rodgers Sandra Spengler Bertie Welch Pamela Klein Resha McQueen Clara Owings Phillip Rogers Dorothy Stallworth Cynthia West Patricia Knight Lois Meadows Jacqueline Page Sandra Rose Burma Stephens Holly Wheeler Eugenie Konde-Ayinde Theresa Melonas Beverly Parker Jill Ross Cherie Stevenson Sherwanna Wheeler Laura Lambert Karen Meneses Sheila Parker Martha Rowe Carol Stewart Lula Whigham-Marable Wendy Landier Gwendolyn Miller Patricia Patrician Tomeka Royster Renee Stinson Joseph White Ann Lane Sarah Miller Doris Patton Lynette Ruckman Felicia Stoddard Marguerite White Ginny Langham Tonya Miller Angela Paul Sandra Rudolph Mathew Strother Janet Widell Amelia Lanz Rebecca Miltner Tracy Payton Valeria Rudolph-Rivers Joyce Stutts Cindy Williams Yolanda Lanzillo Dorene Miree Laura Pearce Bonnie Rust Veronica Sullivan Deborah Williams Martha Lavender Shakila Moore Tonya Pelham Brenda Rutherford Sherry Sutphin Felicia Williams Edna Lecroy Thomas Moore Alicia Pettis Evelyn Ryce Donna Sykes Gwendolyn Williams Patricia LeCroy Victoria Moore Debra Phillips Jennifer Saltzmann April Tate Jacqueline Williams Adrienne Lee Margaret Moore Nadler Tammy Phillips Hellen Salvo Jason Taylor Katheryn Williams Harry Lee Aratolliah Moorer Lashonda Pinchon Angela Sanders Jennifer Taylor Nelda Williams Marilyn Lee Berry Morgan Lelia Elaine Plank Catherine Sanderson Terri Taylor Theletha Williams Nikkia Leflore Jana Morgan Lynn Platt Gabriel Sapalaran Allyson Thomas Ella Williamson Veronica Leftridge Sue Morgan April Poe Marina Savochka Valarie Thomas Joan Williamson Henry Linsky Arlene Morris Erin Ponds Katie Scott Virginia Thomas Licia Williamson Gwendolyn Lipscomb Elizabeth Morris Marilyn Poole Shanda Scott Candace Thompson Cheryl Wilson Crowell Lisenby Judith Morris William Pope Burnell Seals Georgia Thompson Judith Wilson Debra Litton Priscilla Morrissette Alesia Porter Cynthia Selleck Nikki Thompson Terry Wilson Shelicia Morton-Ford Misty Loffer Deborah Potts Shana Sellers Patricia Thompson Lois Wilson-Scott Robin Loftin Anne Mueller Janet Pouncy Lynn Sexton Cassandra Thweatt Donna Wimberly Olga Dawn Logan Danyel Munster Beverly Powell Penny Shadinger Kathleen Troup Jacqueline Windham Sarah Logan Terri Murphy Suzanne Prevost Martha Shaw Cynthia Trujillo Mia Witten Brandy Long Pache Murphy-Jennings Elizabeth Pugh Barbara Sheffield Cathy Turner Felicia Wood Wyndy Looney Eddie Murray Kelli Puhnaty Karen Shelley Rosann Turner Paula Worthington Alexandria Loya Patricia Myers Charles Quintero Delores Sherman Anne Turner-Henson Cara Wortmann George Lucas Lee Nail Cynthia Quisenberry Lanette Sherrill Eucharia Uzochukwu Cathy Wright Gloria Luster Angela Napier Rachel Rachielles Roy Sherrod Stephanie Vansandt William Wynn Cathy Malone Candice Nelson Sandra Raine Pamela Short Doris Vawters Sandra Yester Shelia Marable Deborah Nelson Carol Ratcliffe Allison Shorten Donna Voreis Dima Zaza Whitney Martin Danielle Newman Andrea Reese Frances Ellen Singleton Kim Wagner Lula Zeigler Tiffany Marx Elizabeth Nichols Elizabeth Reid Camie Smith Julee Waldrop

News from the American Heart Association Introducing My Cardiac Coach,™ a Free Please Pardon Our Slip... My LaQuitta “Shai” Wilkins was inadvertently App from American Heart proclaimed “Miss Black America” in the December 2017, January, February, 2018 issue of After a heart attack, you’re told to focus on recovery. Then you’re The Alabama Nurse. Miss Wilkins’ correct title left to figure it out. What are the next steps? Where do you find reliable is “Miss Black Alabama.” We apologize to Miss information? How do you make good health habits and stick to them? Or keep Wilkins and our readers for our error. track of medications and doctor’s appointments? And with all that to worry about, how do you keep from getting too overwhelmed to move forward? Those are just the kinds of questions that inspired the American Heart Association to develop My Cardiac Coach, a free mobile app that can help you find your way to a healthier future after a heart attack. My Cardiac Coach is a personalized recovery toolkit you carry in your smartphone. It gives you anytime/anywhere access to everything you need, including: • Trustworthy information from the experts at the American Heart Association • Interactive lessons to help you learn what you need to know Congratulations!According to a recent Gallup • Progress-trackers for monitoring blood pressure and weight • Tools for logging physical activity and managing medications Poll, for the 16th year in a row • Connections to other survivors through our Support Network Americans have rated nurses as Get My Cardiac Coach now: having the most honest and ethical standards of 22 other professions. Page 8 • The Alabama Nurse March, April, May 2018 Leadership Academy 2018 The ASNA Leadership Academy cultivates nurse leaders to uMotivate uInspire uCreate uInfluence uLead

THE ASNA LEADERSHIP ACADEMY is designed Integrating Holistic Health for nurses by nurses to help participants develop excellent leadership skills through action-oriented projects related to Promotion at the University of their specific interests. Each individual is guided through the one-year program by experienced nurse mentors South Alabama Health System and supported by peers in the group. Mentors will help you create your own project that can be implemented Kortni Crook Kennell, BSN, RN in the workplace or the community. Past projects have 2016 ASNA Leadership Academy Participant significantly improved efficiencies in the workplace, patient care, workplace environments, and instituted creative new Hospital employers across the country have wellness initiatives. The three class days include leadership increasingly been implementing health promotion and development presentations to the Cohort with mentor-time wellness in the workplace. There has been an identified related to individual projects. For busy nurses who want to need to offer integration of holistic health promotion to grow...this is the way to go! Registration (Survey Monkey the community, patients, and employees at the University link at bottom of article) must be in by APRIL 2, 2018. 2017 Leadership Academy graduates and mentors of South Alabama Health System. Based on this identified need, promotion of the hospital’s walking path was the EXAMPLES OF 2017 PROJECTS INCLUDE: focus of my leadership project. • In Situ Mock Codes: Building Confidence & 2018 CLASS FOCUS The University of South Alabama Medical Center Improving Response currently has a walking path. The walking path includes • The Art of Nursing: Artwork as a Mode of Social Day 1: Monday, 16 April 2018 connecting side walks, benches and water fountains. Persuasion to Effect Infant Feeding Choices Employees and visitors often use the walking path. • Clinical Evidence Rubric for Concept-Based u Overview & Expectations However, it has never been advertised to the community, Undergraduate Nursing Curriculum u Leading with Trust, Integrity, & patients or employees. • Establishing the Alabama Association of Clinical Compassion My first step was to consult with our public Nurse Specialists: Empowering & Facilitating a relations (PR) department. Our discussion included Professional Voice the implementation of quarterly walk and talk events • Growing Leaders: Fostering Student Resilience in Day 2: Tuesday, 17 April 2018 featuring physicians, promotion of health system service lines, community involvement, and future plans for Undergraduate Nursing Education u Attend Plenary Sessions at FACES ‘18 • Improving Access to Healthcare for Veterans Living sustainability. After meeting with PR, it was discovered in Rural Areas u Public Policy that the walking path has never been officially opened • The Cost of Incivility u A Message Driven Interview – includes or promoted. Following this discussion, a decision was • Screening for Functional Decline in the Older made to partner with PR. PR would not only improve practice with interview techniques the utilization of the walking path, but assisted with Hospitalized Patient u • Get H.I.P.-A Trident Approach to Increase human Advanced Role Transitions implementation & integration of holistic health promotion. Immunodeficiency virus Screening in Primary Care u Ins & Outs of the WIKI/ Therefore, to reach followers, Facebook, Twitter, • Transitioning from a Metropolitan Trauma Center to Communications Instagram, and local media options would be beneficial. a Rural Hospital PR assisted with promotion. I met with Lisa Mestas, the Chief Nursing Officer The registration fee of $450 covers all meetings, session Day 3: Saturday, 15 July 2018 (CNO) of the Health System. meals, materials, registration for presentation day at the ASNA u Distributed Professional Network Role The CNO discussed the history of the walking path Convention, and 40 contact hours. (Alabama State Nurses and its original concept. Based on our discussion, it Association is accredited as a provider of continuing education u Global initiatives in nursing and health was recommended that I meet with our Chief Executive in nursing by the American Nurses Center’s commission on care Officer (CEO). With hospital administration and PR Accreditation and the Alabama Board of Nursing.) Additional u Community focus support, a ribbon cutting ceremony took place in October costs covered by the participants include travel and lodging. of 2016. A small committee was established to assist with Contributing sponsors ($1000) receive two participant u Interprofessional Issues this event. registrations. For additional information call Charlene Roberson at 334-262-8321 or 1-800-270-2762 or email u Nurses Serving on Boards & Mentor Two television stations, WKRG and Fox 10, covered [email protected]. Time the event and interviewed our staff. Those interviews and other segments aired a total of eight times and reached 238,341 TV viewers with positive messages about USA Medical Center, USA Health and our university. The REGISTER NOW AT ALABAMANURSES.ORG/LEADERSHIP Press-Register also ran a story and photo on the day of the event and were planning to run more photos and a story afterward. The paper’s daily readership is at least 120,000. To achieve sustainability of the project, a calendar That research paper isn’t going to write itself. year of quarterly walk and talks with physicians will be established yearly. Each quarterly meeting will be advertised by PR. I will also continue to collaborate Visit www.nursingALD.com with physicians, community leaders, hospital employees, and health care system administrators. My vision is to to gain access to 1200+ issues of official state nurses publications, offer this service to patients and family members while all to make your research easier! transitioning from the hospital to home. March, April, May 2018 The Alabama Nurse • Page 9 Elizabeth A. Morris Clinical Education Sessions - FACES ‘18

