Association ofCampNurses www.ACN.org

. . .working for healthier camp communities by supporting the practice of camp nursing. My View: Matter Relationships In ThisIssue… Perspectives Worth Sharing: Refugee Camps: Part 2. Health Camp Nursing: The Flip Side Your Rolein Youth Development: A CalltoHealthcare Providers Super Sleuth Drowning: Headedinthe Right Directionat Your Camp? CampNurse RolesforDecreasingUnintentional Contemporary Editorial: Where CanI Take It? knows theparents betterthananyone,andisavaluableresource tothenursewhenitcomesparent support to the nurse if the nurse is talking with a parent about their child going to the ER. The director director, whenthedirector hastobreak badnewstoaparent forexample.Or, thedirector canbea nursinglicensure,concerning ormedicationadministration.The nursecanalsobeasupporttothe the nurseneedstoeducatecampdirector ontopicssuchasspecific healthissues,statelaws this andkeepthedirector informedinatimelymannerofanyhealthissuesthatmightarise.Sometimes of all.Thedirector holds accountabilityfortheentire camp.Thenursemustunderstandandappreciate Directors some oftheday-to-daylittlethingsthatmakeusalldifferent from eachother. Relationshipsmatter. are miscommunications. Itrequires from awillingness tolearn eachother, andawillingnesstooverlook relationships with theothernursesrequires asking foropencommunicationandclarificationwhenthere we couldnotsurvivethesummerifdidn’t haveeachother’s backsandworkasateam.Building relationships and try to understand each other, teamwork naturally develops.Inalarge, busy camp, aspect aswell.There willbedisagreements, there willbemiscommunication,butwhenyoubuild to camp.But,Ialsolookforward togettingknownewones. the friendshipswithnursesthatIhavemadeoveryears,andmissthosewhoaren’t abletoreturn completely different, from totallydifferent cultures, andyetwebecameveryclosefriends.Ivalueallof had wemetonthestreet, wouldneverhavebecomethefriendsthatweare today. Ourbackgrounds are rooms. Thistime I willinglyshared aroom withanursewhohadbecome a closefriend–a nurse who, that Ihadaprivateroom forafewyears,untilourcampstaff grew againandwewere askedtoshare room, except foroneroom, andmyfirstsummerIhadtoshare thedouble room asthe“newbie.”After eight nurses and two nursing assistants at the camp where I work.Mostof the nurseshave a private ate allmymealswiththem,andshared aroom atnightwithleastoneofthem.There are usually what I amgoing to say. In NO other job that I haveever had, have I worked so closely with othernurses, Nurses when Istartedjusthowmuchrelationships matter. nursing skills,andgettingtospendsomequalitysummertimeinthegreat outdoors.LittledidIknow about relationships. Iwasgettingtogocampasanadult,theopportunityusemypediatric I’ve beenacampnurseforeightyears,andwhenIappliedmyfirstpositionhonestlywasn’t thinking The relationship betweenthecampnurseanddirector isbyfaroneoftheverymostimportant Relationships betweennursesmatternotjustforthefriendshipsthatdevelop,butteamwork If youhavemore thanonenurse,orotherhealthprofessional atyourcamp,youwillunderstand I believethattohaveasuccessfulcampexperience,it’s allabouttherelationships thatyoubuild...... Relationships Matter –MyView – ...... 14 12 9 7 3 2 1 Practice Updates Association News Association ACN 207Symposium New Products, NewIdeas Camp Health–ClinicallySpeaking: Epi-Pens December 2016 volume 26, number 4 December 2016volume26,number ...... Continued onpage8 ...... 28 26 23 21 18 Volume 26, No. 4

Editorial: Where Can I Take It?

This issue of CompassPoint is definitely one for winter. This attention this coming season. Maybe now (rather than in the is the time of year that summer camp nurses have more time– middle of a harried camp day) is the better time to think about hypothetically, that is. We’ve put last season away and have not relationships to work on for next season. Beth Schultz takes yet gotten into the immediate planning for the coming season. relationships in a different direction in her adventure of changing It’s a time for reflection on the past and contemplating more camps, leaving the familiar and jumping into uncharted waters. broadly about our roles and the growth we would like to see. Is that in your future? If you concur, then this is the issue for you! When I was Tracey Gaslin and Barry Garst spell out roles in youth reviewing the first draft pages I couldn’t help but think of that development and label their piece, “A Call to Health Care famous Dr. Seuss line, “Oh, the places you will go!” To get the Providers.” There’s a lot to think about here in translating most out of this issue I suggest reading each article and then these ideas to individual camps but there are also practical taking time to ask yourself, “Where can I take this information?” suggestions that seem really easy to implement. Which will you do? Mary Tobin and her coauthors look at decreasing unintentional drowning and ask whether your camp is headed in There is an abundance of great content in the features as the right direction. I never did, much less thought of, half of the well. I encourage you to do more than just skim the work of things she suggests could be part of the contemporary camp the authors and feature contributors. Consider how to take the nurse role. Some seemed fairly easy to implement without a lot information and make it your own! of time or money. Read it asking, “What’s in it for my camp?” Susan B. Baird, RNL, MPH, MA Debra Isaacson takes “My View” on a great trip about Editor relationships. I don’t think any of us take the value of building positive relationships lightly but really thinking intentionally about our own relationships at camp might bring to our consciousness areas or persons that could benefit from our

ACN Board ACN Board

Cheryl Bernknopf, RN, BScN* CompassPoint Editor...... Susan Baird, RN, MPH, MA [email protected] 905-771-6577 [email protected] 508-888-3249 Barry Garst, PhD CompassPoint Editorial Board...... Kathleen Bochsler, RN [email protected] 540-525-7058 Barbara Hill, RN, MSN, CNE, CMSRN Mary Marugg, RN Debra Isaacson, RN, DNP Jane McEldowney, BS, RN, NCSN [email protected] 785-221-0182 Doris Nerderman, RN, BSN Paula Lauer, RN, BAN* Ellen Reynolds, RN, MSN, CPNP [email protected] 715-572-5075 Chris Stephens, MN NP, ENC(C), CFRN Beverly McEntarfar American Camp Association (ACA) Liaison....Tracey C. Gaslin, PhD, CRNI, CPNP, FNP-BC [email protected] 347-220-7103 [email protected] 502-232-2945 Beth Schultz, RN, DNP Education Committee...... (CHAIR) Jeana Wilcox, PhD, RN, CNS, CNE [email protected] 904-377-3550 Cheryl Bernknopf, RN, BScN Marianne Rudd, RN, BSN, CRNI Jeana Wilcox, PhD, RN, CNS, CNE Lisa Cranwell-Bruce, DNP, RN, FNP-C Bev McEntarfer [email protected] 816-225-8013 Lorraine Battle, BSN, RN Bev Unger, RN Paula Lauer, RN, BAN Melissa Zampatti, LPN * Designates Executive Committee Member Kelly Edwards, BSN, RN Founder ...... Jeanne Otto, RN, MS, MEd Research Committee...... (CHAIR) Barry Garst, PhD Executive Director...... Tracey C. Gaslin, PhD, CRNI, CPNP, FNP-BC* Beth Shultz, RN, DNP Tricia Huey, DNP, CPNP [email protected] 502-232-2945 Debra Isaacson, RN, DNP Tricia Kardon, RN, BS Ann Laske, EdD, RN, CNE Melissa Zampatti, LPN Association of Camp Nurses (ACN) Roberta Blumberg, RN, BSN Nancy Krahl, RN, MSN, MA 19006 Hunt Country Lane - Fisherville, KY 40023 Phone: 502-232-2945 Lorraine Battle, RN, BSN www.ACN.org Email: [email protected]

CompassPoint is an official publication of the Association of Camp Nurses (ACN), a not-for-profit nursing organization. CompassPoint is published four times a year and is intended as an informational resource only. Neither ACN nor its staff can be held liable for the practical application of any ideas found herein. Readers are invited to submit items for publication to Susan Baird, Editor, via email at [email protected]. Contents may not be reproduced without prior written consent. Member dues and subscription fees are $60 annually. CompassPoint is a peer reviewed publication indexed in CINAHL. © 2016

2 December 2016

Contemporary Camp Nurse Roles for Decreasing Unintentional Drowning: Headed in the Right Direction at Your Camp? Mary Tobin, RN, PhD, Alison Givens & Jacquelyn Thorp

Abstract: As American camper populations shift,so do roles of camp nurses regarding preventing unintentional drowning. American camps are currently experiencing a significant up-tick in campers and counselors from global, diverse and vulnerable backgrounds with an accompanying increased drowning risk. Contemporary American camp nurses must be proactive and update their competence in identifying drowning risks and implementing evidence-based interventions for decreasing drowning risks. This article expands on the growing issue of drowning risks at camps and explores linkages between camp nurse drowning prevention assessments and interventions. Hiring camp nurses without updated drowning prevention competencies may prove a fatal error in camp planning. Camps should design more holistic and effective efforts to decrease drowning risks at camp and include nurses more broadly at planning tables because nurses have unique knowledge and skill-sets to design more holistic and effective efforts to decrease drowning risks at camp.

Consider the following scenarios to determine drowning swimming abilities and water safety knowledge among campers risks. How would you demonstrate your drowning assessment and counselors. Drowning prevention is clearly a collaborative risk competence? camp wide effort and should involve the camp nurse in 1. A new international camper on a camp scholarship from designing effective holistic camp drowning prevention policies. Bangladesh attends camp. These policies should be applied uniquely and thoughtfully at 2. A camper proudly tells the camp nurse he uses each new camp session. hyperventilation as his secret technique before swimming Contemporary camp nurses may need to function as the one mile competitive pond swim. change agents for altering well-engrained routine camp 3. A young new counselor tells you he frequently uses orientation schedules to allow for added time to assess new his waterfront shift to rest up and recharge for his busy drowning risks and teach high quality drowning prevention afternoon sporting activities. interventions. For example, it may be important to increase 4. A camp expands and builds shore front cabins to draw camp nurse staffing and alter staffing patterns to include a campers interested in extreme winter camping. camp nurse at the waterfront during peak and risky swim times.

These case examples all include important camp-related Background and Introduction to Contemporary drowning risks. Issues Changing drowning risks and prevention interventions Drowning remains a leading cause of preventable death in have arrived at camp! Today camp nurses must collaborate with children across the world (Young &Herring, 2006). According to camp planning teams to design unique drowning prevention Engel (2015) more than 388,000 unintentional drowning deaths strategies at each camp. Unfortunately only scant empirical occur annually. Drowning in lower and middle income countries studies exist to guide camp nurses on this important issue but accounts for 96% of the total global instances of drowning camp nurses can apply evidence from studies conducted in (p.1). It is estimated that near drowning occurs two to three other settings to camp contexts. This article increases camp times more than drowning but it is assumed that almost all near nurse awareness of drowning risks and interventions in camp drownings are never reported (Turner, 2004). It is estimated that settings. Clearly the application of drowning prevention is an an average of 3533 unintentional drownings occurs annually emerging camp nurse research issue and a marketing need for in America or 10 per day. One in five drownings are under 14 camps. Unintentional drowning and the potential legal issues and,interestingly, 80% are male. Children ages one through which may ensue following a drowning could cause tsunamic 4 years old have the highest unintentional drowning rates. devastation both emotionally and financially to campers, Approximately 30% of all unintentional deaths from drowning families, nurses and all involved in a camp. Prevention and early occur in pools. It is important to note that African Americans identification of drowning risks is key. males ages 5- 19 have a 5.5 % higher rate of drowning in Experts recommend implementing layers of assessments America (Morrongiello, Sandomierski, Schwebel & Hagel, 2013). and protection because no single drowning prevention strategy Drowning is a global problem, especially in third world is likely to prevent all submersion deaths and injuries. Camp countries. For example, Engle (2015) presented research done nurses must approach each camp and camper as unique and in Southeast Asia targeting at-risk children in Bangladesh seek to identify specific drowning risks. Variations exist in significantly decreasing the rate of drowning through teaching