TIME AANS ACADEMIA CLINICAL 1 CLINICAL 2 GENERAL OPIOIDS PEDIATRIC RESEARCH

0800-0915 PLENARY A – Intraprofessional Communication – Dr. Arlene Morris

BREAK – VISIT EXHIBITORS (Exhibit Hall) 0915-1000 VIEW POSTERS (2nd floor Hall)

1000 - 1100 PLENARY B – Mental Health in Alabama – Lynn Beshear, RN, Alabama Dept. of Mental Health Commissioner

Video/Lecture Neurofeedback: A Emergency Dept. Opioid Therapy… How to Pass the Self-Directed & Hands On 1115 - 1215 Third Treatment Triage: The Other A Whole Health NCLEX Leadership Training: Option… Door… Approach Seizures

LUNCH ~ Fellowship Hall 1215-1315 View Posters (2nd Floor)

1315-1430 PLENARY C – Annie Mae Bellow – A Pioneer Alabama Nurse – Anne Gibbons, JD

1430-1440 BREAK ~ VISIT EXHIBITORS, VIEW POSTERS

Pt. 1 – Elderly as a Photovoice: Video/Lecture Hazards of The Role of Culture: A Classroom Living Well: Self & Hands On 1440-1540 Mentoring Zika Virus Update Electronic Nurses in & Critical Thinking Care for Nurses Training: Cigarettes Addiction Care Pt. 2 – Childhood Strategy… Tracheotomy Obesity Video/Lecture Pt. 1 – Keeping Evolution of Resuscitative Legendary Nurses Role Communicating Type 2 Diabetes & Hands On Patients Safe.. Technology and Endovascular “Notable” Nurses in Caring for 1550-1650 with the Next Mellitus in Training: Diabetes & Education (Social Balloon Occlusion in Alabama’s Individuals & Generation Adolescents… in the Pediatric Pt. 2 – Does a Media) of the Aorta Black Belt Families… Population Faith-Based… Posters will be located on the second floor above the Sanctuary ASNA’S LEADERSHIP ACADEMY WILL BE HELD IN ROOMS 806-808 (Located to the right of the Sanctuary)

Mental Health First Aid: Increasing Knowledge and Awareness While Proactively Helping Those in Need

Commissioner Lynn Beshear, We want to help blanket the state with “first aiders” • Professionals who regularly interact with citizens Alabama Department of Mental Health who recognize the signs and symptoms of a mental or (such as police officers, human resource directors, substance crisis. You may notice someone who exhibits and primary care workers) Prevention and early intervention are essential to symptoms while sitting in the waiting room or during an • School and College faculty and staff changing the way we support those with mental health appointment. Mental Health First Aid helps to increase • Houses of faith and their communities or substance use disorders. One way to proactively assist confidence in, and the likelihood to help an individual in • Friends and family of individuals with mental illness those in need is obtaining training in Mental Health First distress. Aid. Just as CPR helps one learn the skills to save an Alabama has over 90 trained and nationally-certified Trainees are taught how to apply the evidence-based individual having a heart attack, Mental Health First Aid instructors statewide teaching the curriculum. In just one five step action plan in a variety of situations such as provides the know-how to assist someone experiencing a day, you can learn the skills to ensure someone gets the helping someone through a panic attack, engaging with mental health or substance use-related crisis. The Alabama help they need and perhaps, save a life. Encouragement someone who may be suicidal, or assisting an individual Department of Mental Health supports the growth of those and endorsement of Mental Health First Aid by nurses who has overdosed. trained in Mental Health First Aid. and medical staff is essential to help others understand its Find out more and find links to find a course and Mental Health First Aid is an evidence-based, peer- importance. obtain training or become an instructor on the Alabama reviewed program designed to help grow knowledge of Mental Health First Aid is intended for all people and Department of Mental Health’s website at http://www. signs, symptoms and risk factors of mental illness and organizations that make up a community. The course is a mh.alabama.gov/MentalHealthFirstAid.aspx. addictions. The training is a great refresher for psychiatric benefit to: Please consider taking a Mental Health First Aid course nurse training. Mental Health First Aid is an 8-hour course • Nurses and staff at doctor or dental offices, so we can all be part of the proactive effort to reduce that gives you the skills to help someone who is developing a hospitals, and nursing homes stigma around mental illness and addiction, increase mental health problem or experiencing a mental health crisis. knowledge and understanding, and help those in need.

Alabama Hospital Staff Nurse Study Your Voice is Important! Why are Nurses Suing the EPA? In order to examine nursing work environment, staffing characteristics How is it that our shampoo can contain carcinogens and were “generally regarded as safe” without any evidence and patient safety, we are conducting our floor cleaner reproductive toxicants? about their safety or harm to confirm this assumption. a study of AL staff RNs who work on For over a decade nurses have been working with This was a way in which to “grandfather” a host of toxic inpatient units. You will receive a a wide range of partners, including other health chemicals and thus protect them from new requirements postcard in the mail in March/April professionals, environmentalists, and health-affected for safety testing. Additionally, the burden of proof 2018 requesting you to go to an online groups, to up-date the nation’s chemical safety policy. regarding toxicity was the responsibility of the public link to take the survey. Written in 1976, the Toxic Substance Control Act was and the Environmental Protection Agency, rather than Participation is voluntary, yet we need your help to an ineffectual safety net for people and the environment requiring manufacturers to prove that a chemical or accurately represent nursing work environments in AL from exposures to toxic chemicals in our air, water, food, product is safe before letting us use the product in our hospitals. If you have any questions, please call Dr. Pat and products. It did not require companies to do any sort homes, schools, or workplaces. In every instant in which Patrician at (205) 996-5211 or e-mail at [email protected]. of pre-market testing of their products for toxicity or the EPA tried to prove that a chemical was dangerous, the potential harm. industry prevailed in keeping it on the market. An example If you have questions about your rights as a research participant, Worse, it established that any chemicals that were or concerns or complaints about the research, you may contact the already in the market place (some 80,000 chemicals) UAB Office of the IRB (OIRB) at (205) 934-3789 or toll free at Nurses Suing the EPA continued on page 12 1-855-860-3789 from 8:00 a.m. to 5:00 p.m. CT, Monday - Friday. Page 10 • The Alabama Nurse March, April, May 2018 Elizabeth A. Morris Clinical Education Sessions - FACES ‘18

CLINICAL 2A – Emergency Department Triage: The 3. Relate the value of media-focused instruction, Elizabeth A. Morris Clinical Education Sessions – Other Door to Triage – Dr. Frankie Wallis, Sherichia facilitated discussion and story sharing to increasing FACES ‘18 Hardy, MPH, BSN mental health awareness and in changing stigma. Tuesday, April 17, 2018 At the conclusion of the presentation, the participant Eastmont Baptist Church should be able to: CLINICAL 1B – Zika Virus Update – Dr. Lynn Chilton Montgomery, AL 1. Acknowledge the need for a “back-door” triage process. At the conclusion of the presentation, the participant 2. Develop an understanding for an appropriate should be able to: ambulance triage process to improve patient safety. 1. Examine the epidemiology, signs/symptoms, and 7:15 – 8:00 AM 3. Identify factors related to emergency department complications of the Zika Virus. REGISTRATION backlogs. 2. Contrast methods of vector control and prevention...... 4. Relate the roles and responsibilities of ambulance 8:00 – 9:00 AM triage personnel. CLINICAL 2B – Hazards of Electronic Cigarettes – PLENARY A 5. Identify the socioeconomic impact on emergency Joy Griffith, BSN, RN At the conclusion of the presentation, the participant PLENARY A – Intraprofessional Communication – GENERAL A – Self-Directed Leadership for Nurses– should be able to: Dr. Arlene Morris Drs. Linda Gibson-Young and Loretta Forlaw 1. Identify the hazards of using electronic cigarettes. The session will explore intraprofessional communications At the conclusion of the presentation, the participant 2. Discuss the limited effectiveness of electronic and how this can promote positive patient outcomes. should be able to: cigarettes in smoking cessation. 1. Examine the matrix of Self-Directed Leadership. 2. Complete a Self-Directed Leadership questionnaire in GENERAL B – Living Well: Self Care for Nurses – 9:15 – 10:00 AM class. Mona Shah-Joshi BREAK 3. Develop, in class steps to move towards Self- At the conclusion of the presentation, the participant ...... Leadership. should be able to: 10:00 – 11:00 AM 1. Explore the benefits of self care using concepts of PLENARY B OPIOIDS A – Opioid Therapy…A Whole Health breathing, meditation, and yoga. Approach – Sherry Cox, Col (Ret), USAF, NC; RN-BC, PLENARY B Mental Health in MA; VA Health Coach, Joseph Moates, MD, Dr. Durinda OPIOIDS B – The Role of Nurses in Addiction Care – Alabama – Lynn Beshear, RN, Alabama Warren Dr. Mercy Ngosa Mumba Dept. of Mental Health Commissioner At the conclusion of the presentation, the participant At the conclusion of the presentation, the participant This session will examine the status of should be able to: should be able to: mental health in Alabama, both what 1. Relate the impact of Opioid crisis in the U..S. 1. Relate how nursing is relevant in the fight against the is positive and where we need to focus 2. Describe the effectiveness of an SMA in the reduction national opioid crisis. efforts to provide the best care. of Opioid therapy. 2. Examine ways nursing can take leading role to improve patient outcomes. 11:00 – 11:15 AM PEDIATRIC TRACT A – Charolette Jones, BSN, RN, BREAK CPN, Jennifer Williams, BSN, RN, CPN, Jennifer Glenn, PEDIATRIC TRACT B – Charolette Jones, BSN, RN, ...... CRNP, Loretta Hill, MSN, RN CPN, Jasmine Coleman, CPN, Jennifer Williams, BSN, RN, CPN, Jennifer Glenn, 11:15 AM – 12:15 PM MSN, RN CRNP, Loretta Hill, MSN, RN CPN, Jasmine Coleman, SESSION A At the conclusion of the presentation, the participant MSN, RN should be able to: At the conclusion of the presentation, the participant AANS A – How to Pass the NCLEX ® – should be able to: Stuart Misner, MSN, ACNP-BC, HURST Seizures: (Lecture/Video) Review Services (No CE credit will be 1. Discuss the prevalence of epilepsy in children. Tracheotomy: (Lecture) awarded for this session) 2. Identify the seizure types along with treatment. 1. Describe the different types of traches and their At the conclusion of the presentation, the 3. Assess patient during seizure. purposes. participant should be able to: 4. Relate the importance of the caregiver. 2. Identify reasons patients go home with traches. 1. Summarize how to pass the NCLEX® 3. Demonstrate home teaching (suctioning, trache change, Seizures: (Hands On) when to call 911). 1. Demonstrate correct placement of patient during seizure. CLINICAL 1A – Neurofeedback: A Third Treatment 2. Describe use of rescue meds during seizure. Tracheotomy: (Hands On) Option for ADHD – Dr. Beverly J. Meyers 3. Relate when to call 911. 1. Recreate scenarios parents go through before At the conclusion of the presentation, the participant discharge. should be able to: 12:15 – 1:15 PM 2. Describe what to do when a patient comes to your 1. Discuss the use of neurofeedback to improve attention LUNCH facility. and behavioral control for children diagnosed with ...... ADHD. RESEARCH B (Pt. 1) – Elderly as a Culture: Reducing 2. Recall two negative outcomes of over arousal of 1:15 – 2:15 PM Health Disparities Related to Increased Fall Risk – neural circuits within the brain, i.e. impulsiveness and PLENARY C Drs. Alice Younce & Bridget Moore distractibility. At the conclusion of the presentation, the participant 3. Describe the benefits of producing more beta waves in PLENARY C – Annie Mae Beddow – A Pioneer should be able to: the brain for children with ADHD. Alabama Nurse – Anne Gibbons, JD At the conclusion of the presentation, the participant 1. Analyze the culture of the elderly as it relates to should be able to: learning needs. 1. Describe the life story of Annie Mae Beddow, a 2. Evaluate at least three modifiable risks that place the pioneer nurse in Alabama. elderly at a higher fall risk than the person <65 years old. 2:30 – 2:40 PM 3. Design a teaching plan and include at least two ways to BREAK engage the elderly during fall prevention education...... RESEARCH B (Pt. 2) Childhood Obesity: 2:40 – 3:40 PM Implementing a Healthy Lifestyle Program in a Rural SESSION B Pediatric Clinic – Dr. Rebecca Thompson At the conclusion of the presentation, the participant AANS B – Mentoring – Dr. Marsha Cannon should be able to: At the conclusion of the presentation, the participant 1. Implement a healthy lifestyle modification program should be able to: targeting adolescents age 12 – 18 with a body mass 1. Explore the value and benefits of a mentor. index of 85% or greater in rural pediatric clinic. 2. Examine mentor and mentee expectations. 2. Evaluate the impact of the modification program 3. Describe the process of developing; maintaining and targeting adolescents age 12 – 18 with a body mass terminating the mentor relationship. index of 85% or greater in a rural pediatric clinic. 3. Determine if such health lifestyle programs can ACADEMIA B Photovoice: A Classroom Critical promote lifestyle change in a rural pediatric population. Thinking Strategy to Increase Mental Health Stigma Awareness – Dr. Monairee Jones 3:50 – 4:50 PM At the conclusion of the presentation, the participant SESSION C should be able to: 1. Describe how Photovoice can be used to increase AANS C – Communicating with the Next Generation – student understanding of labeling and stigma. Amy Morris, MPA, BSN, RN-BC 2. Identify potential opportunities for partnerships in At the conclusion of the presentation, the participant incorporating stigma education into college psychology should be able to: courses. March, April, May 2018 The Alabama Nurse • Page 11 Elizabeth A. Morris Clinical Education Sessions - FACES ‘18