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simple water survival skills to at-risk Bangladesh youth. dry-drowning, near-drowning, wet-drowning or secondary Swimming lesson access in various parts of third world drowning because they are antiquated medical terms not countries is scant, often due to diarrheal and respiratory captured in big data sets aimed at recording drowning incident infective organisms in local swimming holes. Thus some rates. international campers may be at especially risk for drowning Drowning Causes are Multi-factorial because they likely have had little or no access to swimming Most experts agree drowning is rarely the result of a single lessons or drowning prevention education. cause and no single prevention strategy works (Wallis, Wyatt, Contemporary camp nurses should not assume that Franklin, Taylor, & Nixon, 2015). Drownings are very tragic drowning prevention education was effectively provided to events and sadly cannot be completely prevented. Drowning campers by their regular health care providers. According to risk factors such as age, aquatic location, behavior, physical an American Academy of Pediatrics survey, less than one- environmental factors, social factors and proximity of water all third of physicians indicated they provide drowning prevention likely interact to create the perfect storm for a tragic drowning information in wellchild checks (Turner, 2004). Furthermore incident. Camp nurses must assess each camp and camper’s many American at-risk youth and especially international youth unique drowning risks. No camp is alike, thus unique risks and have had scant access to well child check-ups. With rising cost interventions work to decrease drowning at each camp. After of health insurance, many at-risk American youth are unable to a drowning or near-drowning incident the debriefing session visit a pediatrician unless there is a medical emergency. Thus should involve the whole administrative team including the these vulnerable youth populations present with increased risk camp nurse to add to the depth of the discussion. of drowning at camp. This knowledge gap could prove a fatal gap at contemporary camps. Unique Elements of Drowning: Assessments and Sadly, drowning prevention is not broadly publicized Interventions in today’s media and brochures on drowning are not easily Ranking swimming ability is not a sole means accessible (Turner, 2004). Rarely does media broadcast of drowning prevention: According to Morrongiello, warnings on water safety or drowning risks. Thus most camps Sandomierski, Schwebel and Hagel (2013), better swimmers may never realize the severity of this problem until it happens to are actually likely to participate in more water-related camp one of their campers. Although no specific data on drownings activities and they may feel overly confident and swim in high- at camp could be located, continued teaching about drowning risk settings such as remote natural bodies of water with no prevention would surely decrease incidence of camp drownings. life-guards present. However research evidence in this area is Camp nurses (or even student nurses) could augment lacking. The Academy of Pediatrics emphasizes that swimming waterfront safety practices and drowning prevention education lessons are not recommended as a sole means of drowning while campers wait for swimming proficiency tests usually prevention. According to Turner (2004) drowning is a silent killer held on opening days of most camps. This swim test wait even in good swimmers because children rarely splash in the time could be used as an effective teachable moment in camp water or call out for help. Swimming ability is only one factor in programming to query new campers about their drowning risks drowning prevention and does not mean even good swimmers knowledge base. Effective teaching, using creative, interactive are risk-free of drowning. and engaging pedagogies could save a camper’s life! Camp Barriers, gates and electronic surveillance at pools nurses should be used broadly for wellness teaching and not and water fronts: According to Engle (2015) gates can reduce merely for treatment of injuries or camper intake on opening the risk of drowning by 83%. Gates made of cast iron bars days of camp. This change may involve altering camp nurse which retain visibility prove to be more difficult to climb. Engle ratios during the first week of camp and the first few days of recommends that pool fences should be four feet high and have each new opening session. no opening under the fence. While many camps have gated pools, most camps also have open waterfront areas which Drowning defined: Changing Nomenclature and Statistics are unable to be effectively gated. These open water access points present special dangers for curious young campers. According to Laskowski-Jones (2000), drowning is a Surveillance cameras located at waterfront may offer an early process resulting in primary respiratory impairment from alert of campers at open water points. submersion in liquid medium. Implicit is a liquid-air interface Life jackets: Lack of a life jacket was a factor in 88 % of all present at the entrance to the victim’s airway which prevents boating-related unintentional drownings (Wallis, Watt, Franklin, breathing of air. Outcomes may result in delayed morbidity, Taylor & Nixon, 2015). Camps should provide evidence that delayed or rapid death, or life without morbidity. According to they are teaching proper life jacket sizing and use. Auditing Engel (2015), health care workers should no longer use the terms

4 December 2016

and inspecting for life jacket use may also be wise, especially water causes a reflex inspiratory gasp with aspiration which during mid camp season when campers and counselor often further impairs victims’ ability to hold their breath under water. get lax with routine safety practices. Evidence of life jacket use Engle further presents that while hypothermia has occasionally monitoring could become important later in defense if legal proven effective in helping late resuscitation efforts, there is issues occur following an unintentional drowning at camp. considerable debate on this topic. Although extended time Alcohol: Turner (2004) presents alcohol as a factor in available for effective CPR in cold water drowning offers hope, 70% of all drownings. Although alcohol is prohibited at most sadly this evidence is based on little more than rare isolated camps, camp nurses would be remiss to assume that misuse case reports. of some alcohol and drugs among staff and counselors does Lack of supervision, electronics, addictions, distracted not occasionally occur. Continued strict policies on alcohol and counselors: Contemporary camp counselors often suffer from drug use at camp may help assure camps that alcohol impact electronics addictions. It is plausible to imagine that despite on drownings is decreased. Unannounced drug and alcohol a “no electronics rule” at waterfront, counselors may sneak screening of counselors and staff may have merit if drug and cell phone time at swim areas. Research shows distracted alcohol use is a concern of a camp nurse or director. waterfront supervision is a major risk in drowning. Inevitable Medical conditions: While seizures are a well-known risk lapses of counselor supervision makes supervision alone for drowning, especially in bathtubs and large bodies of water, insufficient as a drowning prevention technique. Engle (2015) notes that autism also presents a less known Swimming on a full stomach: Is it a drowning risk? drowning risk. Many campers with conditions on the autism Avoiding swimming for an hour after eating is not well supported spectrum now attend summer camps to help augment social in the literature but simply as a part of camp lore is a major skill development presenting a new hidden risk of drowning. drowning risk. However, Young and Herring (2006) advocate Many parents give their children drug holidays at camp from swimmers avoid over-exertion while swimming and that resting ADHD and behavioral meds, again augmenting risk of drowning before swimming aids focus and swimming ability. Nonetheless due to a lack of focus or challenging behaviors. Cardiac until clear evidence on this drowning risk becomes known, it is arrhythmias, in particular long QT syndrome, may also be a prudent to purposefully schedule swimming periods after rest cause of a small fraction of unexplained drownings. to aid focus while swimming. Language: Many camps now have numerous campers Social, economic and race factors: African American with English as their second language. Thus high quality campers may come from lower incomes or have higher rates interpreters should be used at camps to bridge language gaps of absent father figures. Contemporary camps often recruit and assure campers truly understand specific camp water from low income African American groups, with the goal of safety policies. For example some inner city youth might speak augmenting the influence of male role models in these at-risk in African American English and thus clear communication aggregates at camp. However, low income African American between campers and life guards may prove difficult. It is campers may not actually feel comfortable learning from or also a growing camp marketing niche to bring in international talking with an all-male waterfront staff. This socio economically campers and counselors to camps to help them grow English rooted communication gap may increase drowning risks skills. Planning ahead for access to high quality interpreters or in this aggregate, since these campers may generally be informatics to translate may decrease drowning risk and aid unaccustomed to receiving guidance or instruction from males drowning prevention education effectiveness and quality. (Dayer-Berenson, 2011, p. 158). Swimming water—Temporal and geographic issues: Competition at the water front: Pushing a swimmer’s Health care staff should emphasize that swimming conditions limits or doing water activities that are risky, even if they don’t can change dramatically in different bodies of water (Turner, seem to be, can be a downing risk. For example shallow 2004). For example, swimming in a chilly swift-flowing water drownings can occur from blackouts from competitions mountain river is drastically different from swimming in a of extended periods of breath holding. Many camps have warm swimming pool. Drowning risks significantly increase waterfront camp traditions which are actually quite risky. For with different environmental conditions as well (e.g. water example some camps have annual water competitions which depth, temperature, currents, weather). Nurses staffing winter stretch safety limits (e.g. diving for watermelons, swimming camps must emphasize drowning risks in cold seasons. the width of the lake, canoeing with multiple campers in a Campers should not skate, walk or boat on thawing iced over canoe,etc.). frozen bodies of water without clear permission from camp Specialty medical camps may have increased hidden administrators or nurses. drowning risks: Some specialty medical camps may have According to Engle (2015) an unexpected immersion in icy increased drowning risks due to the camper population.

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For example, according to a recent article in CompassPoint areas at camps. However camp nurses should study evolving by Huey and Buckner (2014) a camp designed for children American Camp Association (ACA) regulations for water safety specifically affected with sickle cell disease alleviated isolation standards and best practices. Often camp nurses are not even and empowered these campers with affective, cognitive and brought into off-season discussions on ACA camp accreditation psychosocial support. Since sickle cell disease primarily strikes standards. Camp nurses are often only involved in accreditation African American males the increased risk of drowning in this aspects related specifically to compliance with standards on unique specialty camp needs to be recognized. This would be the health center. Camp nurses should be brought into broader true as well for camps serving children affected with epilepsy, areas of ACA camp accreditation discussions because safety autism, and amputations. and health permeate almost all components of camp. A recent study found that only 73% of camps even had written health Incorporating Nursing Input policies and protocols involving drowning or near-drowning Camp counselors traditionally teach swimming lessons (Olympia, Holler, Armstrong, Adedayo, & Dunnick, 2015). but camp nurse input is needed as well. The camp experience Preventing drowning proactively, through careful camp planning has long been rooted in the premise that children at camp and policy development should be a practice employed by all can develop self-assurance in swimming through lessons camps with system changes made as needed. provided by supportive swimming education camp counselors. This outdoor swimming classroom is a rich environment Gaps in the Research to teach campers about water safety. However the more A gap in the research exists regarding the efficacy of camp camp swimming lessons are educational, interactive and drowning prevention interventions for children and adolescents. interdisciplinary, the more campers will likely learn and use Engle (2015) suggested an emerging high-risk sub-population at the drowning prevention strategies to enhance their swimming camp for drowning may be overly confident athletic teens who self-esteem and compliance with camp safety regulations. seek the thrill and challenge of extreme nature experiences (e.g. Often camp nurses are not brought into pre-camp drowning polar bear lake swims, winter boating and distance swimming). prevention planning discussions or in the educational design of For example, internet shows abound encouraging cliff diving these areas of programming. Camp nurses should be involved and campers may try and imitate these feats and record them in this educational aspect of camp but with the critical shortage on body cameras to post on social media. of camp nurses this may not be feasible. Tertiary Focus: Counseling After a Drowning Event Camp nurses may need to broker with camp directors and Camp nurses must advocate on a tertiary level for access advocate for changing waterfront staffing practices schedules to high quality grief and counseling services for all involved after for camp nurses. Perhaps camp directors should consider a camp drowning event. Camp nurses need to meet the diverse having a camp nurse to staff swimming areas during peak psychosocial needs of campers and families who tragically lose at-risk drowning times. Camp nurses at the waterfront may a camper to drowning. Supportive counseling services should be another mature set of eyes and ears to help stop risky be made available to all relatives and friends of drowning victims water games such as dunking or swimming in dangerous lake over an extended period of time and especially on anniversaries conditions. While maintaining long engrained camp waterfront of deaths which involve a resurgence of strong emotions. traditions is very important, modifying them to be less risky may be a wise move. Drowning prevention Practice guidelines: Developing Drowning Screenings Survival rates improve with the following drowning prevention strategies (Young and Herring (2006): While members of the Association of Camp Nurses (ACN) 1. Teaching swimming skills help campers from completely are rapidly developing practice guidelines for the unique going under. specialty practice area of camp nursing, no practice guidelines 2. CPR and life-saving skills by lifeguards or bystanders save currently exist regarding drowning prevention. Such practice near drowning victims. guidelines could offer “Best Practices” on drowning prevention 3. Having items that can be tossed available at swimming processes for camp nurses. Perhaps Masters or DNP students areas help. could develop these practice guidelines as part of their 4. Using the buddy system is a key component in drowning graduate work and partner with other reputable associations prevention. such as the American Red Cross to adapt brochures to specific 5. Individual with seizure disorders should shower instead of camp-based context. bathe. Although legislation exists mandating adequate home pool 6. Avoid alcohol before and during swimming. fencing, it is not possible to fence all lake swimming access 7. Don’t let swimmers hyperventilate before going under water.

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8. Know your limits and the limits of others. participation in swim lessons on parents’ judgments of children’s drowning risk, swimming ability, and supervision Conclusion needs. Accident Analysis & Prevention, 501169-1175. Drowning prevention interventions must be designed for doi:10.1016/j.aap.2012.09.008 each camp to match contemporary camps and campers needs. Olympia, R., Holler, K., Armstrong, C., Adedayo, P., Dunnick, J., Hartley, J., & Doshi, B. (2015). Compliance of camps in the This is especially true for international and low income campers United States with guidelines for health and safety. Pediatric who frequently lack swimming proficiency and adequate Emergency Care, 31(3) 178 -185. drowning prevention knowledge. Camp staff must recognize Turner, J. (2004). Prevention of drowning in infants and children. their own biases toward the use of ineffective and outdated Dimensions Of Critical Care Nursing, 23(5), 191-193. waterfront practices and be open to changing past risky water- Wallis, B. A., Watt, K., Franklin, R. C., Taylor, M., Nixon, J. W., & Kimble, R. M. (2015). Interventions associated with drowning based camp traditions. The ultimate goal is a more intensive prevention in children and adolescents: systematic literature drowning prevention system at each camp and the revising of review. Injury Prevention (1353-8047), 21(3), 195-204. camp practices customized to fit the unique campers, families, doi:10.1136/injuryprev-2014-041216. and staff of each camp. Providing changes to risky camp Young, S., & Herring, J. (2006). Teaching water safety in K-12 physical education. Strategies: A Journal For Physical And practices is paramount because it will increase safety and Sport Educators, 19(4), 7-11. camp sustainability. Mary Tobin RN, PhD is Associate Professor of Nursing and Chair at Coe References College in Cedar Rapids, Iowa. Mary has over eight years of camp nurs- Dayer-Berenson, L. (2011). Cultural Competencies for Nurses. Sun- ing experience, mainly at Camp Netop in Casco Maine and is an active bury, MA: Jones and Bartlett. Association of Camp Nursing (ACN) member. Engel, S. C. (2015). Drowning episodes: Prevention and resuscitation tips. Journal of Family Practice, 64(2), E1-6. Alison Givens and Jacquelyn Thorp are senior nursing students at Coe College. Alison is currently serving as the Nursing Writing Fellow in the Huey, T and Buckner, E.B. (2014).Camps for children with sickle cell Coe College Writing Center. disease. CompassPoint. 24(3) 14–18. Laskowski-Jones, L. (2000). Responding to summer emergencies. Mary would like to thank the whole 2016 NUR 400 Community and Pop- Nursing, 30(5), 34-39. ulation Oriented Nursing class for their contributions to this article. We Morrongiello, B. A., Sandomierski, M., Schwebel, D. C., & Hagel, hope the information can help camps to decrease risks of unintentional B. (2013). Are parents just treading water? The impact of drowning.

Super Sleuth By Barbara Hill, RN, MSN, CNE, CMSRN "I don't feel good..." A 16 year-old camper reports to the health center complaining, "I just don't feel good" and a headache. After talking to the camper, the following is discovered. She regularly drinks energy drinks every day and starts her day off with 2 cups of coffee to wake up at home. Since being at camp, she admits to being more active and sweating a lot. She has not had access to any of her usual beverages at camp so she is drinking cola. On physical exam there are no significant findings, but her subjective information is significant.

The answer is on page 25

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– My View – Relationships Matter Continued from page 1 communications. I certainly couldn’t do the job I do if I had a parents. I try to understand their point of view and what it is poor relationship with the director. I’m fortunate to work at a like to have your child in someone else’s care for four or eight camp with directors who are very involved and invested in all weeks. It is important to work together with parents, include things at camp. Relationships matter. them in the decision making when possible and inform them what is going on in a timely manner. Trust is not something that Counselors happens overnight and trust is the one thing I would like to have Yes, counselors are sometimes more work than the from the parents. Relationships matter. campers, right? But it is so worth our time to get to know them as people. When I am doing things at camp with the Campers counselors, I forget that I am a 50 year old woman. They remind Ah, the campers. They are the epicenter of the camp. They me what it is like to be young and enjoy life. They are also the are the reason camp exists. A nurse’s relationship with a camper eyes and ears of the camp. They will talk to the nurses about is two-fold: to help them become independent with their own anything it seems. It is important for the nurse to be “in the health care, and to intervene in times of injury or illness. Our know” especially in a co-ed environment in order to minimize goal for campers is not for them to be in the health center, but the risk of communicable diseases. Counselors are also the for them to be participating in all things camp. This is the one people that spend the most time with the campers. Nurses mindset I believe is the hardest for nurses. A nurse who is good must include counselors in important need-to-know medical at triaging and taking care of the little things as well as the big information about their campers. When I start thinking that I ones will be a successful camp nurse. work long hours, I think about the counselors who are with the Seeing campers grow up year to year is one of the most kids all day, and putting them to bed at night. Counselors need rewarding things I have experienced. I think of camper Maria our support. Relationships matter. (not her real name). Her first year of camp was also my first year. She became someone who went to the nurses frequently Other camp staff for minor issues, and as the years went by she developed a Camps that run efficiently have an excellent support staff. relationship with me. She learned to trust me and knew that I have made friends from all over the world by getting to know I only had her best interest in mind. Every summer there was some of the folks on the maintenance crew and in the kitchen. always that one nurse who grumbled each time Maria checked Not only that, but if I have a concern about a special diet for a in. They didn’t appreciate the reasons Maria came to the nurse camper, or a potential food-borne illness, it helps when I know so often. They didn’t try and get to know her. This past summer who to talk with. When the nurses have a particularly busy was her last one. As I was making my way to the several cabins day, having a good relationship with the cooks can mean the waiting for their lice check-in, I heard this booming voice across difference between eating crackers for dinner or having a meal the yard “DEEEBBBBRRAAAAAA” she screamed when she saved back for you because they understand. I make a point saw me. I can’t tell you how much that touched me. She ran each summer to get to know the maintenance staff as well, so I over to me and said that her goal for her last summer is to NOT can educate them on important safety issues and they can help see the nurses unless it was an emergency. She already had a build me that ever-important shelf that I can’t live without in the plan in motion, one that we had been working on the past few health center. Relationships matter. summers. Relationships matter.

Parents Summing Up I don’t know of any camp nurses that haven’t had some In conclusion, nurses have a unique place at camp and kind of issue with a parent. Whether it’s not turning in health their relationship building skills need to fit the various groups forms, not sending the medications to camp in the form that they work with. It is important to develop these skills as they will camp requires, or a parent upset with the nurse because their impact the overall camp experience for the nurse. Relationships child’s orthodontia broke and there isn’t an orthodontist willing matter. to touch it in the area. But you know what? It’s their child. Period. Debra Isaacson ,RN, DNP I always have to remember that I am caring for 500+ campers who are someone else’s child. And as much as sometimes we Debra works as a camp nurse each summer at Lake of the Woods/ have a communication break down with a parent, I have worked Camp Greenwoods in Decatur, MI. In her off time from camp she is a nursing professor at Washburn University in Topeka, KS. She is an ACN very hard in my eight years to nurture the relationships with Board Member.

8 December 2016

Your Role in Youth Development: A Call to Healthcare Providers Tracey Gaslin, PhD, CPNP, FNP-BC, CRNI and Barry A. Garst, PhD

Abstract: Camp Nurses are well versed in providing medications, injury care, and health education. This article discusses the role that healthcare providers can play in youth development as well as the implications of our efforts in providing more holistic care.

Camp nurses love their jobs—being in the outdoors, As healthcare providers at camp, we have unique hanging out with campers, and sharing in the fun of childhood. opportunities to develop supportive and encouraging However, when asked about their role in youth development, relationships with our clients, as well as to help them develop responses have included: autonomy (Ramsing & Sibthorp, 2008). We have extended time, “That is the job of the counselors and staff” more encounters, and greater exposure to engage individuals “The camp director manages those elements” in conversation. Consider participating with campers in some “The camp leadership is responsible for camper behavior” of the following ways: As healthcare providers we too often dismiss holistic 1. Spend time at the camp fire, signing songs, and “reading” care skills (Benner, 1982) learned in our formative education the enthusiasm for camp. and clinical practice. Once we identify that it is “someone 2. Attend night-time chats in the cabins/lodges and participate else’s job” then we may not foster and care for individuals to in the discussions of the day. our best ability. This article highlights three elements of youth 3. Sit with campers during a meal and learn about their life development: experiences. 1. Relationships 4. Create opportunities for discussion when campers present 2. Relevance for health services – take time to focus on communicating with the individual (not the condition) in your care. 3. Youth Voice 5. Participate in one camp activity a day (i.e., swimming, Each of these youth development elements can be canoeing, arts) that allows you to connect with campers influenced through the camp experience (Garst, Browne, and boost their well-being in small ways. & Bialeschki, 2011) as well as through interactions with healthcare staff. What are some simple steps we can take to Camp nurses and healthcare providers should explore a support youth and help them develop the resiliency needed to network of supportive relationships that demonstrate respect and an eagerness to learn about the individuals in our care. manage stress and challenges in their daily lives? This is a call This relational reciprocity is important, as all people are to action for Camp Nurses as we play an integral role in helping campers achieve developmental outcomes through the camp motivated to be reciprocal in how they treat others based on experience. how others treat them (Cialdini, 2006). Young people want to experience reciprocity in relationships; feeling valued in both Relationships receiving support and in giving to others. A concerted effort Relationship-building is a foundational component of at relationship-building will have long-term rewards for all human experience, and developing healthy relationships with individuals involved. peers and adults undergirds personal growth (Scales, Benson, & Roehlkepartain, 2011). Research identifies that having positive Relevance relationships helps children improve self-esteem, elevates Normal growth and development involves a drive to learning, boosts well-being, supports problem-solving and understand “self” in which youth feel connected and cared for encourages self-advocacy (Rubin, Bukowski, & Parker, 1998). by others (Lerner, 2005). We desire opportunities to collaborate An important outcome of supportive, healthy relationships with peers in authentic ways. What makes campers become is an increase in autonomy for young developing minds. BFF’s (Best Friends Forever)? What connection is made through When children and adolescents develop a sense of control, the camp experience? The answer – relevance. Whatever the their intrinsic motivation to learn and grow is expanded. event or situation, younger individuals are processing how the Autonomous youth are more likely to persist in challenging experience, interaction, and communication relates to them. situations. In addition, the learning that occurs through these Children, in particular, are in search of meaningful situations challenges helps youth process information at a deeper and that relate to and help establish their world view. These more meaningful level of understanding (Collins & Stenberg, meaningful situations have been described as “sparks”— a 2006). passion for a self-identified interest, skill, or capacity that

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metaphorically lights a fire in a young person’s life, providing “walk with your friends after school,” “don’t go out after dark” happiness, purpose, energy, and direction (Scales, Benson, & are all elements we hear shared in an effort to ensure security Roehlkepartain, 2011). (Backett-Milburn& Harden, 2004). Many youth are burdened by What we know about healthy development is that a fear of not getting in the right school, not having the best activities requiring coordination, negotiation, and influence friends, and not meeting parental expectations. These fears help individuals relate to the experience and develop a lasting deprive youth of their voice and contribute to “overparents” relevance for assessing and managing future challenges desperate to minimize the difficulties or challenges their child (Theron, Liebenberg, & Ungar, 2015). At camp we encourage might face (Garst & Gagnon, 2015; Padilla-Walker& Nelson, thoughtful exploration of friendships, nature, activities, and peer 2012). Maturation and a successful transition into adulthood encounters. We mentor campers in their efforts to negotiate a requires experience with both success and failure, where situation and positively influence outcomes. When achieving individuals face difficulties, practice problem-solving, and outcomes that boost self-worth, campers begin to appreciate display competence. Through this process of competence these skill-building interactions and may be able to translate the building, individuals “speak up” about situations and learn to learning to future life events (Weiss, Bolter, & Kipp, 2014). be more agile and adaptive to situations (Scales, Benson, & As healthcare providers at camp, we need to be conscious Roehlkepartain, 2011). of a young person’s need for relevance. Operating in a state Camp has a unique opportunity to challenge campers with of mindfulness allows us to interact with youth in ways that new tasks and high expectations allowing them to demonstrate connect campers to personally important elements (Gillard, competence and growth (Thurber, Scanlin, Scheuler, & Roark, Nyaga, & Bialeschki, 2011). Consider the following: Henderson, 2007). In the safe space of camp, children are 1. Hang outside the dining hall before or after a meal – listen allowed to dig into open, messy experiences and have the to and connect with campers around the topics being opportunity to talk about ideas, issues and problems that discussed. have not already been solved for them. The unpredictability of 2. Participate in opportunities to connect experience with daily camp life injects an element of uncertainty and volatility learning. Instead of asking “What did you learn today” requiring campers to voice concerns or challenges they may be you might say “I see that you conquered the climbing wall having. In these situations, caring adult staff as well as peers today – you seem to have learned about how persistence have the opportunity to hear their voice and to reciprocate in and effort can help you achieve. Are there other areas positive, supportive ways. where hard work has been beneficial?” Healthcare providers should be key players in helping 3. Seek opportunities to communicate regarding health campers find their voice. Health education taught us that encounters with campers. This is a great way to reinforce providing care was a partnership between the care provider and health practices as they relate to their current situation. “It the patient (Millard, Hallett, & Luker, 2006). Information, plans, seems you decided to jump over some big rocks on the and treatments should be discussed and decisions made as a hike today – How do you feel about that decision? What joint effort between both parties. Camp nurses and healthcare impact might this injury have on the rest of your camp providers should consider: experience? What is our plan for your personal safety?” 1. Give the camper a voice in the care you are providing. 4. If the camp is not technology restricted – consider how Share your findings and recommendations for care and you might use technology to connect with campers: texting ask their opinion. Seek to understand the viewpoint of the to follow up on their injury, calling as a reminder to take individual being treated. Create an environment where they medication, emailing support in tough situations/decisions. feel valued in their healthcare decisions. You can accomplish great things in “140 characters or less” 2. Ask essential questions. Essential relates to questions if the camper is an integral part of the decision-making that help guide not just physical care, but the entire processes. health encounter. Be honest, be true and developmentally If we want to imbed thoughtful learning and more appropriate in your communication. “How are you feeling profound understanding, we should consider how we make about this experience?” “How might I assist you as we camp experiences relevant. Through a network of activities, work on your injury?” “What are some things we have both encounters, exchanges, and observations, campers can learned from this situation?” develop more genuine and elaborate ways to connect with 3. Encourage camper sharing. Speak little, listen more. others if they first understand how it relates to them. Gaining voice is often related to the offering of time and attention to do so. Be slow to respond allowing the camper Youth Voice to be with their thoughts without feeling pressured for time. Daily decisions are often driven by fear: “don’t play alone,”