1. State the different age groups that separate RESEARCH C (Pt. 2) Does a Faith-Based Breast 17. Diagnosis and Management of Amyotrophic Millennials, Generation X and Z. Cancer Education Program Increase Mammography Lateral Sclerosis – Octavia Ingram, BSN, RN, Troy 2. State three ways these generations differ from each Screening in African American (AA) Women in University MSN Student other in their world views or what is important to them. Southeast Alabama? – Alveta Reese, MSN, RN 3. Relay a communication technique that is appropriate At the conclusion of the presentation, the participant 18. Managing Vomiting: An Educational Video for for patient care with Millennials, Generation X and Y. should be able to: Caregivers of Pediatric Emergency Department 1. Describe the health disparity that exists between AA Patients – Jennifer Childress, MSN, RN, CPEN, Lisa ACADEMIA C – Evolution of Technology and women and white women in breast cancer death rates Maloney, MSN, RN, & Kathy Monroe, MD Education (Social Media) – Dr. Sola Aina-Popoola in Southeast Alabama. 19. An Exploration of Formal Mentoring Experiences At the conclusion of the presentation, the participant 2. Discuss the implementation of a faith-based breast of Junior Faculty in Associate Degree Nursing should be able to: cancer education program for AA women in Southeast Programs – Marsha Cannon, EdD, MSN, RN 1. Examine the effectiveness of various social media Alabama. tools that enhance learning. 3. Discuss the need for further research regarding the 20. Using Deliberate Practice in a Open Lab Setting to death rate differences in breast cancer among AA and Enhance Nursing Skills and Physical Assessment CLINICAL 1C – Type 2 Diabetes Mellitus in white women in Southeast Alabama. with a Focus on At Risk Students – Amy Curtis, Adolescents: Use of GLP-1 – Dr. Ava Mitchell PhD, RN, Karol Renfroe, MSN, RN, & Meghan Jones, At the conclusion of the presentation, the participant MSN, RN, ACNPC-AG should be able to: POSTER SESSIONS: 21. Planning Vacation for a Child with Cystic 1. Discuss changes in glycemic outcomes of adolescent Fibrosis – Kendall Frawley & April Robinson, patients with Type 2 Diabetes after receiving GLP-1 1. Clinical Judgement Scripts as a Strategy to Foster Samford University, Ida V. Moffett School of Nursing Students CLINICAL 2C – Resuscitative Endovascular Balloon Clinical Judgment – Cheryl B. Hines, RN, EdD, Occlusion of the Aorta (REBOA) – Dr. Frankie Wallis, CRNA 22. Hospital Acquired Infections – Jordan Ames, India Alford, MSN, NE-BC & Michael Lovelace, RN 2. Depression in Middle Aged Adults to Elderly: A Melanie Beckman, & Lauren Crouse, Samford At the conclusion of the presentation, the participant Comparison and Contrast of Treatment – Takiffany University, Ida V. Moffett School of Nursing should be able to: McLeod, BSN, RN, Troy University MSN Student Students 1. Describe the use of REBOA in trauma resuscitation. 2. Contrast the use of REBOA versus other traditional 3. Full Practice Authority for Nurse Practitioners in 23. Adventures in Disney: Planning Vacation for hemorrhagic control measures. Underserved Populations – Shekina Dillon, BSN, a Child Diagnosed with Celiac Disease – Alex 3. Evaluate the benefits of hemorrhage control using an RN, Troy University FNP Student Herring, Chenice McQueen, & Catherine Walker, aortic compression device. Samford University, Ida V. Moffett School of Nursing 4. Childhood Obesity: Implementing a Healthy Students Lifestyle Program in a Rural Pediatric Clinic – GENERAL C – Legendary “Notable” Nurses in Rebecca Thompson, DNP, APRN, FNP-BC 24. Managing Sickle Cell Anemia While Traveling – Alabama’s Black Belt – Dr. Constance S. Hendricks, Katherine Hymel, Mujah Gaye, & Kendra Prince, Keshala Barlow, RN; Tammy Blackmon, RN; Sharon 5. The Impact of a Computer-Based Digital Platform Samford University, Ida V. Moffett School of Nursing Hardy, RN; Sirrea Johnson, RN; Dorene Miree, RN, on Health Assessment Skills of Online Master of Students Shana Sellers, RN, Cynthia West, RN, Felicia Williams, Science in Nursing Graduates – Tomeka Mechell RN; Dr. Sola Aina-Popoola, Dr. Valarie Thomas, Dr. Ola Royster, PhD, DNP, FNP-BC 25. Ambassadors for Veterans of America (A4VA) – Fox, & Dr. Denisha Hendricks Amy Southern, MSN, RN, Kanini Z. Rodney, MPH, At the conclusion of the presentation, the participant 6. Depression/Teenage Suicide – Jessica Allison, Annie MBA, MD, FACP, & Durinda C. Warren, PhD, RN should be able to: Blankenberg, Alisa Jackson, Jamie Jones, Cody Oliver, Brandy Sawyer, Terra Taylor, Chattahoochee 26. Climate Control: Does Caring Really Matter? – 1. Discuss the basic steps to establishing an assignment Wendy DuBose, EdD, MSN, RNC within the provided guidelines. Valley Community College ADN Students 2. Describe at least one unique experience as shared by 7. Why there is an Increasing Incidence of Childhood inaugural cohort and Notable Nurses. Obesity in the United States – Tammy Carey, Contact Hours: 3. Explore the connection of this assignment and the Sharnnett Davis, Shanna Doty, Richard Garland, ANCC = 1.0 CH/session – 7.0 CH Possible (includes ANA initiative on “Honor A Nurse.” Calista Smith, Alicia Spearman, Nou Whitehorse, posters) ABN = 1.2 CH/Session – 8.4 CH Possible Sandra Wilson, Chattahoochee Valley Community (includes posters) OPIOIDS C – Nurse’s Role in Caring for Individuals College ADN Students and Families Affected by Opiate Addiction – Martha Ann Eisenberg, BSN, RN & Dr. Lisa E. Gurley 8. Substance Abuse in Children – Ansley Brawner, At the conclusion of the presentation, the participant Haleigh Forsyth, Mark Franklin, Christopher should be able to: Jenkins, Sasha Rivera, Sara Rountree, Morgan FACES ‘18 Registration Form 1. Describe the impact of opioid addiction on individual Shaeffer, Samantha Wheeler, Chattahoochee Valley on page 12 and families. Community College ADN Students 2. Discuss the role of the nurse in caring for individuals 9. Autism – Veoia Dowdell, Latavia Norris, Curtis and families affected by opioid addiction. Peeler, Chattahoochee Valley Community College ADN Students PEDIATRIC TRACT C – Charolette Jones, BSN, RN, CPN, Jennifer Williams, BSN, RN, CPN, Jennifer Glenn, 10. Type I Diabetes – Ashley Cook, Angela Edmond, CRNP, Loretta Hill, MSN, RN CPN, Jasmine Williams, Lindsay Ellis, Jessica Elswick, Jaquita Frazier, MSN, RN Temyella Hunter, Meagan Lord, Chattahoochee Rehab Select @ Shelby Ridge At the conclusion of the presentation, the participant Valley Community ADN Students should be able to: 11. Pediatric Safety – Vanessa Centeio, Sandi Clark, You can make a DIFFERENCE. Diabetes (Lecture/Video) Wanda Geter, Carrie Hale, Keeli Hinesley, Come join our FAMILY! 1. Describe the different types of Diabetes in the Samantha Lavender, Lora Mikkanen, Haylie Norton, pediatric population. Chattahoochee Valley Community ADN Students 2. Describe signs and symptoms to look for when they 12. Asthma in Children – Ste’phanie Britt, Allison come to your facility. Hartley, Ashley Pangelinan, Krystyna Petermann, RNs & LPNs 3. Discuss treatment (Use of insulin pens and pumps). Brittany Sutton, Kassi Van Pelt, Ayanna Wilson, Excellent Nurse to Patient Ratio Chattahoochee Valley Community ADN Students • Very Competitive Pay Diabetes (Hands On 1. Demonstrate use of insulin pens. 13. Metabolic Complications in Polycystic Ovary • Flexible Scheduling 2. Demonstrate use of insulin pumps. Syndrome – Karen Vaughan, BSN, RN, Troy • Supportive Family Environment 3. Demonstrate giving emergency meds (gel and injection). University MSN Student • Sign on Bonus 14. Collaborative Testing as an Approach to Retention • Scholarship Opportunities RESEARCH C (Pt. 1) Keeping Patients Safe by and Student Satisfaction in a Community College Employing Professionalism to Negate Incivility Among • Career Advancement Opportunity Nursing Program – Lauren Cain, MSN, RN, EdD(c), Nurses – Dr. Mary Hanks Donna Bruce, MSN, RN, Jane Hopson, MSN, RN, At the conclusion of the presentation, the participant CNE, & Christine Rains, MSN, RN should be able to: 1. Discuss the link between professional behavior and 15. Former Nurse Faculty’s Perceptions of Deans’/ incivility and how incivility creates unsafe patient Directors’ Leadership – Shanda Bishop, PhD, MSN, conditions in the health care environment. RNC-OB We LOVE what we do! 2. Introduce a method to create healthy work environment for new graduate nurses and patients 16. HPV Vaccination: What Nurses Need to Know – 881 3rd St. NE Alabaster, AL 35007 while maintaining a culture of civility on nursing units Logan Jones, Shannon Prima, Whitney Matheny, 205-620-8500 | Cell 205-542-8411 among nursing professionals. Samford University, Ida V. Moffett School of Nursing [email protected] Students Page 12 • The Alabama Nurse March, April, May 2018 Elizabeth A. Morris Clinical Education Sessions - FACES ‘18

The Alabama State Nurses Association is accredited as a provider of continuing nursing education by the Make check payable to: ASNA Concurrent Session Choices American Nurses Credentialing Center’s Commission on circle only one per session Accreditation. Mail to: ASNA Alabama Board of Nursing Provider Number ABNP0002 360 N. Hull St. 10:00 AM Session A 2:40 PM Session B (valid until April 6, 2021). Montgomery, AL 36104 AANS A AANS B CLINICAL 1A ACADEMIA B Refunds: If cancellation is received in writing prior to Fax to: 334-262-8578 CLINICAL 2A CLINICAL 1B April 10, 2018 a refund (minus a $20.00 processing fee) GENERAL A CLINICAL 2B will be given. After April 10, 2018, no refund will be Online registration open until 11:59 PM, Apr. 10, given. ASNA reserves the right to cancel at any time. A 2018. Visit https://alabamanurses.org OPIOIDS A GENERAL B full refund will be issued in this event. PEDIATRIC A OPIOIDS B If unable to register prior to 11:59 PM, Apr. 10, 2018, PEDIATRIC B you may register at door. Please note that you will be RESEARCH B Nurses Suing the EPA continued from page 9 charged a $10 late fee. 3:50 PM Session C of the challenges under the original law, the EPA *the optional lunch is available only until Apr. 10, AANS C could not even ban asbestos – a know carcinogen with 2018 – it is not available after Apr. 10, 2018 OR for at ACADEMIA C unquestionable evidence of harm. door registration. In 2016, after making significant and debilitating CLINICAL 1C compromises, we (nurses and others) helped to usher in Contact Information: CLINICAL 2C a new chemical law, passed by a Republican Congress GENERAL C Name: ______and signed by President Obama that replaced the 1976 OPIOID C law. The biggest and most important compromise of Credentials:______the new federal law is the fact that it pre-empts states PEDIATRIC C from passing chemical safety laws that are more Organization: ______RESEARCH C effective than the new federal law once a chemical is ______under review by the EPA. Historically, we have looked Poster exhibits available for viewing from to progressive states to pass legislation on health and Mailing Address: ______9:00 AM – 3:40 PM safety before federal laws have made their way through ______Congress and to the President. This exception flies in See our website, https://alabamanurses.org for a the face of Republican calls for increasing state’s rights Email:______over federal mandates. Instead, we now have states list of local hotels/motels incapacitated from further protecting their citizens from Phone:______toxic chemicals, even if their citizens overwhelmingly Lunch Menu: want the added protection. Fees if received by Apr. 10, 2018: Steak, served medium well, baked potato, salad, rolls, Another problematic issue with the new chemical ( ) $55 ASNA Member dessert and tea or water. safety law is the time line that was created for reviewing ( ) $75 Non Member potentially, and often known, toxic chemicals. Only 10 ( ) $25 Student/Student Presenter Credit Card Information: new chemicals are required to be reviewed in the first ( ) $50 Presenter # ______year and then by 2019 twenty chemicals need to be ( ) $15 *Optional Lunch under review at any given time. The Registry for Toxic ( ) $0 * Presenter Lunch Effects of Chemicals includes over 150,000 chemicals Exp. Date: ______CVV#: ______( ) $0 ASNA Volunteer for which there is some toxicological evidence; over 80,000 chemicals are in the market place. Think about how many years it will take to get through that Amount Enclosed:______Signature: ______list at a pace of 10 - 20 chemicals per year. And, more importantly as nurses, consider how many years and decades we may see preventable health effects from toxic chemicals that have not been reviewed because we just haven’t gotten to them yet. from the effects of toxic chemicals, and 3) The EPA allow a toxic chemical to be used in products that would As a nurse, whose mantra is “evidence-based must have the power to ban chemicals that create the otherwise be deemed unsafe. practice,” I find it difficult to help individuals and greatest risk of harm. At the issuance of the new guidelines, nurses joined communities navigate the necessary purchasing Our new chemical safety law, which has a very long a number of other organizations in suing the EPA decisions required to live, work, learn, and play name and honors the original Senator who sponsored for placing the public at an unreasonable health risk. because of the lack of information about so many of the the bill, is called the Frank R. Lautenburg Chemical “The new guidelines fly in the face of our attempts to chemicals that make up our everyday products. Because Safety Act for the 21st Century. Once signed into law protect the public’s health,” asserts Katie Huffling, we don’t require complete labeling for the vast majority in 2016, the EPA was mandated to issue guidance Executive Director of the Alliance of Nurses for of products, we can’t even do our own independent documents for how they were going to review the Healthy Environments. Three separate suits were filed literature searches regarding the ingredients. When chemicals under the updated regulation. Unfortunately, in District Courts around the country. It is anticipated nurses started working on the revamping of the old the EPA is now under a different and admittedly anti- that the judges in the courts will consolidate the chemical law, we had 3 elements that our coalition regulatory administration. The new guidelines, issued cases and there will be one case heard. To follow members agreed upon: 1) We need basic health and in June 2017, reflect this bias. Instead of looking at the court case and other information about chemical safety information on all chemicals in the marketplace, all possible uses of a chemical in the marketplace safety and chemical policy, you can go to www. 2) We must be able to protect the most vulnerable of our and commerce, the new guidelines allow the EPA to saferchemicalshealthyfamilies.org. population, including the fetus, infants, and children, pick and choose which uses they will consider when To join in free monthly national calls with other determining if the chemical poses an unreasonable nurses who are concerned about chemicals and public health risk. Consider the case of lead. Lead can be health policy, go to the website of the Alliance of found as a contaminant in air, water, food, toys, and Nurses for Healthy Environments: https://envirn.org/ even in lipstick. If they only look at one or two of these policy-advocacy/ sources, the EPA may be missing important exposure With so many policy changes occurring – in health sources that could underestimate the health risks and care, the environment, and other important areas – it is sometimes difficult to keep up. We welcome you to join our calls and just listen, if you like, to hear from nurses who are engaged in helping to protect human and Auburn University Legal Nurse Only $895 offered environmental health. We also, especially, invite you to Join Us and Work on Purpose. New Salary Program Consultant Training Course online – 7 weeks get involved and join a growing number of nurses who are concerned about potentially toxic chemicals in our Working in health care can give you a RN Opportunities sense of purpose like no other industry. everyday lives. Emergency Successful graduates will receive a certificate Find your purpose at DCH. ICU for 42 contact hours of continuing nursing Acute Care Author: Barbara Sattler, RN, MPH, DrPH, FAAN, You’ll discover a high-tech workplace education from The Center for Legal with a community feel. Psych Professor, University of San Francisco School of Studies that they may be able to use to fulfill Nursing and Health Professions (bsattler@usfca. Home Health continuing education requirements. For Find your Purpose with a additional course information, please click edu) and Board Member of the Alliance of Nurses for caring career at DCH! on https://www.legalstudies.com/ Healthy Environments (www.enviRN.org) Based in Tuscaloosa, Alabama DCH Health System is an vendor/auburn-university/ www.dchsystem.com/jobs Equal Opportunity Employer (Permission to publish and republish.) March, April, May 2018 The Alabama Nurse • Page 13

Continuing Education

Management of Nicotine Addiction

needing to consume more nicotine to replicate this pleasurable behavior. It also promotes the reduction of manoamine oxidase (MAO) inhibiter enzyme. This enzyme is involved Authored by: Charlene Roberson, MEd, RN-BC, in the metabolism of dopamine. Thus reduction in MAO has the effect of causing more circulating dopamine. The presence of nicotine causes the release of corticosteroids and Disclosures: Neither the author or planning committee have any conflict of endorphins on various brain receptors. The net effect is a more efficient processing of interest. information and reduction in fatigue. At the same time there is a sedative effect which reduces anxiety and induces euphoria. All of this is dependent on the amount of nicotine Target audience: All health care workers present in the blood. It also stimulates the hypothalamic-pituitary axis. The net result is a stimulated endocrine system. The downside is that the person needs continually Purpose/Goal: To enable nurses to provide supportive care to patients attempting increasing levels of nicotine to maintain this stimulation. Experts in the field of addiction to withdraw from nicotine rank nicotine ahead of alcohol, cocaine, and heroin in terms of addictive properties. To put this in perspective – it is easier to quit using alcohol, cocaine, or heroin than Learning Outcome: The nurse will be able to explore the addictive properties of nicotine. The addiction occurs quickly, NIH states that a teenager who smokes as few as Nicotine and provide guidance for the various methods of Nicotine reduction and/ 4 cigarettes may develop a lifelong addiction to nicotine. Addiction results from positive or cessation. reinforcement of administration of nicotine and withdrawal symptoms start within a few hours of the last cigarette. Contact Hours: 1.5 (ANCC) and 1.8 (ABN). Contact Hours are valid February 28, 2018 through February 27, 2020. 1.5 pharmacology hours. Continuing Education continued on page 14

Fees: ASNA Member $ free Non Member $15 (Fees must be paid on line and at the same time as completing the evaluation.)