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4. Allow for choice when possible. Giving children choices Roth, J. L., & Brooks-Gunn, J. (2003). What exactly is a youth allows them to feel valued as part of a process. “Do you development program? Answers from research and practice. Applied developmental science, 7(2), 94-111. want to walk to the dining hall or drink some water here?” Rubin, K. H., Bukowski, W. M., & Parker, J.G. (1998). Peer “What do you prefer that we do first: clean your abrasions interactions, relationships, and groups. In W. Damon (Series or take your medication?” Ed.) & N. Eisenberg (Vol. Ed.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (5th Children and adolescents need to feel a sense that they ed., pp. 619–700). New York: Wiley are equipped to meet the challenges and struggles of life. By Scales, P. C., Benson, P. L., & Roehlkepartain, E. C. (2011). building relationships, creating relevance, and empowering Adolescent thriving: The role of sparks, relationships, and youth voice, we can help prepare young individuals for future empowerment. Journal of youth and adolescence, 40(3), 263- 277. life opportunities and challenges. Adolescents can be especially Theron, L., Liebenberg, L., & Ungar, M. (2015). Youth resilience and recalcitrant when they feel dismissed by adults and therefore culture. Netherlands: Springer. requiring more mindfulness and diligence in our encounters. Thurber, C., Scanlin, M., Scheuler, L., & Henderson, K. (2007). Youth Camp healthcare providers can help youth work through a development outcomes of the camp experience: Evidence for variety of experiences and potentially marginalize negative multidimensional growth. Journal of Youth and Adolescence, 36, 241–254. life experience. It is imperative that healthcare providers Weiss, M. R., Bolter, N. D., & Kipp, L. E. (2014). Assessing impact use their education, training, and expertise to expand youth of physical activity-based youth development programs: Val- development. idation of the life skills transfer survey (LSTS). Research Quarterly for Exercise and Sport, 85(3), 263-278. References Backett-Milburn, K., & Harden, J. (2004). How children and their Tracey C. Gaslin PhD, CRNI, CPNP, FNP-BC is a professor and dual families construct and negotiate risk, safety and danger. certified nurse practitioner in pediatrics and adults. She specializes in Childhood: A Global Journal of Child Research, 11(4 429-447. camp nursing, pediatrics, and children with bleeding disorders. Her Benner, P. (1982). From Novice to Expert. American Journal of doctoral degree is in educational and organizational leadership and is Nursing, 3(4), 402-407. passionate about participating in service-learning opportunities. She periodically works as a camp consultant and legal consultant. She pre- Cialdini, R. (2006). Influence: The Psychology of Persuasion. Harper Business; Revised Edition viously served as the Medical Director at The Center for Courageous Kids where she worked with children with chronic disease, disability and Collins, W. A., & Steinberg, L. (2006). Adolescent development in life-threatening illness. She currently serves as the Executive Director interpersonal context. In N. Eisenberg (Vol. Ed.), W. Damon, & R. M. Lerner (Series Eds.), Handbook of child psychology, for the Association of Camp Nurses. 6th ed., Vol. 3: Social, emotional, and personality development (pp. 1033–1068). New York: Wiley. Barry A. Garst. Ph.D. is an Associate Professor of youth development leadership at Clemson University. Prior to joining Clemson’s faculty in Garst, B., Browne, L., & Bialeschki, M.D. (2011). Youth development 2014, Dr. Garst served as the director of program development and and the camp experience. In L. Allen and R. Barcelona (Eds.), New Directions for Youth Development, 130, 73-87. Jossey- research application with the American Camp Association, where he Bass. provided leadership for research and educational projects including the Healthy Camp Study. Dr. Garst currently serves on the ACN National Garst, B. & Gagnon, R.J. (2015). Exploring overparenting within the context of youth development programs. Journal of Youth Board. His current interests include the career-development impacts Development, 10(1), 6-18. of camp experiences, the influence of overparenting on youth program quality, and organizational capacity-building for effective program eval- Gillard, A., Roark, M. F., Nyaga, L. R. K., & Bialeschki, M. D. (2011). Measuring mindfulness in summer camp staff. Journal of uation. Experiential Education, 34(1), 87-95. Lerner, R. (2005). Promoting Positive Youth Development: Theoretical and Empirical Bases. Paper prepared for the Workshop on the Science of Adolescent Health and Development, National Research Council, Washington, DC. Washington, D.C.: National Academy of Sciences. Millard, L., Hallett, C., & Luker, K. (2006). Nurse-patient interaction and decision making in care; Patient involvement in community nursing. Journal of Advanced Nursing. 55(2), 142-150. Padilla-Walker, L. M., & Nelson, L. J. (2012). Black hawk down?: Establishing helicopter parenting as a distinct construct from other forms of parental control during emerging adulthood. Journal of Adolescence, 35(5), 1177 Ramsing, R., & Sibthorp, J. (2008). The Role of Autonomy Support in Summer Camp Programs: Preparing Youth for Productive Behaviors. Journal of Park & Recreation Administration, 26(2).

11 Volume 26, No. 4

Camp Nursing: The Flip Side Beth Schultz, DNP, MSN, BSN, RN

Abstract: After many years of spending my summers as a camp nurse at an all-girls summer camp I found myself in a complete 180; facing a summer in an all-boys camp with a new set of challenges and wondering if I was up for the change. As God opened the door and pushed me through, I found a place where boys were mentored by amazing young men to become Godly, Christian leaders; their lives forever changed for the better.

Camp Nursing: The Flip Side be thinking about working at an “all-boys” camp? Well no, but For many years I worked as a camp nurse at an all-girls, I could listen. The nurse who had been handling the Health missions-based camp in Florida. Even after moving to South Center from many years, Grandy (her camp name), was well Carolina, I traveled back and forth each summer to serve as into her 80’s, willing to continue to help, but ready to pass the the camp nurse. I wrote every policy, created every form, torch. I agreed to make a trip to visit Camp McCall. stocked and inventoried supplies, and enjoyed every minute What I found was an all-boys, missions-based camp with a of camp. Watching the lives of the campers and staff change rich history, a beautiful mountain setting, a dedicated staff and and seeing them grow each year was heartwarming. We had an amazing group of former staffers who continued to provide a seasoned camp director who did a great job of running the support in many ways years after they were no longer on staff. camp and experienced staff that nurtured and encouraged our Current staffers were often the sons of former staffers or former girls. Campers would check in on Monday and check out on campers themselves, with a desire to make a difference in the Friday. Each week had similar challenges for me and I was lives of the boys who came to camp. Former staff had created confident in my ability to handle the complaints and concerns an organization called “Friends of McCall” to help meet various of the campers and staff that came my way. During the summer needs of the camp and this enabled former staff to continue to of 2013 I heard that small voice whisper that I was spending serve. The new camp director and his wife, Matt and Ginger my last summer at Camp WorldLight. I was sure God was not Allen, gave up a busy life in Washington D.C. to return to South serious. I was comfortable in my shell and had often made the Carolina to take on the challenge of running Camp McCall. comment that I was an “all-girls” camp kind of nurse, absolutely Matt, who is known by his camp name Spinner, had grown up not a nurse who would work at an “all-boys” camp. as a camper and then been on staff in the 90’s. He was a naval intelligence officer who knew that camp had played a major role Stepping Out in Faith in shaping him into the well-respected leader he had become. Early in 2015 I received an email and a phone call and a Once a staffer, always a staffer; when he was asked to return to message via carrier pigeon from a new camp director. Camp camp he couldn’t say no. The bond and brotherhood of Camp McCall was literally an hour north of where we lived, and the McCall continues to draw campers and staff back to a place camp director was in desperate need of leadership in the that changed their lives. How could I even consider saying no? Health Center. He was persistent, so I agreed to meet with God had an amazing plan for me, I just needed to step out in him. I couldn’t believe that I was even considering a change. faith. Would I really contemplate leaving my girls? Could I possibly

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Accepting the Challenge more experienced nurse. She had been a camper and camp I was not sure if I was up for the challenge. The Health counselor at a summer camp so she was a great addition to Center needed to be cleaned out, reorganized and updated. our health center staff. We had three nurses who had worked Nurses needed to be contacted and scheduled for the summer. at camp before that were willing to help out, and I recruited a Policies and procedures needed to be revised, forms created, former student who was an Emergency Department nurse to inventory done, and supplies ordered and stocked. Some camp help as well. She was a lifesaver. sessions were three days, others were five. Some sessions New Experiences adults brought campers from their churches and others the I stocked the Health Center much the same way I had campers were dropped off. There was no Internet, no cell phone stocked Camp WorldLight’s Health Center with a few exceptions. reception, and no air conditioning in the Health Center. The golf There was no Midol in the cabinet but there were many different cart was pitiful and would hardly make it up the hill to the dining remedies we could use to treat chafing. Wet bathing suits worn hall, much less to the chapel. There were “we have always all day long would lead to a distinguishable gait up the hill in done it this way” practices that would have to be updated or front of the Health Center but often times young campers were stopped. In all of this, there was a sincere desire to make sure reluctant to see the nurse to get treatment. If the rash got bad the campers had a magical experience, and the staffers willing enough they would give in and come through the door with a to help out any time the nurses called. look of pain and tears. There was no heating pad for menstrual Time for a Change cramps but I found that I needed ice packs by the case and that The summer of 2015 was a time for learning and changing. the combination of a red Gatorade and a honey bun was sure to The ACA accreditation visit would happen in the summer of elicit vomiting. I discovered that staffers visit the health center 2016 so I had a year to get the Health Center ready. After being more often when the camp nurse is a young blonde and that a a member of the Association of Camp Nurses for many years, dehumidifier in an un-air-conditioned building in the mountains attending educational symposiums and developing friendships can fill up quicker than a 12 oz cup under a faucet. I got into the with many wonderful camp nurses, I knew I would have the groove of having “trip” kits ready and keeping track of Epi-Pens resources I needed. There were some things in place that across camp. would make my job much easier at Camp McCall. We had great There were many firsts for me at camp that summer. I physician support. We had two physicians who I could call on if wished I had listened more intently to the presentation on a staffer needed to be seen or needed a prescription called in. eye injuries at ACN’s Symposium, taken better notes during My ACN membership provided me with a discount with Moore Tracey’s talk on concussions, and gotten the chance to hear Medical which was extremely helpful. So, I began getting the about what to do with injuries that involved teeth. Finding a Health Center ready for a busy summer. dentist on a Sunday afternoon is impossible. I learned that I was provided with a list of names of nurses who had not all copperhead bites require treatment, only the ones that helped out in the past, and I began working to find Health involve the release of venom, but they will all send a nurse into Center coverage for the summer. As a nurse educator, I a panic attack. contacted former students as well as former camp nurses to I learned that camp staff, male or female, are dedicated ask for help. We all learned a great deal that summer: the new to their campers and give much more than they receive over camp director and the new nurses as well as the the span of a few short summer months. They impact their veteran nurses and the staffers who had been campers for a lifetime. One of my junior nursing students saw used to having Grandy run the Health Center. my “Camp McCall Staff” water bottle this fall and said, “You Even Grandy had the opportunity to learn worked at Camp McCall? I went every summer, some of the best some new nursing that summer. We talked memories growing up were at Camp McCall.” And of course my about patient confidentiality, record and next thought was, “….and I see a future camp nurse!” medication storage, and documentation. Beth Schultz DNP, MSN, BSN, chairs the Undergraduate Nursing Pro- We cleaned out and restocked first aid grams at Anderson University in Anderson, SC. She serves on the kits and conducted safety surveys. We Executive Board of ACN and is a member of the Research Committee. updated our process for medication She recently worked as part of a group that revised ACN’s Scope and administration and documentation for Standards of Camp Nursing Practice. She first served as a camp nurse campers and staff. in 1992.

I did have one new graduate Camp McCall is an all-boys mission’s based camp in Sunset, South nurse working in 2015 and she did Carolina and is associated with the South Carolina Baptist Convention. great. I was sure to pair her with a The camp was established in 1959 and serves boys aged 6-18.

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– Perspectives Worth Sharing – Refugee Camps: Part 2. Health Ellen Buckner, PhD, RN, and Bernardita Gaspar, MD

Abstract: Displaced persons may reside in camps or non-camp settings and the health care they receive is often provided by international relief organizations. This report summarizes selected published articles on health care for displaced persons and includes an interview with a physician actively engaged in providing that care. Pediatric nurses and indeed camp nurses can help by advocating for children around the world. Volunteering to work with distressed populations or participating in global missions creates awareness and mobilizes our society to support those in desperate need. Part 1 of this article, Child Protection, appeared in the March 2016 CompassPoint.

As international violence escalates we have become encourage collaboration between researchers and practitioners, aware of the profound impact on displaced persons and their and apply innovative research designs. Authors recognized the health. According to the UN High Commissioner for Refugees needs to integrate mental health with national and local health, (UNHCR) more than 60 million persons are currently displaced education, and social systems (Tol, et al, 2011). in the world with more than 20 million fleeing violence (UNRA, In addressing NCD in refugee camps, Shahin, Kapur, 2015). Refugees and other displaced persons constitute a and Seita (2015) noted that diabetes and hypertension were humanitarian crisis with almost half being children (Murray, significant health needs for individuals. The strategy for 2015). One report described displaced women’s healthcare addressing these in low resource environments emphasized needs in their own words as “the need for the restoration of hope healthy lifestyle, early detection, and implementation of and human dignity” (Pinehas, van Wyk, & Leech, 2016). Mental treatments when available. Co-morbidities were also frequently health needs are widespread with few tested interventions (Tol, found. Medications included oral anti-diabetes agents and et al., 2011). Communicable and non-communicable disease insulin. Antihypertensive drugs included a range of agents, (NCD) are major challenges as those in camps are vulnerable when available. These authors emphasized the importance of populations due to overcrowding, inadequate housing, limited healthcare worker training and follow-up appointments to track access to safe water and sanitation, and lack of access to progress in control of the condition (Shahin, Kapur, & Seita, primary health care (3RP, 2015). 2015). The 2016-2017 Regional Refugee & Resilience Plan Women’s health care poses additional challenges beyond (3RP) was developed by more than 200 agencies providing purely physical needs encompassing the need for restoration humanitarian relief in a coordinated region-wide response to of hope and human dignity (Pinehas, van Wyk, & Leech, 2016). the Syrian crisis. Communicable diseases include respiratory In their descriptive phenomenological study of women in a infections, diarrhea, hepatitis A, tuberculosis, mumps, measles, refugee camp in Namibia, these authors found women were and cholera. Routine vaccination for preventable diseases such overwhelmed by being under others’ control. Their reproductive as childhood immunizations and polio is a priority for health care and social needs were unmet in part because of lack of freedom agencies. NCD include hypertension, diabetes, cardiovascular and autonomy in seeking and accessing care. There were major disease, lung disease, and cancer. Emergency care includes problems in the camps with abuse and stigmatization. There care for those injured in conflict with significant rehabilitation was lack of basic confidentiality with information such as HIV needs to follow. Obstetric and neonatal care are needed at all status readily available to those who would use it to shame levels—primary through tertiary (3RP, 2015). or create fear. There were cultural issues with availability of In a review of more than 160 articles on provision of mental contraceptives. Uncertainty was common from food insecurity health services in refugee camps, it was found that the most to reprisals, and to fears about the future (Pinehas, van Wyk, & commonly reported mental healthcare activities were counseling Leech, 2016). for individuals, facilitation of community support of vulnerable Children experienced overwhelming risk both in camps individuals, provision of child-friendly spaces, development and in the journey to reach them (Murray, 2015). Involuntary of community-initiated support, and basic counseling for displacement was often accompanied by separation from groups and families (Tol, et al., 2011). Key recommendations family, exposure to conflict, mourning of loss, and anxiety for improving mental health and psychosocial support were in resettlement. Physical stressors included exposure to to strengthen the evidence for effectiveness of mental health infectious disease, malnutrition, and food insecurity. Lack of services in humanitarian settings, to broaden outcomes beyond immunizations, clean water, and sanitation increased risk. post-traumatic stress disorder and internalizing symptoms, to Infectious diseases included TB, malaria, and parasites.

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Overcrowded living conditions and refugees coming from Who works with you to provide these services? How they endemic areas increased transmission. Indoor spraying or recruited and trained? mosquito nets and oral medications were rarely available. I work with competent service providers such as medical Malnutrition resulted in protein and micronutrient deficiencies doctors, nurses, pharmacists, and community health workers (Murray, 2015). to name a few. Our staff is recruited from the local community as well as the beneficiaries, meaning displaced individuals and Interview with Bernardita Gaspar, MD, Medical Syrian refugees. International Medical Corps provides equal Director, International Medical Corps– Iraq. opportunities for host and displaced populations alike. Tell me a little about yourself and your experience with To ensure that our team continues to grow professionally healthcare for displaced persons. and provide quality services, they are provided with internal and My name is Bernardita Gaspar. I was trained as a medical external trainings such as Management of Common Morbidities doctor in the Philippines and volunteered with the Department using Guidelines endorsed either from the Ministry of Health of Health where I was deployed to the “Doctors to Barios or the WHO, Pharmacy Stock Management, Gender-based Program” which provides healthcare in small villages. After Violence Guiding Principles, Psychological First Aid training, five years, I went into global health and have worked in Darfur, and other relevant trainings. Liberia, Haiti, Libya, and now Iraq. I learned some Arabic in Most of the national staff are either a few years out of Darfur, but we always had translators for English. My longest university or have not had the opportunity for continuing employment has been with International Medical Corps. professional education. Having this in mind, the commitment of International Medical Corps to align programs to international Can you tell me about the camps you serve? standards and ensure sustainability, trainings are always International Medical Corps works in four provinces in Iraq included as part of the interventions. in which we work both inside and outside of camps. There are seven camps with most displaced persons coming from Iraq What are the primary health concerns of IDPs and/or and Syria. In Erbil, camps for displaced Iraqis are relatively refugees in the camp? What are the most common health nearer the city while the refugee camps for Syrians are located services requested? outside of the city limits. Transportation expenses to the city Acute respiratory conditions, gastroenteritis, diarrhea, for basic services are an additional burden for the displaced hygiene, and water-related infections, scabies, and lice families. The largest camp, International Medical Corps, has infestation are some of the health concerns seen among been supported through a static clinic had a population of beneficiaries. Chronic conditions such as hypertension and around 40,000. Services are very basic including general medical care, consultations, dispensing of essential medications, community health, and psychosocial services. Diagnostics are a challenge since lab services are only available in the city. For example, a physician can identify hypertension and dispense medications with a current protocol, but for any specialty care the patient must go to a specialist before a diagnosis can be made—for example cardiologist, endocrinologist, internal medicine. So far we have been able to refer but with the economic crisis in Iraq, the fees and transportation are issues that beneficiaries continue to face. In other areas, aside from transportation and health service fees, beneficiaries also affected by sectarian tensions with fear of being targeted due to their religious affiliations.

Do patients fear for their well-being? Yes. I have been told of patients and caregivers who refuse ambulance services for fear of being kidnapped or disappearing. There is fear of being persecuted and not being treated because they are Internationally Displaced Persons Two of our psychosocial workers at a camp called Al Salam (IDP) or from a particular sect. Camp in Bagdad.

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diabetes are also quite common. Patients usually depend community members did not acknowledge the need for the on International Medical Corps to provide them with their intervention. Through continued dialogue with community maintenance medications. General medical consultation is the leaders, local authorities, and community members, our team most attended service in the clinics. The doctors would usually has slowly developed trust among potential advocates and see at least 40-42 patients in a day, sometimes more. beneficiaries. Aside from clinic–based health services, we also provide community outreach services. Community health workers Are there problems that result from water sanitation (CHWs) are trained to have knowledge of morbidity and highest problems? Is water chlorinated? need. They learn how to respond to current need first. For Yes, we see a lot of problems due to inadequate water and example, when there was an increase in scabies in January, the sanitation facilities. For example, there was a cholera outbreak CHWs were trained to identify beneficiaries who are infested last year from September to December 2015. Diarrhea and and conducted a campaign to distribute treatment. We often skin diseases such as scabies and pediculosis are common coordinate with other organizations, especially for non-food conditions seen among our patients. Water is chlorinated with items. So that in this case, one NGO provided blankets so we the support of WASH partners. could remove home infestations. Are there communicable disease concerns? Are there How do nurses function in this setting? immunizations? Our interventions are curative, preventative, and Yes, communicable diseases are still a concern especially educational. Nurses are significant in supporting these cholera. Tuberculosis also persists to be a public health problem interventions. Nurses provide initial assessments, treatments, especially now when healthcare services have been weakened and follow-up care. Nurses are increasingly supported to do by the continuing conflict. There is an expanded program for health education within the clinic. The doctors are often focused immunizations (EPI) which has a schedule of vaccinations more on the one patient and not always looking at the broader provided directly by government-managed services. UNICEF problem within the community. We support them to learn that supports the department of health with the vaccines for polio, there is more than just their curative role. hepatitis B, measles, and cholera.

Is women’s health provided? Can you share a story of a particular person or family that Yes, women’s health is provided, though not yet impacted you? comprehensive. There have been positive changes in the One of our medical doctors told a story about a 9-year- past few months regarding the provision of antenatal care, for old girl who was burned in Baghdad. She was a victim of child example. A few months ago, antenatal services were provided abuse. The girl was brought to the hospital but when she came in a limited number of facilities; however, recently, there was out of the hospital she still had open wounds. She was brought confirmation that general practitioners can provide antenatal to the medical doctor working in one of International Medical services as well. Corps’ mobile medical units. After treating her wounds, the medical doctor referred her to a psychosocial worker who talked How do you care for mental health needs? with her and encouraged her. At first she was not talking at all. International Medical Corps integrates mental health She would not speak; she was withdrawn. The worker went to and psychosocial support services (MHPSS) with health the shelter and coaxed her and encouraged her. She worked interventions. A network of outreach workers trained to with her to bring her to the clinic with the MD/nurse, where they identify individuals at high risk of mental health issues and treated her wounds and talked with her. After several weeks those needing psychosocial support services provide house- she started to talk and smile! Last time I saw her we brought to-house visits. Any beneficiary who self-reports or who gives our country director and she was smiling for us! It showed she consent for further help are referred to a psychosocial worker trusted our staff. for further assessment and on-to-one counselling. Should the Mothers trusting us with their concerns, fathers who come person need further evaluation and possible treatment, he/she for help acknowledging that there is a problem when they start is referred to the psychiatrist who provides scheduled visits to beating their children or their wives, and children giving joyful the static clinics. smiles–these are the moments that encourage me! In addition to providing MHPSS services, International Medical Corps also offers gender-based violence (GBV) Do you have any other comments or things you would like prevention and response services. Acceptance and advocacy to share? for such services had been an uphill climb for our team. Initially, Dedicated colleagues make all of this happen. We have MDs and nurses, psychosocial workers, community health

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workers, and even engineers! Engineers are learning to References provide health services logistics. They learn what it takes to 3RP Regional Refugee & Resilience Plan 2016-2017[3RP] (2015). dispense medications and treatments, and provide mental and Retrieved from http://www.3rpsyriacrisis.org/the-3rp/ community health services. By providing their expertise, our Bell, S. A., Lori, J., Redman, R., & Seng, J. (2015). Development of a brief screening tool for women’s mental health assessment team of health providers are able to serve our beneficiaries in in refugee settings: A psychometric evaluation. International the best way possible. Journal of Nursing Studies, 52(7), 1202–1208. https://doi. org/10.1016/j.ijnurstu.2015.04.003 Summary Murray, J. S. (2016a). Displaced and forgotten child refugees: Health needs in refugee camps are extensive and A humanitarian crisis. Journal for Specialists in Pediatric aggravated by poor living conditions. Physical and mental health Nursing, 21(1), 29–36. https://doi.org/10.1111/jspn.12133 care services are provided often by humanitarian agencies. Pinehas, L. N., Wyk, N. C., & Leech, R. (2016). Healthcare needs of displaced women: Osire refugee camp, Namibia. International One way pediatric nurses and indeed camp nurses can help Nursing Review, 63(1), 139–147. https://doi.org/10.1111/ is to advocate for children around the world. Pediatric nurses inr.12241 and nursing students often volunteer to work with distressed Shahin, Y., Kapur, A., & Seita, A. (2015). Diabetes care in refu- populations or participate in global missions (Murray, 2015). gee camps: the experience of UNRWA. Diabetes Research & Clinical Practice, 108(1), 1–6. https://doi.org/10.1016/j.di- These experiences, though limited, can create awareness and abres.2015.01.035 mobilize our society to support those in desperate need. Pediatric Tol, W.A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T.S., and camp nurses can learn low resource ways to address Souza, R., .… &van Ommeren, M. (2011). Mental health and common health problems. Techniques as simple as reversing psychosocial support in humanitarian settings: linking practice the head and foot of cots in cabins are the same principles in and research. Lancet, 378 North American Edition(9802), 1581–1591. other crowded areas, from disaster shelters to refugee camps. United Nations Refugee Agency (UNRA). Mid-year trends 2015. Some intervention approaches have been begun by nurses. Geneva: UNHCR, 2015. http://www.unhcr.org/en-us/statistics/ Bell, Lori, Redman, and Seng (2015) developed a screening tool unhcrstats/56701b969/mid-year-trends-june-2015.html for women’s mental health assessment in refugee settings and tested it with displaced women in a camp in Rwanda. Research Ellen Buckner, PhD, RN, CNE, AE-C, is Professor and Chair of Under- needs to be done using innovative approaches rather than graduate Nursing Programs at the Ida V. Moffett School of Nursing, Samford University, Birmingham, Alabama. She is past ACN Research controlled trials. Evidence for effectiveness of low-resource Chair (2001-2012). interventions need to be tested. Women's, children's, elderly and other vulnerable population's needs must be addressed. Bernardita Gaspar, MD, is a physician with 14 years’ experience in inter- national humanitarian health care. She is currently the Medical Director for International Medical Corps-Iraq. Prior to this posting she served in South Sudan, Libya, Tunisia, and Haiti. She holds a Medical Doctor (MD) degree from Saint Louis University in Philippines. She cares passion- ately for children, the environment, health and human rights.