Accreditation: The Alabama State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation and the Alabama Board of Nursing (Provider Number ABNP0002 – Expires April 6, 2021)

Instructions for Credit: Participants should read the purpose and learning objectives on line or printed out. After reading complete the post test at the end of the activity and compare your responses to the answers provided and review any incorrect response(s). Participants must complete the evaluation on line and submit the appropriate fee to receive continuing nursing education credit. The Certificate of Attendance will be generated after the evaluation has been completed. ASNA will report the contact hours to the Alabama Board of Nursing within 2 weeks of completion.

Nicotine addiction is a public health dilemma in both the United States and worldwide. According to the National Institute of Health (NIH) 1 out of 5 deaths in the US is classified as tobacco related. Worldwide it is the second most common cause of death and the leading cause of all preventable deaths. Worldwide there are 1.3 billion smokers and 84% of these individuals live in developing countries. Annually, there are 6 million deaths per year worldwide. NIH predicts that this number will be 8 million deaths by the year 2030. The mortality associated with smoking includes atherosclerotic vascular disease, chronic obstructive lung disease, and cancer. Ample research has documented that smoking contributes to other health conditions such as bronchiolitis, obstructive sleep apnea, histiocytosis, idiopathic pneumothorax, low birth weight and perinatal mortality. Overall, cigarette smoking is on the decline in the US. In 1965, conservatively 1/2 of all men smoked and about 1/3 of all women smoked. In 2015 (last year we have statistics) 16.7% men and 13.6% women smoked. The highest numbers are among American Indians (First Nation individuals) and Alaska natives. During this same time period the use of tobacco has decreased in high school and middle school children. But internationally the numbers have increased. For example in China more than 75% of men older than 25 years smoke. The average age of first time smokers is 14.5 years and daily smokers is 17.7 years. Current research continues around adolescent’s vulnerability to smoking and the neurobiologic factors effect on the developing brain. Additional research is being conducted on various mental disorders and secondhand smoke upon children and adolescents. The Surgeon General reports that the level of smoking has leveled off among adolescents; however, the use of smokeless tobacco has increased among white males. 50% of high school male and female tobacco users admit to using more than one tobacco related product. The use of e-cigarettes is increasing and there is much current research on the deliterious effects of e-cigarettes. The direct costs in US dollars is $200 billion worldwide when you include both health care and lost productivity. Developing countries account for 1/3 of these costs. Various factors influence the ever increasing global market for smoking. They include trade liberalization; direct foreign investments; global marketing; transnational tobacco advertising, promotion, and sponsorship in developing countries especially since the US marketing has been curtailed; and international tobacco smuggling.

Why Do People Smoke Even When They Realize the Deleterious Effects of Tobacco? Nicotine has a powerful control on users. The NIH estimates that between 75% – 80% of all users who quit smoking relapse within 6 months. Two of the strongest predictors of nicotine addiction are time of first cigarette and total number of cigarettes smoked per day (not lit but smoked). Nicotine meets the established criteria of being an addictive drug. It is a highly psychoactive substance which induces euphoria, reinforces its own use, and leads to nicotine withdrawal symptoms when absent. The addiction component has two striking side effects by being both a stimulant and a depressant. The best example is when a smoker inhales the first cigarette in the morning it has stimulant properties and later when the nicotine level has been restored it becomes a depressant helping the smoker “chill out.” Nicotine activates the body’s reward center by causing the release of dopamine. In turn this release promotes pleasure and reinforces an associated behavior in the form of Page 14 • The Alabama Nurse March, April, May 2018

Continuing Education continued from page 13 What constitutes a diagnosis of Nicotine Addiction? The Transdermal Patch is the most common and may The DSM-5 (Diagnostic and Statistical Manual be purchased over the counter. The advantage is that Users learn how to control desired behaviors. Small of Mental Disorders, Fifth Edition) refers to Nicotine nicotine is delivered at a steady rate. Overall it has the rapid doses of nicotine increases alertness and arousal Addiction as tobacco use disorder. An individual must best compliance rate as compared to other NRTs. Some where as long drawn out doses yield relaxation and exhibit at least 2 of the following 11 criteria during the last individuals find that the patch needs to be removed before sedation. It affects the body physically by increasing the 12 months: bedtime to ensure better quality sleep. A disadvantage heart rate, accelerating the blood pressure, and promoting 1. Tobacco taken in larger amounts over longer periods is that it does not control breakthrough cravings and weight loss. It often increases the level of alertness and of time other types of NRT may be necessary in times of stress. accelerates speech. Long time users have tar stained 2. Persistent desire or unsuccessful efforts to cut down Several different patch formulations are on the market. teeth and fingers as well as premature skin aging most or control use One you wear for 16 hours and one you wear for 24 hours. notably in the face. It does not cause perceptual or thought 3. A great deal of time is spent on activities necessary Three different strengths are available. Most authorities disorders such as delusions or hallucinations nor does to obtain or use tobacco recommend that someone who smokes 10 cigarettes/day or it have any impact on developing delirium or dementia. 4. Craving or strong desire or urge to use tobacco more should start out with a 21mg/day patch for at least There seems to be no negative impact on abstract thinking, 5. Recurrent tobacco use resulting in a failure to fulfill 6 weeks and then taper to 14mg/day patch for 2 weeks judgement, or the ability to perform simple calculations. major role obligations at work, school, or home and then taper to 7mg/day patch for 2 weeks. Relapse is Important to note is that nicotine use is not a risk for 6. Continued tobacco use despite having persistent or very common. The person needs encouragement to keep suicide. This only becomes an issue when the person has recurrent social or interpersonal problems caused or wearing the patches. The patch is used with Quit Line concurrent depression or anxiety and is suicidal. Nicotine exacerbated by effects of tobacco (e.g., arguments Tobacco Cessation Programs is a stimulant but the act of smoking is a relaxing behavior. with others about tobacco use) A nicotine nasal spray is available by prescription. It is When nicotine is withdrawn the physical effects include 7. Important social, occupational, or recreational very effective for breakthrough cravings. The multidose decreased heart rate, difficulty concentrating, insomnia, activities are given up or reduced because of tobacco pump provides 0.5 mg of nicotine per squirt/pump. Each weight gain due to increased appetite, irritability, use dose has 2 squirts – one for each nostril. Usual dosing is depression, and an increase in the senses of taste and 8. Recurrent tobacco use in situations in which it is 1 – 2 doses per hour and gradually increase to maximum smell. Both the irritability and hunger can be soothed physically hazardous (e.g., smoking in bed) of 40 doses per day. with a dose of nicotine. In early withdrawal the person 9. Tobacco use is continued despite knowledge Nicotine gum is available without a prescription in demonstrates more agitation, irritability, and agitation. All of having a persistent or recurrent physical or both 2 mg and 4 mg strengths. The directions state to of these symptoms tend to disappear within a month or so psychological problem that is likely to have been use as following: 1 piece every 1-2 hours for the first 6 following cessation of nicotine. caused or exacerbated by tobacco weeks and then reduce to 1 piece for every 2-4 hours for There is an association between depression and 10. Tolerance, as defined by one of the following: 3 weeks and finally 1 piece every 4-8 hours for 3 weeks. smoking. Individuals with major depressive disorder a. the need for markedly increased amounts of Individuals highly dependent on nicotine should use (MDD) are twice as likely to smoke. They have a much tobacco to achieve the desired effect the 4 mg strength. Only 50% of the nicotine is absorbed more difficult time quitting smoking and a higher b. A markedly diminished effect with continued use anyway. Individuals should be cautioned to avoid acidic likelihood of relapse as compared to smokers who do not of the same amount of tobacco beverages (soda, coffee/tea, beer, etc.) for 15 minutes have diagnosis of MDD. Smoking is probably an attempt 11. Withdrawal, as manifested by either of the before and while chewing the gum. In addition if the gum to decrease the negative effects of depression. After following: is chewed more than a couple of times the nicotine is attempting to quit they experience greater symptoms a. The characteristic withdrawal syndrome for swallowed and destroyed in the stomach and not absorbed. of nicotine withdrawal. Usually they need additional tobacco The most effective way to use this product is to chew the counseling and additional pharmacologic support. b. Tobacco (or a closely related substance such as piece several times & then park between the check and Insomnia and nicotine are very often interrelated. nicotine) is taken to relieve or avoid withdrawal the gum. It can be moved around. Absorption is increased Depending on statistics studied approximately 10-35% symptoms by parking the gum between the cheek and the gum. Side of all Americans have issues with insomnia. When the effects may include jaw soreness due to chewing or a mild person is awake they reach for a cigarette; the end result is How Does Nicotine Replacement Therapy (NRT) work? burning sensation in the mouth and throat. that nicotine being a stimulant reduces total sleep time and There are currently 6 different types of NRT. These Nicotine lozenges are available in 2 or 4 mg interferes with sleep initiation and probably fragments the include formulations. The mechanism is basically the same as for sleep cycle. • Transdermal Nicotine Patch nicotine gum. The lozenge should be parked between the Nicotine and PTSD are closely related. About 1/3 of all • Nicotine nasal spray gum and check and should not be chewed. The amount of current military service members’ smoke and the number • Nicotine gum nicotine absorbed is slightly higher than with the gum. is increased during combat deployment. Some who do not • Nicotine lozenges Sublingual nicotine tablets are not available in the use cigarettes use smokeless tobacco. Again depending • Sublingual nicotine tablet United States. It comes in a 2 mg tablet comparable to on statistics studied somewhere between 50-85% of all • Nicotine inhaler 2 mg of Nicotine gum. The recommendation is to use individuals with PTSD use tobacco. This is postulated the product for 12 weeks and then gradually reduce the to be in part related to nicotine’s role in reducing trauma number of pills. –induced emotional numbness. In counseling these The patch is intended for long-term use whereas The Nicotine inhaler is only available by prescription. individuals smoking cessation is not the first priority. the other 5 are used for acute dosing which is titrated The apparatus has a mouthpiece and cartridge containing by the user. A device for acute dosing is especially nicotine. It is marketed as being effective to satisfy the effective for the quitter during episodes of intense hand-to-mouth ritual. The cartridge contains 10 mg of craving. This intense or breakthrough craving nicotine and only 4 mg may be delivered per puff and only is usually stimulated by an emotional response. 2 mg is absorbed. It is deposited in the mouth not into the Examples might include seeing someone smoke, bronchi or lungs. Most clinicians compare this to nicotine stressful situations like rush hour traffic, social gum. The average person will use 6-16 cartridges/day. The situation where everyone else smokes, high stress recommendation is to continue use for 3 months and then family situations like a death, etc. have a gradual reduction for 6-12 weeks. The only side effect of NRT is dizziness, headache, When a person uses any type of NRT the quit rate and nausea which is ameliorated by stopping the is increased 50-70%. The percentage is highest for a NRT. None of these symptoms have any adverse combination of NRT and brief smoking cessation treatments. harmful effects. What Medications are Effective in Treating Nicotine Dependence Bupropion (Wellbutrin) exerts its influence on a nicotine user by alleviating the withdrawal symptoms. It is especially effective if the individual has concurrent depression. Research has shown that the effects are equal for both men and women and it is more effective if used with NRT. The drug carries a warning for a mild risk for seizures thus should not be prescribed for those Now Hiring with seizure histories. Dosage is 300 mg/day in 150 mg divided doses. This medication is considered a first-line RNs, LPNs, CNAs medication by the US Clinical Practice Guidelines. As proud members of the Ball HealthCare family of Rehabilitation & HealthCare Centers we strive to keep our focus on what is most important….Our Residents! We are confident that you will find the professional, caring atmosphere at our facilities is very supportive of your desire to excel. If you are in pursuit of excellence and want to join a patient focused team, email your resume to [email protected]. We offer an excellent benefit package and salaries commensurate with experience. Birmingham, Hayneville, Mobile, Monroeville, Roanoke, Robertsdale, Selma, Tuskegee