Is There a Super Sleuth Hiding in You? Really?

See page 24

17 Volume 26, No. 4

– Practice Updates – Linda Ebner Erceg, RN, MS, PHN

Wound Management Updates remains the preferred method for bleeding control – unless it’s a Remember reading that skin is the largest organ system life-threatening arterial bleed of an extremity. That’s the domain of the human body? Now consider all the incidents a camp of the tourniquet. Citing several studies with robust grades of nurse handles that involve the skin: cuts, abrasions, thermal clinical strength, Quinn et. al. state: “A tourniquet can be placed burns, various rashes, blisters. The list goes on. Next, think for up to two hours with minimal risk of complication” (pg 122). of what you learned about managing these assaults. Many This is qualified by noting that an appropriate tourniquet has recall (a) control the bleeding, (b) minimize infection potentials, sufficient width (1.5” minimum) to obstruct blood flow and and (c) bandage appropriately. Yes, some nurses specialize in makes use of a windlass to develop sufficient force to overcome wound care but most of us stop at those glittering generalities arterial pressure. Management of arterial pressure is confirmed and serendipitously pick up additional knowledge as various by the absence of pulses distal to the tourniquet’s location. wounds appear in our practice. Note that 2-hour time limit. A tourniquet left longer than this It’s time for an update, especially given the pre-hospital “should remain in place until definitive medical evaluation setting of our camp nursing practice. A keen kick-off to that occurs” (pg 122). process is found in a Wilderness Medical Society (WMS) Practice Guideline from an expert panel’s review of literature on this topic (Quinn, Wedmore, Johnson, Islas, Anglin, Zafren, and Massorana, 2014). Charged by the WMS to provide an evidence-based guideline for wound management in austere environments, the panel’s review of 137 articles resulted Wilderness Medical Society in information that also informs basic wound management Online at www.wms.org practices. What follows is an overview of that content, content This organization provides the guidelines that support that impacts all wound management practices. care in settings that are one hour or more from definitive Quinn and colleagues began their Guideline by expanding care. What aspects of your camp fall into that category? the goals of wound management. In addition to those listed in the first paragraph, they added promotion of optimal Access recorded online lectures, teaching scenarios, healing, reduction of discomfort and disability associated practice guidelines and more from the WMS website. with wound management, minimizing loss of function, and optimizing cosmetic outcomes. Assessment comments include consideration of the wound’s mechanism of injury and noting its anatomical location. Camp nurses who handle traumatic wounds will appreciate the article’s discussion of injected anesthesia but for those who see “tamer” wounds, minimizing discomfort remains largely dependent upon how the wound is handled during the cleaning and bandaging process. Bleeding Control: Direct pressure is still the preferred method for controlling most bleeding situations. Interestingly, “… manual direct pressure generates an average of 180 mm Wilderness Risk Management Conference Hg” whereas as a pressure bandage provides about half of that Online at www.nols.edu/wrmc/ compressive force, specifically 90 mm Hg (Quinn et. al., 2014, pg 121). Using a compression bandage typically frees one’s This annual event brings together people who hands for other things. The compression bandage does have a influence wilderness experiences for a wide range of role in hemorrhage control but camp nurses should remember participants. Vibrant discussions and robust sessions that one gets most pressure using the manual technique. pepper the experience. Elevation, used as adjunct to pressure for hemorrhage The conference’s Resource Center is rich with take- management, “… is not supported or disputed by any home materials from presenters. Visit & bookmark this site: controlled studies” and pressure points, often taught as the www.nols.edu/wrmc/resources.shtml. second option for bleeding control, are ineffective based on Consider attending this event! results from a cited controlled study. Given this, direct pressure

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There’s a growing number of hemostatic agents marketed is worth a pound of cure” for this scourge and advocate for for incidents in which a tourniquet cannot be used (e.g., neck the use of appropriate protection to at-risk areas (e.g., wearing wound). Quinn et.al. prefer those made of impregnated gauze moisture-wicking socks, breaking in new hiking boots, wearing rather than the powder options but the high cost of these gloves). Research continues to support use of pressure-relieving agents makes routine use at camp unlikely. strategies (e.g., moleskin) for small blisters (<5mm in diameter) Wound Cleaning: The Quinn panel made a distinction and “hot spots” as well as draining – but not unroofing – blisters between wound debris that is inert (without electrical charge) larger than 5mm in diameter and then bandaging them after and debris that holds an ionic charge. Inert debris such as gravel applying a hydrocolloidal (.e.g., petroleum ointment). is unlikely to contribute to infection whereas contaminants like The reviewers reported a scarcity of evidence about burn moist soils and other organic material cause an inflammatory care in remote locations thus their recommendations were response that is more likely to result in infection. Our limited to (a) immersing burned areas in cool water for pain camp setting typically means that one assumes a wound’s relief and to limit the extent of the burn and (b) stating that silver contaminants will trigger infection; consequently, we clean sulfadiazine has been “consistently associated with poorer wounds. Quinn’s panel noted that literature supported using healing outcomes” (pg 127) than use of dressings currently on clean rather than sterile cleaning technique; clean technique the market for burn care. was equal to a sterile one insofar as infection rates were Summative Comments: Quinn et al closed their Guideline concerned. This statement supported using tap, rather than comments with a discussion about wound infection, noting that sterile, water for wound irritation. That being said, cleaning a “no single particular [antibiotic] agent will be reliably effective rabies-prone wound is an exception to this. Specifically, flushes in all scenarios” (pg 128). They then went on recommend of rabies-prone wounds benefit from adding a virucidal agent evacuation of individuals with particular types of wounds (e.g., (e.g., povidone-iodine, chlorine dioxide) to the flushing fluid open fractures; wounds with damage underlying tendon, joint, (Quinn, et.al., 2014). nerve or vessel damage; tetanus-prone wounds requiring Again citing literature, the panel acknowledged the immunization). It’s this last example – the tetanus-prone wound effectiveness of high-pressure irrigation in decreasing a – that should prompt camp nurses to advocate for knowing the contaminated wound’s bacterial load but also stated that high date of each camper and staff member’s most recent tetanus pressure risks pushing debris deeper into the damaged tissues immunization. thus increasing the potential for infection. Granted, it’s hard to MESH Continues to Impact Camp Health; Do Your obtain the recommended high pressure (>15 psi) preferred for Practices Support It? wound cleaning in the field so driving debris deeper may not be Current publications as risky as once believed. are percolating with the Wound Closure: Camp nurses with wilderness medicine impact of mental, emotional background may recall being taught to leave wounds “open,” and social health (MESH) thus allowing them to heal by secondary intention. Quinn et al upon both camper and staff reported that “little data exist to demonstrate a higher incidence experiences. For example, of wound infection with immediate wound closure” (pg 125) ACA’s recently released and that primary wound closure had not been associated with CampLine (2016) noted that 38% of calls to their summer Hot a higher incidence of infection. Consequently, the committee Line were for health and medical issues. This was the category recommends that “most wounds can be treated safely with with the highest ranking, a ranking that it’s held for eight acute primary closure” (pg 125) and goes on to recommend that consecutive years. More interesting, however, was that 42% surgical tapes should be applied to minimize, if not eliminate, of health & medical calls were about MESH issues. MESH had shear stress to the skin. This is particularly important when using previously been included in ACA’s “other” category but has now an adhesive aid such as tincture of benzoin, something that’s emerged as a focus topic. Of the MESH calls, 57% pertained a common practice at camp when the nurse wants a bandage to campers and 43% were about staff. Some centered around to “stick” in spite of the environment’s attempts to dislodge it. suicide threats, some around camper behavior that indicated a The Guideline also discussed using hair to close scalp wounds MESH concern, a small handful were about a death at camp, and the need to note cosmetic outcome associated with wound and others were about handling various emotional responses. management. Meanwhile, the initiative around the concept of trauma- Blisters and Burns: Quinn et al reported that 64% of informed practice continues to gain traction. Camp nursing people hiking the Appalachian Trail were affected by blisters. practice puts the nurse in contact with clients, both campers Experienced camp nurses know that “an ounce of prevention and staff, who bring their unique backgrounds to the camp

19 Volume 26, No. 4

experience. Some of these backgrounds include significant So consider taking a Mental Health First Aid course or reading trauma and/or “toxic stress” that color the individual’s a book such as Mental Health First Aid USA (Kitchener, Jorm & perception of camp experiences. Indeed, if one considers the Kelly, 2013). At minimum, ask campers and staff who seek care CDC sponsored, classic 1998 study of Adverse Childhood from you at the Health Center, “How’s it going with being here Experiences (ACEs) (Felitti, Anda, Nordenberg, Willianson, at camp?” Spitz, Edwards, Voss & Marks) along with more contemporary If this topic intrigues you, also look at the MESH topics on findings about mental health in youth from the National Institute ACA’s website (www.ACAcamps.org). There’s a MESH blog as of Mental Health (https://www.nimh.nih.gov/health/topics/ well as MESH content under the site’s core competencies (http:// child-and-adolescent-mental-health/index.shtml), it becomes www.acacamps.org/staff-professionals/core-competencies/ apparent that childhood trauma(s) and/or toxic stressors affect health-wellness/mental-health). Finally, share your MESH camp almost one in five of today’s youth (Perou, Bitsko, Blumberg, stories with ACN’s representatives on the Healthy Camps Pastor, Ghandour, Gfroerer, Heddon, Crosby, Visser, Schieve, Committee, Tracey Gaslin ([email protected]) and Linda Parks, Hall, Brody, Simile, Thompson, Baio, Avenevoli, Kogan Erceg ([email protected]). & Huang, 2013). Go to your next camp season with an improved MESH skill Now consider that nursing has traditionally defined itself set. in terms of its ability to respond to the human response to Exercise-Induced Anaphylaxis injury, illness and life events (American Nurses Association, “Exercise-induced” is commonly associated with asthma 2015). In addition, ACN’s revised and soon-to-be-released but the concept can also be linked to anaphylaxis. As Scope & Standards of Practice (in press) speaks about the discussed by Nuynh, Hu, Thobani and Scott (2015), exercise- camp nurse collaborating with the client – camper, staff or induced anaphylaxis is rare but, when it occurs, can surprise camp community in general – to address bio-psycho-social unsuspecting people. The response is not consistently triggered needs. Finally, Healthy People 2020 objectives, specifically by the same type or intensity of physical activity by a given HC/HIT-2, direct an “Increase [in] the proportion of persons individual; thus people with the condition are encouraged to who report that their health care providers have satisfactory exercise in the presence of others rather than by themselves. communication skills” (online at https://www.healthypeople. Those “others” should know the signs associated with the gov/2020/topics-objectives/topic/health-communication-and- condition’s on-set as well as what actions to take. This has health-information-technology/objectives). All of this suggests significant implications for camp nurses who are more familiar – some would argue even directs – that our camp nursing with alerting staff to anaphylaxis associated with various practice bolsters attention to MESH needs. A holistic nursing allergies. practice demands it. Nuynh et al point out that the “typical age of onset is Call to Action: Camp Nurses – improve your MESH skills. adolescent age to the third decade of life” (pg 3), making the At minimum, build your skills in at least one MESH area before presentation a potential for older campers and camp staff. The returning to camp. article discusses prodromal symptoms such as feeling fatigued, Up to now, our interface with MESH needs of campers pruritus and cutaneous erythema, symptoms that this target and staff has largely been tied to making sure people get age group should both know and respond to. The authors their prescribed medications. Those days are over. More delineate signs and symptoms associated with the syndrome’s break-through behaviors are happening at camp. As camp four phases and discuss food-dependent exercise-induced professionals, we identify patterns of troublesome behaviors anaphylaxis as a distinct subset of the diagnosis. that remain hidden in other settings. And there’s a growing Treatment of exercise-induced anaphylaxis was lightly difference between the life skills used at camp and those used addressed by the authors. It included use of epinephrine (as at home. As a result, some campers and staff experience in other anaphylactic situations); getting clients to recognize triggering stressors that result in behaviors – including emotional on-set symptoms and, consequently, reducing/stopping their responses – that need the caring support of an informed camp exercise; and being especially cautious when exercising in professional. Nurses are uniquely prepared to provide this. temperature extremes. So start “beefing up” your skill set for MESH needs. I’m not Prevention in known cases is obviously the preferred saying that camp nurses should have a psych nursing credential strategy, specifically reducing physical activity so attacks aren’t but rather that we dust off the skills learned in our basic nursing triggered. If the condition is associated with food ingestion, the courses, skills such as those therapeutic communication authors recommend “avoiding the offending food for 12 hours techniques, and use them with more intention. But we also need prior to exercise” or, if the offending food is unknown, “avoid to update our knowledge to reflect contemporary approaches. eating any food 6-8 hours prior to exercise.” That’s tough to ask