Ball HealthCare Services, Inc . is an equal opportunity employer . March, April, May 2018 The Alabama Nurse • Page 15

Varenicline (Chantix) exerts its effects by being a Family interventions are the most effective and partial agonist. It prevents nicotine binding at receptors recommended when dealing with teen tobacco users. A Select the correct answer to following questions sites. It does not completely bind all the receptors sites number of school based programs are available dealing thus moderate levels of dopamine are maintained. It with tobacco use; however, there is little evidence in the 1. Nicotine reduces monoamine oxidase inhibitor binds at enough receptor sites to prevent withdrawal literature supporting the effectiveness of these programs. enzyme which in turn symptoms. The main side effect is nausea which The scientific literature also notes that both print and a. increases available dopamine slowly resolves over time. There is an increased risk of visual media are saturated with antismoking messages, but b. decreases available dopamine cardiovascular events such as myocardial infarction, it has little impact on decreasing smoking rates. c. has no effect on dopamine unstable angina, arrhythmias, transient ischemic attacks, By far the most effective nicotine cessation programs strokes, or congestive heart failure. The risk is profound are work based. Their efficacy is enhanced when it 2. The physical effects of nicotine include enough not to prescribe the drug to patients with known includes brief behavioral counseling (10 minutes or so) and a. accelerated heart rate cardiovascular problems. Additionally, there have been coupled with NRT and/or medication support. A variety b. decreased heart rate some reports of suicidal ideation; however, there have been of self-help material is available and the best evidence c. has no effect on the heart rate very few reports. The drug is given for 12 weeks. Days 1-3 of its effectiveness is when used in combination with take 0.5 mg/day; days 4-7 take 0.5 mg twice a day, and day other treatment modalities. Individuals who engage in 3. The highest compliance rates of all NRT 8 – end of treatment tale 1 mg/daily. The 12 week course counseling or group therapy have a success rate of quitting products is may be repeated if needed. This drug is considered a first- of 60 -100% (depending of statistics cited) initial cessation a. Transdermal Nicotine Patch line treatment by the US Clinical Practice Guideline. rate. At the end of one year the number is approximately b. Nicotine Gum Nortripline (Pamelor) is considered a second-line 20%. c. Nicotine nasal spray treatment by US Practice Guidelines. It has shown to be Some individuals are able to quit on their own and effective for smoking cessation for individuals who do in reality they are probably not the ones contemplating 4. The main side effect of varenicline (Chantix) is not have a history of major depression. The side effects cessation or these seen in a clinical setting. More than a. nausea include tachycardia, dry mouth, urinary retention, and 90% of all individuals who stop smoking do so using b. diarrhea postural hypotension. It is not used often. the “cold turkey” method. Most relapse. Some sources c. loss of taste Clonidine (Catapres) is also considered a second- that individuals wishing to quit on their own include the line treatment by the US Practice Guidelines. Normally following: this drug is used to treat hypertension but it has shown • Freedom from Smoking – American Lung effectiveness in reducing symptoms of opiate and alcohol Association Compare your answers to the following and any symptoms. Based on this evidence patients have been • Fresh Start – American Cancer Society answered incorrectly go back and review content. treated and have shown an impressive abstinence rate • Tobacco Control Research Branch of the National 1. A 2. A 3. A 4. A of nicotine. There are side effects, most commonly Cancer Institute constipation, dizziness, dry mouth, tired and weak. It is • Nicotine Anonymous – fellowship based program rarely used also for nicotine withdrawal. modeled after Alcoholics Anonymous All of these medications tend to work better if used in • Smoking Quit Line from National Cancer Institute – combination with NRT. A vaccine is under development counselors available by telephone or on line to immunize individuals against nicotine. So far there has • Alabama Tobacco Quitline 1-800-692-9023 – This been very limited success. is a free confidential telephone and on line coaching You’ve earned your Brief behavioral counseling (up to 10 minutes at a time) service for any Alabamian ready to quit tobacco; when used in combination with NRT and/or medications sessions developed for individual schedules; free dream job. tend to have higher success rates as compared to using NRT available for first time participants only one modality. We’ll help you find it at Nurses are in a unique position to provide nicotine How Can Health Care Providers be Most Effective to cessation support to individuals both professionally Enable Individuals to Cope with Nicotine Addiction? and personally. Prevention is an area where nursing nursingALD.com The US Preventative Task Force guidelines recommend is especially well placed as we are such advocates for the “5 – A” approach for all tobacco users. preventive care. By leveraging our nursing resources Your free online resource • Ask about tobacco use with public health organizations, other professional for nursing jobs, • Advise to quit using a personalized message organizations and health promotion organizations we can research, and events. • Assess willingness to quit help shape social attitudes and health policies. The most • Assist with quitting effective methods are 1.) restriction of access of tobacco • Arrange follow up care and support products to minors, 2.) restriction of smoking in public places, 3.) restriction of advertisements, and 4.) increased Within this framework healthcare providers should prices of tobacco products through taxation. Providing provide information to all patients about the harmful help may be frustrating for many nurses as we collectively effects of tobacco even if they are not interested in become uncomfortable with their many, many relapses. It cessation. And if interested they should be provided helps to keep in mind that quitting opioids and alcohol is with a range of available options to help them cope with easier than quitting tobacco. harmful effects of tobacco and nicotine addiction. The patient should be instructed about the expected withdrawal Selected Bibliography syndrome, how long it lasts and how to cope with the Lande, R. Gregory and Xiong, Glen, L. Nicotine Addiction, Great Nursing Opportunities! symptoms. In addition, information should be provided Medscape, updated Aug. 10, 2017. There is a great opportunity for Registered Nurses to join the Vaughan Team! We have about the various NRTs, medications, and counseling Lande, R. Gregory and Xiong, Glen, L. Niccotine Addiction positions available on day and night shift. New Graduate Nurses are welcome to apply. Temporary RN Licensure is accepted for new graduates and they are provided assistance in and/or group sessions. The pro and cons of each modality Clinical Presentation, Medscape, updated Aug. 10, 2017 Lande, R. Gregory and Xiong, Glen, L. Nicotine Addiction passing the NCLEX exam. What can VRMC offer you? should be discussed. They also need a supportive network Treatment a & Management, Medscape, updated Aug. 10, 2017 • An individualized orientation program or peers or groups. • Opportunities for growth & advancement • Flexible scheduling • “Fellowship” program for Critical Care areas • Customer service-driven environment • $5,000 Sign-On bonuses to nurses with previous experience Alabama Medicaid Tobacco Treatment Coverage We offer an extremely competitive salary and excellent benefits package! Join the Vaughan Team today by applying online at www.VaughanRegional.com Covered Services/Medication Address: 1015 Medical Center Parkway, Selma, AL 36701 Email Contact: [email protected] or [email protected] Vaughan Regional Medical Center is an Equal Opportunity Employer.