20 December 2016

of affected campers and staff; consequently, if the condition Nuynh, P.N., Hu, E.K., Thobani, S.A., Scott, L. (2015). Exercise- is noted on a person’s health history, camp nurses might induced anaphylaxis. Available online beginning at http:// emedicine.medscape.com/article/886641-overview. consider talking with the family to obtain more information as Quinn, R.H., Wedmore, I., Johnson, E.L., Islas, A.A., Anglim, A., well as consulting the camp director regarding camp-specific Zafren, K., Bitter, C., Mazzorana, V. (2014). Wilderness Medical responses. Interestingly, Nuynh et al stated that prevalence of Society practice guidelines for basic wound management the diagnosis “is not well established” (pg 2). Although reported in the austere environment: 2014 update. Wilderness and environmental medicine, 25, 118-133. world-wide, a systematic process to establish prevalence rates Perou, R., Bitsko, R.H., Slumberg, S.J., Pastor, P., Ghandour, were, according to the authors, limited. R.M., Gfroerer, J.C., Hedden, S.L., Crosby, A.E., Visser, S.N., As readers might suspect, there is more to read about this Schieve, L.A., Parks, S.R., Hall, J.E., Brody, D., Smile, C.M., condition. Develop both your awareness and knowledge of this Thompson, W.W., Baio, J., Avenevoli, S., Kogan, M.D., and condition. Huang, L.N. (2013). Mental health surveillance among children: United States, 2005-2011. Morbidity and Mortality Weekly Report, 62(2), 1-35. References Redford, J., and Pritzker, K. (2016). Teaching traumatized kids. The American Camp Association Staff (2016). Top trends 2016. Atlantic. Accessed 12 August 2016 at http://www.theatlantic. CampLine, 27(2), 1—13. com/education/archive/2016/07/teaching-traumatized- American Nurses Association (2015). Code of ethics for nurses. kids/490214/. Silver Spring, MD: American Nurses Association. Felittti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, Linda Erceg, RN, MS, PHN, coordinates the Certificate in Camp Nursing A.M., Edwards, V., Koss, M.P., and Marks, J.S. (1998). program for Bemidji State University, Bemidji, MN. With over 30 years Relationship of childhood abuse and household dysfunction as a camp nurse at the Concordia Language Villages and as ACN’s to many of the leading causes of death in adults. American former executive director, Linda’s experience and a deep connection Journal of Preventive Medicine, 14(4), 245-258. to the Camp World contribute to her CompassPoint submissions. She Kitchener, B., Jorm, A., and Kelly, C. (2013). Mental health first aid chairs the Healthy Camps III committee, has a column in ACA’s Camp- USA. Lutherville, MD: Mental Health Association of Maryland, ing Magazine, and is preparing to re-write The Basics of Camp Nursing Inc. with co-author Myra Pravda. Email Linda at [email protected].

– Camp Health - Clinically Speaking – Epi-Pens Doris Nerderman, RN, BSN

Consider these situations: thought to look at expiration dates but is sure they are still • The mother of two campers brings a twin pack of Epi-Pens good. to you at check-in. Both campers have peanut allergies. These situations are hypothetical but are certainly plausible. Her son will be across the lake with the boys division and They raise some issues likely to come up as a result of the her daughter will be near you on this side of the lake. She tremendous increase in the cost of Epi-Pens. This column aims questions whether she could leave one pen with each of to bring some issues related to Epi-Pens to your attention and them or just leave both with you. offer some ideas. • You are new to your camp in Northern Minnesota and opening up the Health Center. The camp’s stock of Epi- Recent Attention Pens has been in the cupboard since last summer. They Epi-Pens have recently been in the news because of a are still within the use-by date but you wonder whether huge increase in cost. Cost has risen 500% since 2007 and they are okay to use after a winter in an unheated building. currently cost approximately $600 per twin pack. Consumers • Again at check-in, a mother hands you two Epi-pens no scream “outrageous’ while Mylan Pharmaceuticals tries to longer in the box or in a carrying case. They look kind of rationalize the price increases. Mylan’s website is now offering beat up and you note the fluid in the pen seems to have reduced costs for some users but not for everyone. Mylan is small floating brown specks. The pens are not out-dated. also saying they will be offering a generic Epi-Pen within the • You check in a camper and note that the Epi-pens have next few months that will be about half-price. You may find expired. The mother is very surprised and states she hadn’t situations this summer similar to a couple of those above that

21 Volume 26, No. 4

may stem from increased cost. As a camp nurse, I have been expensive these items are. Put it in perspective: “For every Epi- aware for many years of how the purchase of Epi-pens can take pen we don’t need to replace, camp could purchase (fill in the a chunk out of the health center budget. blank) instead.” Also be sure to: 1. Discuss proper care and handling. Make sure they are Some Budget ideas for the Health Center: aware not to leave in vehicles, in hot sun, etc. 1. Consider stocking vials of epinephrine/syringes in areas 2. Emphasize importance of returning pens to health center where qualified health center staff would be administering promptly on return to camp according to your camp the medication. Costs amount to a few dollars compared to policy–especially those belonging to individual campers. the high cost of Epi-pens. Not all allergic reactions come to By doing so, it helps assure pens have been left in a safe your door but enough do that this might be worthwhile. You environment where stability is not compromised, kids do would need a policy and procedure to guide this approach. not have access, and pens are available to use “to juggle 2. Carefully determine the number of pens needed. Most of your pen supply.” Develop a system that staff need to sign the health center Epi-pens needed are for out-of-camp out first aid supplies--don’t rely on memory. If staff sign out trips. Discuss with camp staff prior to season to determine for items, they tend to be more responsible. Also, If they do exactly the maximum number of trips that would be going not bring it back you know who to contact. out at one time. By purchasing according to daily need rather than individual programs, you might be able to cut About those Situations down on number of Epi-Pens you need to purchase. Be Probably you guessed the responses to the situations at the willing to juggle your supply of pens from different first aid beginning of the article or they were covered in the content here. kits as needed in order to get by with fewer. You need two Epi-pens in an emergency situation as the first 3. Depending on where you purchase your Epi-Pens, you may dose does not always get the desired response. Discoloration be able to request the longest possible expiration dates. or specks in the syringe liquid indicates breakdown and should This may make it possible to get two summer seasons out not be used. My bet is that a few nurses never look inside the of a pen. If you can manage to buy half your supply every box at check-on, but you need to especially if the box itself other year, you also keep your budget approximately the looks beat-up. As much as we want to save on camp and same from year to year. parents budgets, we still need to be safe. 4. Be mindful of proper storage. Epi-pens are affected by And Finally... temperature and light. Package instructions state the pens One of the reasons that epinephrine in these kits is so should be kept between 59° and 86° F. and protected from expensive is lack of competition. Plans are that Kaleo will be light. If you need to keep a pen somewhere at all times and rereleasing the Auvi-Q in 2017. It is unknown what effect this you are worried about temperature fluctuations you might will have on costs but even if there is a reduction, these units consider purchasing a temp controlled storage container. remain one of the highest priced items in any camp health The glove compartment of a camp vehicle is definitely not center budget and parents still struggle to be able to provide the place to store a pen. Also consider temperature with these for their children. Let us as camp nurses work to help winter storage. In most locations, Epi-Pen cannot be left in make a difference with both. unheated buildings. 5. Check out website www.epipen.com. Currently there are References some coupons available to qualified consumers. There is www.Kaleopharma.com. also an offer for free carrying case and other helpful tags www.Mylan.com when you register your epipens (up to 6) with the site. Once registered, consumers are provided with expiration date reminders. This is good information to pass on to parents. This information to parents could prevent the occurrence of two of the previous scenarios for future summers.

Educate the Staff You already have Epi-Pen handling and administration as part of your staff education but probably have not included information about cost. Add that! Emphasize just how much these items do cost. When we read about the cost increase we gasp in surprise. Most teenage/college staff do not realize how

22 December 2016

New Products, New Ideas Paula Lauer, RN, BAN & Susan B. Baird, RN, MPH, MA

Browsing websites in the off-season? You'd be Yoga and Mindfulness Prac- surprised what you might find! tices for Children Card Deck: Yoga and Mindfulness Practices Stethoscope Watch: In the era of smart- for Children Card Deck offers over phones, many of us are no longer wear- 50 activities to support health, ing watches. This can make doing rou- well-being, empowerment and tine vitals a little more challenging. A an improved capacity to navigate way to help with this is to pick up a the many stressors of life without stethoscope watch. It clips right onto a becoming overwhelmed. Beauti- standard stethoscope and you’ll always fully illustrated by children’s yoga have the time with you. Prestige Medical teacher, Karen Gilmour, coupled Stethoscope Watch shown--$13.57. Several others to choose with easy-to-read instructions. from at Amazon.com. This would be a fun health activity at camp. $19.99.

Air Purifier with Projector: Air Pu- And here are some other ideas. rifier with Projector: If a camper or staff member has allergies that are acting up at #Cut The Bull Tool Kit: camp and need a night in the health center, Shriners Hospitals for Chil- an air purifier might help them to breathe a dren® has designed an ar- little easier. GermGardian Kids Night-Night ray of free materials to as- 4-in-1 HEPA air purifier with projector shown. sist with addressing bullying. Available on Amazon.com. Designed for schools, many of the resources fit well for camps. One-in-four U.S. students 2017 Lippincott Pocket Drug report being bullied. Those numbers can be two to three times Guide for Nurses: The 2017 Guide higher for kids with disabilities, according to the National Center provides current, vital drug informa- for Education. Go to the Resource Center at www.shrinersinter- tion “in a nutshell.” Based on the pop- national.org/cutthebull. ular Lippincott Nursing Drug Guide by Amy Karch, this handy pocket guide Prevent Mosquito Bites: by the same author gives essential The Centers for Disease Con- information on over 2,000 medica- trol and Prevention provides tions in an easy-access A-to-Z format. tips and resources about The “mini” drug monographs include how to safely and effectively generic and trade names, drug class, use insect spray and steps to pregnancy risk category and con- control mosquitos inside and trolled substance schedule, “black box” warnings, indications out-of-doors. In response & dosages, dose adjustments, adverse effects, drug interac- to the Zika issue, many new tions, nursing considerations, and patient teaching. A special materials are available. You section reviews Patient Safety and Medication Administration. will find a variety of new post- Appendices cover topical and ophthalmic medications, laxa- ers and other information to tives, combination products, contraceptives, biological agents incorporate into your orien- (vaccines), and more. $13.59. tation message. All are free! www.cdc.gov/zika/prevention/prevent-mosquito-bites.html.

23 Volume 26, No. 4

Digital Clearinghouse Offers Hundreds of Drinking Water gredients – triclosan and triclocarban. This rule does not affect Resources: The National Drinking Water Alliance (NDWA), a consumer hand “sanitizers” or wipes, or antibacterial products coalition of nonprofits, academic institutions and advocates, used in health care settings. Washing with plain soap and run- works to ensure that all children can access safe water in the ning water remains one of the most important steps consumers places they live, learn and play. The NDWA recently launched can take to avoid getting sick and to prevent spreading germs its new online resource clearinghouse for drinking water to others. If soap and water are not available and a consumer research, policy, access and education. DrinkingWaterAlliance. uses hand sanitizer instead, the U.S. Centers for Disease Con- org provides users with literally hundreds of useful toolkits, trol and Prevention (CDC) recommends that it be an alcohol- research studies, fact sheets, promotional materials, and policy based hand sanitizer that contains at least 60 percent alcohol. papers from a broad spectrum of sources, as well as the latest Released 9/16/2016 from www.fda.gov/NewsEvents/News- developments in the field. If you want to add new life to your room/PressAnnouncements/ucm517478.htm. tired messages about hydration and drinking water, visit this amazing resource and click on Education. Novelty Makeup: Face paints can be fun at camp for FDA Issues Final Rule on An- skits or special events. This tibacterial Soaps: The FDA site offers tips to help keep issued a final rule that over- the fun without leaving us- the-counter antiseptic wash ers with a rash, swollen eye- products can no longer be marketed lids, or other reactions. Go because manufacturers failed to demon- to www.fda.gov/Cosmetics/ strate that products are more effective than soap and water ProductsIngredients/Products/ucm143055.htm for user safety and are safe for long-term daily use. This applies to consumer information about both the application and removal of face antiseptic wash products containing one or more of 19 spe- paint. Eye safety is also addressed. cific active ingredients, including the most commonly used in-

ACN does not endorse or sponsor any of the products included.

BSU’s Certificate in Camp Nursing is accepting students for Spring’s “Introduction to Camp Nursing” course. This course begins 6 March 2017. Won’t You Join Us? Questions? Email Linda Erceg ([email protected]). Visit http://www.bemidjistate.edu/academics/graduate-studies/programs/camp-nursing/

ACN Camp Nurses: • Your experience as a camp nurse may qualify you for exemption from the Introductory course. Email Linda Erceg (LErceg@ bemidjistate.edu) to discuss this.

Program Update: • Many camp nurses want their Certificate in Camp Nursing (CCN) but do not have a baccalaureate degree. We are in the process of making the Certificate available to undergrads. The first two courses are currently available; we anticipate having the last three available in Autumn 2017. • The program is now eligible for some financial aid with more aid anticipated – but funders want to see interest in the courses. If you’re interested in your CCN, please get started NOW with the two courses available as undergrads or as a graduate student.

24 December 2016

Super Sleuth Answer Answer: Caffeine withdrawal headache with a component of dehydration

Fast Facts on Caffeine

Product Amount Caffeine (mg.)

Milk Chocolate 8oz. 5 Dark semi-sweet chocolate 1oz. 20 Brewed green tea 8oz. 20 Anacin 1 tablet 32 Pepsi cola 12oz. can 38 Expresso 1oz. shot 40 Coca Cola 12oz. can 46 Brewed black tea 8oz. 50 Mountain Dew 12oz. can 54 Midol 1 gelcap 60 Excedrin pain reliever 1 tablet 65 Dexatrim Natural 1 tablet 80 Jolt cola 12oz. can 80 Red Bull energy drink 8.3oz. can 80 Monster energy drink 16oz. can 80 Jolt caffeine energc gum 2 pieces 100 Penguin caffeinated mints 6 pieces 100 Cafergot 1 tablet 100 No Doz 1 tablet 100 Brewed coffee 12oz. cup 200 Vivarin 1 tablet 200 Ripped Extreme Ephedra Free 2 capsules 220

Retrieved from http://emedicine.medscape.com/article/821863-clinical#showall A quick review of the table above and one can easily conclude that caffeine is the most widely used drug in the world. Caffeine changes the way you act and feel. One can become addicted and therefore have withdrawal symptoms when intake is stopped. Caffeine takes effect in less than an hour and lasts 8-10 hours. Some people are sensitive to caffeine and children may also be very sensitive to the effects of caffeine. Side effects of caffeine include restlessness, anxiety, irritability, insomnia, tremors, and hyper-stimulation of the cardiovascular or GI system. Cardiac symptoms include palpitations and chest pain. GI effects can include nausea and vomiting, diarrhea, and anorexia. Withdrawal symptoms include headache, fatigue, drowsiness, impaired concentration, depression, anxiety, and irritability. The symptoms begin 12-24 hours after sudden cessation of caffeine and peak 20-48 hours after withdrawal. The symptoms may last for a week. It is clear this camper needs to hydrate with water as well as taper the caffeine intake. The nurse should have an open discussion about the effects of caffeine and withdrawal symptoms. References Caffeine Toxicity Clinical Presentation. Retrieved from http://emdicine.medscape.com/article/821863-clinical#showall How Much Caffeine Is Too Much Caffeine? http://www.medicinenet.com/script/main/art.asp?articlekey=173047&pf=2 Neurologic effects of caffeine: overview, consumption of caffeine. http://emdicine.medscape.com/article/1182710-overview#showall

25 Volume 26, No. 4

                       Where are ACN’s Meeting Rooms? Conference Hotels

ACN co-locates its conference with the American Camp We’ve notWhere yet receivedare ACN’s confirmation Meeting Rooms of the rooms? AssociationConference (ACA) Hotels conference. A benefit of co-locating is that ACN assigned to ACN events. As soon as we get that members ACN can access co-locates ACA’s its conference conference hotel with rate the by telling American the hotel’s Camp We’veinfo, it not will yet be provided received inconfirmation the conference of the app. rooms reservation desk that you are part of the ACA confe rence when making Association (ACA) conference. A benefit of co-locating is that ACN assigned to ACN events. As soon as we get that yourmembers room can reservation. access ACA’s This conference year, four hotel hotels rate are by beingtelling usedthe hotel’s for the info, it will be provided in the conference app. event:reservation Hyatt, desk Doubletree, that you are Hotel part Andaluz of the ACA and confe Plazarence Hotel. when making your room reservation. This year, four hotels are being used for the event:Attendees Hyatt, will Doubletree, be able to accessHotel Andaluz a single andpage Plaza on t heHotel. American Camp Association website ( www.acacamps.org), featuring all four hotels, to make reservations. The first three are adjacent to the conventionAttendees will center be able where to accesssessions, a single exhibits page and on regi thestration American will Camp be located, Association along websitewith most ancillary events.(www.acacamps.org The Plaza is ),a shortfeaturing shuttle all four ride hotels,away from to make the center. reservations. The hotel The reservation first three arelink: adjacent to the http://www.acacamps.org/conference/hotelconvention center where sessions, exhibits and. registration will be located, along with most ancillary events. The Plaza is a short shuttle ride away from the center. The hotel reservation link: Groundhttp://www.acacamps.org/conference/hotel Transport Between Airport & Hotel. Looking for a way to get from the airport to your h otel? Visit the link below to determine which Groundmethod Transport would Between be best for Airport you: & Hotel Looking for a way to get from the airport to your h otel? Visit the link below to determine which http://www.abqsunport.com/getting-around/ground-transportation/method would be best for you:

Meals &http://www.abqsunport.com/getting-around/ground-transportation/ Snacks Included with Your Registration (subject to change as schedule and catering require)

Meals &Monday, Snacks 20 Included Feb, 2:00 with pm – Your Managing Registration Camp Health (subject Services to change – Pre-conference as schedule andoffering catering require)  Monday, 20 Feb, 7:00 pm - Annual Meeting: Open to ACN members.  Tuesday,Monday, 2120 Feb, Camp2:00 pm Nurse – Managing Symposium Camp: Health Services – Pre-conference offering  Monday,o 7:30 20 Feb, am –7:00 Registration pm - Annual opens Meeting : Open to ACN members.  Tuesday,o 12:00 21 Feb, pm Camp - Camp Nurse Nurse Symposium Lunch & Awards:  Wednesday,o 7:30 22am Feb, – Registration ACA/ACN Dayopens: Sessions open for both nurses and camp professionals together; Grando Opening12:00 pm of - ACACamp Exhibit Nurse Hall Lunch in the& Awards evening (requires ticket for access- ticket cost covered in  Wednesday,Symposium registration)22 Feb, ACA/ACN Day: Sessions open for both nurses and camp professionals together; Grand Opening of ACA Exhibit Hall in the evening (requires ticket for access- ticket cost covered in NursingSymposium Contact Hours registration) Contact hours will be submitted for approval.

Nursing Contact Hours Contact hours will be submitted for approval. Questions? Call ACN’s office (502-232-2945). Executive Director, Tracey Gaslin will gladly help with concerns or Questions?questions regarding the event. Call ACN’s office (502-232-2945). Executive Director, Tracey Gaslin will gladly help with concerns or questions regarding the event.

26 December 2016

  Early Bird Registration Symposium Take advantage of ACN’s Early Bird price. Your registration fee is $50 less if you register by 31 Dec 2016.Must be postmarked by 20-22 February 2017 31 Dec 2016 to receive this discount. Albuquerque, NM Registration Form

REGISTRATION OPENS 1 SEPTEMBER 2016

N ame for Your Your for Name Badge & Mailings: ______Phone Number: (____) ______F i rLst ast Mailing Address: ______Street Add Cress Sity tate/Province ZIP E-Mail E-Mail A ddress: Address:

What Size T-Shirt Do You Prefer? ______

Must Complete for Nursing Contact Hours: Nursing License Number: ______State/Province of License: ______

Name & Location of Your Camp: ______Name of Camp State/Province Pre-Conference Health Seminar on Monday 20 Feb 2017 NEW!! Monday, 20 February: Management of Healthcare Services, 2pm-5pm Presenter: Linda Erceg RN, MSN, PHN (Nursing contact hours included). Registration by 31 December 2016: $40.00 ______Registration after 31 December 2016: $50.00 ______Full CAMP NURSE SYMPOSIUM: 20-22 February 2017 Monday, 20 February: ACN’s Annual Meeting, 7-8:30 pm Tuesday, 21 February: ACN’s Camp Nurse Symposium Best Deal! Wednesday, 22 February: ACN/ACA joint sessions& ACA’s Grand Opening of the Exhibit Hall. Does NOT include the Pre-Conference Seminar (Nursing contact hours included) ACN Member: Registration by 31 December 2016: $250.00 ______ACN Member: Registration after 31 December 2016: $300.00 ______ACN Member Speaking at Symposium & Register by 31 Dec 2016: $200.00 ______ACN Member Speaking at Symposium & Register after 31 Dec 2016: $250.00 ______Nonmember Registering by 31 Dec 2016: $350.00 ______Nonmember Registering after 31 Dec 2016: $400.00 ______

Annual Meeting and Tuesday ONLY CAMP NURSE SYMPOSIUM: 20-21 February 2017 ACN’s Annual Meeting on Monday evening, 20 Feb, 7-8:30 pm. ACN’s Camp Nurse Symposium education sessions on 21 February. (Nursing contact hours included). Member: $200.00 ______Nonmember: $300.00 ______ACN Member Speaking at the Tuesday Camp Nurse Symposium: $150.00 ______Extra ticket for Tuesday’s Camp Nurse Luncheon $75 each: ______

Donation to ACN – help off-set costs of ACN initiatives like education and research! Your Donation: ______Total Amount: ______Go Online to register (www.acn.org) or make your check payable in U.S. dollars to Association of Camp Nurses and send it with this completed form to: ACN Symposium – 19006 Hunt Country Lane – Fisherville, KY 40023

Cancellations prior to 1 January 2017 are refunded except for $50 administrative fee. Cancellations after 1 January 2017 receive no refund.

27 Volume 26, No. 4

Association of Camp Nurses PRSRT STD 19006 Hunt Country Lane U.S. POSTAGE Fisherville, KY 40023 PAID BEMIDJI, MN PERMIT NO. 19

Association News

Symposium 2017 has done a great job for several years challenging us with her Our next symposium will be in Albuquerque, NM. The cases. Many thanks to Barb for all her work! This is a popular dates are 20-22 February 2017. Early Bird Registration ends 31 feature that helps keep readers on their toes and we want December 2016. Register online at www.acn.org. the feature to continue. If you think you would be interested We are offering four hotel options in Albuquerque including in taking over this feature or submitting even one case, get in the Hyatt, Doubletree, Hotel Andaluz and Plaza Hotel. touch with CompassPoint Editor, Susan Baird (508-888-3249 or Attendees will be able to access a single page on the American [email protected]) to share your ideas. Camp Association website (www.acacamps.org), featuring all four hotels, to make reservations. The first three are adjacent to Camp Nursing – Scope and Standards the convention center where sessions, exhibits and registration The Third Edition of ACN Scope and Standards of Practice will be located, along with most ancillary events. The Plaza has been completed. Thanks to all who committed time, effort, Hotel is a short shuttle ride away from the center. Make your and energy to this important effort. This document has gone to hotel reservations NOW! print and will be available for purchase SOON!!

Pre-Symposium Seminar – NEW OFFERING 2017! Awards On Monday 20 February 2017 – “Managing Health • Did you have a great summer camp? Services” – Join as we gain new information and updates about • Did you work with some talented camp nurses? current challenges, practices, and opportunities to improve Now is the time to consider nominating that special camp nurse camp health care services. You can register online at www.acn. for an award: org. Jean Otto Award Camp Nurse of Year Award Is There a Super Sleuth in You? Criteria and information about the awards are available on Barbara Hill, RN, RN, MSN, CNE, CMSRN, has served the website (www.acn.org). Don’t Delay, nominations can be readers well in her Super Sleuth role for CompassPoint. She accepted anytime from now through 15 December 2016.

Connect with Us! Association of Camp Nurses CampNurses

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