Free tobacco cessation counseling is provided Health Information Design, 1-800-748-0116. PA through the Alabama Tobacco Quitline. Form available at https://tinyurl.com/ALMedicaid. 3. Fax Quitline referral form to Quitline at 1-800- Refer patient to Quitline by faxing signed referral 692-9023. consent form to the Quitline at 1-800-692-9023. Consent form can be found at Plan First Recipients do not require prior approval http://www.adph.org/tobacco. for smoking cessation products. The Smoking Cessation Prior Authorization Request Form should 1. Prescribe any of the seven approved medications** not be submitted for those recipients. for cessation, if patient is eligible. **Approved cessation medications include 2. Fax both the Alabama Medicaid Pharmacy nicotine patches, gum, lozenges, inhalers, nasal spray, Smoking Cessation Prior Authorization (PA) varenicline and Bupropion SR, according to Treating Request Form AND the Quitline referral form to Tobacco Use and Dependence, U.S. Clinical Practice Guidelines, 2008. Page 16 • The Alabama Nurse March, April, May 2018

Clinical News

Copeland Care PrEP Clinic HIV Testing Pre-Exposure Prophylaxis When preparing to take any test or exam one might experience a number of emotions ranging from fear, nervousness, to strong anxiety. These emotions What is PrEP? Recommended Indications for PrEP Use by are also quite common when it comes to taking an The word PrEP stands for Pre-Exposure Prophylaxis Heterosexually Active Men and Women HIV test, but the more often one takes an HIV test which means to prevent or control the spread of an • Adult person the less fearful the experience becomes. Currently infection or disease. The main goal of PrEP is to prevent • Without acute or established HIV infection there are three types of HIV Tests that are easily HIV infection. This is done by taking a pill (Truvada) • Any sex with opposite sex partners in past 6 months accessible through local clinics or private physicians. which is composed of two drugs (Emtricitabine/Tenofovir • Not in a monogamous partnership with a recently • HIV Antibody test (3rd Generation HIV Test) disoproxil fumurate) daily. This is the same medication tested HIV-negative partner Rapid Oral quick used to stop the virus from growing in people who are AND at least one of the following: • HIV Antibody/Antigen Test (4th Generation already infected. • Is a man who has sex with both women and men Test) Alere Determine, INSI (behaviorally bisexual) • HIV RNA Test (NAT or NAAT) Who can take PrEP? • Infrequently uses condoms during sex with 1 or more PrEP is mainly for people who are considered at risk – partners of unknown HIV status who are known The collection method for 4th generation test is High risk negatives (person in a relationship with someone to be at substantial risk of HIV infection (IDU or small blood sample collected via finger prick. 3rd who is HIV positive, sex worker, someone sleeping bisexual male partner) generation tests have the options of blood sample or with multiple people, MSM); a woman who wants to get • Is in an ongoing sexual relationship with an HIV- oral fluid. Both 3rd and 4th generation tests provide pregnant by a HIV positive partner; and injection drug positive partner same day results. Each test takes 20 minutes to users. process with the exception of the INSI test which As recommended by the CDC (Preexposure Recommended Indications for PrEP Use by Injection takes only one minute to process. The RNA test prophylaxis for the prevention of HIV infection in the Drug Users sample is collected intravenously, and is usually sent U.S. practice guideline and providers’ supplement, 2014) • Adult person out for processing which may take up to two weeks. the following are indications for PrEP use by MSM, • Without acute or established HIV infection Any of these tests would be a great tool for Heterosexually Active Men and Women, and Injecting • Any injection of drugs not prescribed by a clinician finding out ones current status. 3rd generation tests Drug Users. in past 6 months have a window period of 3-12 weeks and can only AND at least one of the following: see antibodies. The 4th generation test can recognize Recommended Indications for PrEP Use by MSM both antigens and antibodies and have a window • Adult man Any sharing of injection or drug preparation equipment period of 2-6 weeks. The window period is 2-6 • Without acute or established HIV infection in past 6 months weeks for the RNA test. • Any male sex partners in past 6 months • Been in a methadone, buprenorphine, or suboxone Any individual who is sexually active should • Not in a monogamous partnership with a recently treatment program in past 6 months test annually to every six months, and request their tested, HIV-negative man • Risk of sexual acquisition sexual partners to do the same. AND at least one of the following: • Any anal sex without condoms (receptive or Source: CDC, Preexposure prophylaxis for the prevention of HIV infection in the U.S. practice guideline and providers’ References: insertive) in past 6 months supplement, 2014 U.S Department of Health and Human Services (2017). • Any STI diagnosed or reported in past 6 months HIV Testing. Retrieved from: https://aidsinfo.nih.gov/ • Is in an ongoing sexual relationship with an HIV- understanding-hiv-aids/fact-sheets/19/47/hiv-testing positive male partner Where can you access PrEP? There are several ways to locate your nearest PrEP clinic. You can go to the following links: https:// preplocator.org or https://www.greaterthan.org/new- national-directory-prep-providers/. In the Montgomery area, PrEP is offered at Copeland Care Clinic. Please visit http://www.maoi.org/ for more information about our PrEP clinic. You can also contact our PrEP Coordinator, Bretia Gordon at (334) 280-3349. Birmingham SimpleWreath SimpleWreath specializes in handmade, natural looking wreaths that enhance the beauty of your home, both inside and out. Nursing and Rehabilitation Center, LLC Etsy: http://www.etsy.com/shop/simplewreath Facebook: https://www.facebook.com/simplewreath E-mail: [email protected] Looking for qualified LPNs, RNs & CNAs

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I would love to have you visit my shop! If you have questions or would like to request a custom order, please do not hesitate to contact me. March, April, May 2018 The Alabama Nurse • Page 17

Clinical News

Spike in HCV Linked to Opioid Injection Hits Young Adults Hardest

Gail Connor Roche baby is exposed to drugs in the womb and goes through for drug injectors as well as testing, treatment and withdrawal after birth. prevention efforts to counter HCV. A jump in acute hepatitis C infection (HCV) in the “These trends illustrate the extraordinary burden “Integrated health services that include syringe US dovetails with a similar increase in injection of of the opioid epidemic on the health of women and service programs, medication-assisted treatment, opioids, with young adults hit hardest by the combined children in the United States,’’ the authors wrote. and comprehensive HCV testing and linkage to care health threats, new analysis shows. As many as 8% of pregnant women worldwide and treatment of HCV-infected people who inject Research from the US Centers for Disease Control are infected with HCV, according to the Society drugs (PWID) are essential to reduce prevalence and and Prevention (CDC) found that acute HCV cases for Maternal-Fetal Medicine (SMFM). The society incidence,’’ the researchers concluded. rose 133% from 2004 to 2014, while admissions to recommends that pregnant women at risk for HCV be The study, “Increases in Acute Hepatitis C Virus substance use disorder (SUD) treatment facilities for screened at their first prenatal visit. Infection Related to a Growing Opioid Epidemic and opioid injections climbed 93%. “Obstetric care providers will likely encounter HCV Associated Injection Drug Use, United States, 2004 to Injection drug use (IDU) is the primary risk more than they have in the past,” SMFM member 2014,” was published online in September. factor for HCV transmission and the leading cause Brenna L. Hughes, MD, MSc, told MD Magazine when of incidence in the US, according to the research the screening guidelines were released in November. published in the February 2018 issue of the American The analysis also found a previously unidentified Journal of Public Health. jump in both acute HCV and admissions for POA “Taken together, the findings point to a close injection among the US Hispanic population. Alabama Opioids relationship between the two troubling trends,” the While admissions for POA use account for less than CDC noted. 1% of total SUD admissions in this population, there Individuals aged 18 to 29 showed the most extreme was a 429% surge in admissions for POAs from 2004 to Epidemic Fact Sheet increases in rates of injecting heroin and prescription 2014. That compared to the 4% rise for heroin injection • The drug overdose death rate in Alabama is 15.7 opioid analgesics (POAs) coupled with acute HCV admissions, the team found. per 100,000 population. In 2015, 736 people died infections. These young adults had a 400% rise in HCV The researchers relied on the CDC’s National from drug overdoses in Alabama. cases, a 603% surge in admissions for heroin injection, Notifiable Disease Surveillance System (NNDSS) • The opioid overdose death rate in Alabama is 6.1. and an 817% jump in admissions for injection of POAs. for hepatitis C data. They analyzed national SUD In 2015, 282 people died from opioid overdoses in “Our findings, which reveal national increases in admissions data from the Substance Abuse and Mental Alabama. both the number of persons injecting POAs and the Health Services Administration (SAMHSA.) • Doctors in Alabama prescribe 142.9 opioid number of acute HCV infections, indicate a more A total of 12,953 cases of acute HCV infection were pain relievers per 100 persons, compared to the widespread problem than previous studies have shown,” reported in the US from 2004 to 2014. The annual national rate of 82.5 per 100 persons. researchers led by the CDC’s National Center for incidence rate increased from 0.3 cases per 100,000 in • Medicaid covers 19 percent of people in HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 2004 to 0.7 cases per 100,000 in 2014. Only 7 states, Alabama. (NCHHSTP) wrote. Delaware, North Dakota, Nevada, Texas, Vermont, • Medicaid covers 6 percent of medication-assisted Previous studies have shown that people who inject South Carolina and Michigan, saw a decline in reported substance abuse treatment in Alabama. POAs have a higher risk for HCV infection than HCV cases. • The uninsured rate in Alabama is 10.1 percent. persons who inject heroin and non-opioids, the authors For drug-injection statistics, the team found an noted. increase of 500% or higher in the number of admissions Source: JEC Democratic Staff. Data from CDC, Kaiser Overall, women fared worse than men in new HCV for POA use in 8 states. Arizona, Florida, New Family Foundation, IMSHealth, ACS 2015, CBO. Note: Premium infections. Rates of acute cases of the virus for women Hampshire, New Mexico, and West Virginia showed increases are based on the second lowest cost silver tax plan and jumped almost four-fold, while rates for men increased rises of 1000% or more. CBO projections. Premiums are before tax credits. Premiums for each state are based on the premium for a major city in each state. more than two-fold over the 11-year period. For heroin admissions, 5 states and the District of Decreases in coverage assume that the projected decreases in Women of childbearing age had a marked rise in Columbia saw increases of 500% or higher. Kentucky, coverage are divided proportionally along with the current size of hepatitis C. That finding is consistent with reports West Virginia and the District of Columbia saw increases the insured population for each category. Number losing private showing the number of infants born to HCV-infected of 1000% or greater. No state reported a decrease in coverage just looks at those losing coverage on the individual mothers is increasing. admissions for POA injection; Hawaii saw a decline in market and through their employers. https://www.jec.senate.gov/ public/_cache/files/6c604f91-3d90-4b0e-bdec-25780bfc9167/ The researchers found a four-fold increase from admissions for heroin injection over the 11-year period. state-opioid-epidemic-fact-sheets.pdf 2004 to 2014 in overall incident cases of neonatal The CDC cited the need for community opioid abstinence syndrome (NAS), which occurs when a prevention services that support treatment and recovery

ANA News

American Nurses Association Responds to the HHS Announcement of the New Conscience and Religious Freedom Division

Silver Spring, MD – The following statement is decide not to participate on the grounds of conscientious http://www.nursingworld.org/ attributable to Pamela F. Cipriano, PhD, RN, NEA-BC, objection must communicate this decision in a timely and FunctionalMenuCategories/MediaResources/ FAAN, president of the American Nurses Association appropriate manner, in advance and in time for alternate PressReleases/ANA-Responds-to-HHS-Announcement. (ANA), in response to the U.S. Department of Health and arrangements to be made for patient care. Nurses should html Human Services (HHS) announcement of the formation not be discriminated against by employers for exercising of a new Conscience and Religious Freedom Division. a conscience based refusal. The American Nurses Association (ANA) is the “The American Nurses Association Code of Ethics for However, we must take care to balance health care premier organization representing the interests of the Nurses with Interpretive Statements states that a nurse professionals’ rights to exercise their conscience with nation›s 3.6 million registered nurses. ANA advances the has a duty to care. It also states a nurse is justified in patients’ rights to access a full range of health care nursing profession by fostering high standards of nursing refusing to participate in a particular decision or action services. Discrimination in health care settings remains practice, promoting a safe and ethical work environment, that is morally objectionable, so long as it is a conscience- a grave and widespread problem for many vulnerable bolstering the health and wellness of nurses, and based objection and not one based on personal populations and contributes to a wide range of health advocating on health care issues that affect nurses and preference, prejudice, bias, convenience, or arbitrariness. disparities. All patients deserve universal access to high the public. ANA is at the forefront of improving the Nurses are obliged to provide for patient safety, to avoid quality care and we must guard against erosion of any quality of health care for all. For more information, visit patient abandonment, and to withdraw only when assured civil rights protections in health care that would lead to www.nursingworld.org. that nursing care is available to the patient. Nurses who denied or delayed care.” Page 18 • The Alabama Nurse March, April, May 2018

Clinical News

Increase in Hepatitis C Infections Linked to Worsening Opioid Crisis

Spike in new infections could have devastating long- term consequences New research from the Centers for Disease Control and Prevention (CDC) suggests that the recent steep increase in cases of acute hepatitis C virus infection is associated with increases in opioid injection. The study examines data from CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states. Across the nation, researchers found substantial, simultaneous increases in acute hepatitis C (133 percent) and admissions for opioid injection (93 percent) from 2004 to 2014. These increases were seen at not only the national level, but also when data were analyzed by state, by age, and by race and ethnicity. Taken together, the findings point to a close relationship between the two troubling trends.

“Hepatitis C is a deadly, common, and often invisible result of America’s opioid crisis,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “By testing people who inject drugs for hepatitis C infection, treating those who test positive, and preventing new transmissions, we can mitigate some of the effects of the nation’s devastating dramatically from 2004 to 2014 among younger Hepatitis C poses a long-term threat opioid crisis and save lives.” Americans (ages 18-39). Until recently, hepatitis C primarily affected older • Among 18- to 29-year-olds, there was a: generations, but as the opioid crisis worsened, the virus The new analysis, published in the American Journal ú 400 percent increase in acute hepatitis C; gained a foothold among younger Americans. Most of of Public Health, builds upon earlier research identifying ú 817 percent increase in admissions for injection of the 3.5 million people in the United States already living a similar regional trend in four Appalachian states that prescription opioids; and with hepatitis C are baby boomers, born between 1945 faced increasing rates of new hepatitis C virus infection. ú 600 percent increase in admissions for heroin and 1965, but the greatest increases in new infections are Hepatitis C is spread through infected blood, which can injection. being seen in young people. And as infections increase contain high levels of the virus in a single drop. This, • Among 30- to 39-year-olds, there was a: among young women, so has the rate of hepatitis C among combined with needle and injection equipment sharing ú 325 percent increase in acute hepatitis C; pregnant women—placing a new generation of Americans behaviors among some people who inject drugs, is fueling ú 169 percent increase in admissions for injection of at risk. infections among younger Americans. prescription opioids; and About 75 percent to 85 percent of newly infected people ú 77 percent increase in admissions for heroin develop chronic hepatitis C virus infection. As there are Steep increases among young people, whites, and women injection. few noticeable symptoms, many people are unaware of Rates of opioid injection—especially injection of their infection until serious liver problems or other health prescription opioid pain relievers, as well as heroin— There were also sharp increases among whites and complications arise. Hepatitis C is the leading cause of and acute hepatitis C virus infections increased most among women. cirrhosis and liver cancer and the most common reason for liver transplantation in the United States.

“We have the incredible opportunity to stop new infections and prevent people from dying of hepatitis C,” said John Ward, M.D., director of CDC’s Division of Viral Hepatitis. “With the right treatment and prevention efforts, we can eliminate hepatitis C as a public health threat within our lifetime – but to do so we must stop new infections at the source.”

Dual epidemics demand an integrated response The new findings underscore the need for comprehensive community opioid prevention services programs that: • Support drug treatment and recovery services, including medication-assisted treatment, which can help people who inject drugs stop injecting – the primary risk behavior leading to new hepatitis C virus infection. • Provide a range of testing, treatment and prevention services for hepatitis C and other infectious diseases, including hepatitis B and HIV.

CDC and SAMHSA work closely with states, communities, and prescribers to prevent opioid misuse, abuse, and overdose and to address hepatitis C risk among people who inject drugs. CDC’s role is to: • Track both the hepatitis C and opioid crises. • Help states scale up effective programs and tailor prevention efforts to their local communities. • Equip health care providers with the tools and guidance needed to make informed clinical decisions. • Undertake research to identify and alert communities that are at particularly high risk for infectious disease outbreaks tied to injection drug use.

https://www.cdc.gov/nchhstp/newsroom/2017/hepatitis- c-and-opioid-injection-press-release.html March, April, May 2018 The Alabama Nurse • Page 19

Clinical News

Self – Care for the New Year

K.C. Vick, MPH Boundaries: Boundaries are typically figurative barriers we use to protect Director of Capacity Building, Medical Advocacy and Outreach ourselves, our time, our emotional and mental bandwidth, and our general health. For instance, it is important for many of us to set a boundary between our At the close of 2017, we saw many national figures coming forward to share their personal and professional lives. To protect our personal or social time, we might experiences of harassment and abuse. This wave of public awareness surely reached choose to communicate to our work colleagues that we are unavailable for non- you on social media, or perhaps in emotional moments with your loved ones. emergency matters on the weekends. As a wellness educator, I’m compelled in this New Year to initiate deeper In romantic and sexual relationships, boundary-setting might include a conversations around mutually respectful and affirming relationships, including conversation about exclusivity or commitment level, or maybe a discussion about romantic and sexual ones. As nursing professionals, you likely find yourself engaged what birth control methods or safer sex strategies might be used. in education and prevention work with the individuals and communities you serve. In a friendship or familial relationships, you might intentionally limit the length There are opportunities for you to support your clients’ ability to build positive and regularity of visits with someone you find emotionally taxing. relationships that contribute to good health and quality of life. You may also need to communicate to people in your life the discomfort you feel Historically, much of our health education on relationships has focused on the with a particular topic. For example, some people who have survived a traumatic prevention of sexually transmitted infections and unplanned pregnancy. While these event need to avoid discussing or viewing media showing similar experiences. are important topics to address with audiences of all ages, they are secondary to core Most of us intuitively set boundaries such as these, but it can be good to themes affecting all dimensions of health, primarily self-awareness and boundary- deliberately cultivate them as our needs and desires shift. setting. As we resolve ourselves to a year of healthy relationships and public If we do the hard work of respecting ourselves and our needs, setting good discourse, it might be helpful to briefly explore these core themes: boundaries with others, respecting other people, and communication clearly around Self-awareness: Our most important relationship is the one we have with these topics, we might foster healthier relationships in 2018 and beyond. ourselves. Across our lifespan, we will continuously learn how to healthfully relate to other people. As we learn, we must remember to check in with ourselves, nurturing our own self-awareness and health. It is good practice to regularly ask the following: • Are my relationships mutually respectful and functional? Do I need to revisit, revise, or renew any agreements or boundaries I have declared with a family Continuing Education Classes member, spouse, partner, friend, or colleague? American Heart Association • Do I feel violated or pressured by anyone in my life? Have I felt emotionally • Basic Life Support (CPR) or physically unsafe with anyone in my work, home, faith community, social • Advanced Cardiac Life Support (ACLS) group, romantic or sexual life? • Pediatric Advanced Life Support (PALS) • Where am I feeling new needs or desires? What might I shift to fill those new needs or desires? Short Term Programs • Do I need to seek outside support around my responses to the above questions? • Emergency Medical Technician If so, who am I able to safely discuss and explore these matters with? Should I • Emergency Medical Technician Advanced talk with my therapist, sponsor, or health provider? Will journaling or praying help?

ALABAMA BOARD OF NURSING PLANS TO ELIMINATE LATE RENEWAL FEES

In January, the Alabama Board of Nursing proposed a rule change that would let nurses renew through December 31, without paying a late fee.

Due to the overwhelmingly positive response we have received from licensees, the Board intends to move forward with certifying the change as final at the March 16 meeting. Nurses would begin to see the change when 2018 RN Renewal opens on September 1.

Follow us on Facebook and Twitter to stay up to date on future rule changes. College of Nursing University of South Alabama High quality programs online and on-campus • BSN (Traditional and Accelerated) • RN to BSN • BSN to MSN • RN to MSN • Post MSN to DNP • BSN to DNP • Post Graduate Certificates • Subspecialty options available

The University of South Alabama is a place of unlimited possibilities, unrestricted ideas, and exceptional accomplishments. • USA College of Nursing is currently the largest academic program at USA.

• One of the largest Nursing programs in the United States. • Accredited by the Commission on Collegiate Nursing Education (CCNE), One Dupont Cir., NW, Suite 530, Washington, DC 20036 (202) 807-6791. #WeAreSouth www.southalabama.edu/colleges/con

Excellent Nurse Opportunity!

The Alabama Department of Public Health is now hiring for the position of: LICENSURE AND CERTIFICATION SURVEYOR – classification number 40726, nurse option. This involves professional work surveying health care providers to determine compliance with state and federal regulations. To qualify you must have a Bachelor Degree in Nursing and two years of direct patient care nursing experience OR an Associate degree in Nursing or diploma in Nursing and five years of direct patient care nursing experience.

This position offers competitive compensation, generous paid time off and excellent benefits. Extensive overnight travel is required. For more information and to apply please go to:

http://www.adph.org/employment/index.asp?id=474 or http://personnel.alabama.gov/Default.aspx.

If you have questions please contact Diane Mann at [email protected].

The Alabama Department of Public Health is an Equal Opportunity Employer