DNA REPORTER

CONSTITUENT MEMBER OF ANA

Volume 46 • Issue 3 The mission of the Delaware Nurses Association is to improve healthcare in Delaware by the advancement of nursing. Quarterly publication distributed to approximately 6,700 RNs and LPNs in Delaware. June, July, August 2021

Index

Presort Standard Executive Director’s Report...... 2-3 The Public Health Nurse’s Role in Early Intervention...... 11 US Postage PAID President’s Report ...... 3 The Importance of Public Health Nursing in Policy Development...... 12 Permit #14 A Brief History of Public Health Nursing Princeton, MN in Delaware (1920–2020+)...... 4-5 The APRN’s Role in Providing current resident or 55371 Pediatric Immigrant Care...... 13 Honoring Delaware Nurses...... 5 Advancing Disease Surveillance: Public Health Public Health Nurses in Delaware ...... 6-7 Nursing and Infectious Disease Epidemiology...... 14 The Impact of a Pandemic on Childhood Immunization National Academy of Medicine Rates: A Public Health Nursing Perspective...... 8 Consensus Study Report...... 16 DNA Membership Assembly Updates...... 9 New, Renewing, & Returning Members...... 17 Adjusting Your Money Mindset...... 10 Advocacy Updates...... 18-19 Page 2 • DNA Reporter June, July, August 2021 Executive Director’s Report

Christopher E. Otto, MSN, RN, CHFN, PCCN, CCRN importance of public health nurses, among all Executive Director nurses, in the role of policy development. This could REPORTER [email protected] be at the employer/organizational, state, national, or 302-733-5880 or international level. Dr. Hall-Long is a tenured public health nurse and public servant that beckons OFFICIAL PUBLICATION of the “Nursing is love in action, and us to advocate for our neighbors and colleagues. Delaware Nurses Association there is no finer manifestation of Next, Holly Schiavone, MSN, APRN, CPNP-PC, it than the care of the poor and CNL discusses a vulnerable and growing population, pediatric immigrants. She shares scientific insights 4765 Ogletown-Stanton Road, Suite L10 disabled in their own homes.” Newark, DE 19713 – Lillian Wald on the role of the Advanced Practice Registered Nurse in screening, developing, implementing, Phone: 302-733-5880 Web: http://www.denurses.org Public Health Nursing and evaluating healthcare services for children This issue of the DNA of immigrant families. Malikah Taylor, MPH, The DNA Reporter, (ISSN-0418-5412) is published quarterly MSN, RN who serves as Section Chief, Infectious every March, June, September and December by the Arthur Reporter includes articles L. Davis Publishing Agency, Inc., for the Delaware Nurses centered on public health Disease Prevention and Control at the Division Association, a constituent member association of the American nursing in Delaware. The of Public Health shares significant insight on Nurses Association. Christopher E. Otto infectious disease surveillance and epidemiologic Delaware Nurses Association EXECUTIVE COMMITTEE would like to express our gratitude to Dr. Rebecca collaborations. Malikah has extensive expertise and Walker, PhD, JD, MSN, RN who organized, experience in these practice areas and is an asset to President: Leslie Verucci, , MSN, APRN, ANP-BC Delawareans and the nursing community. Past President: Gary W. Alderson,Esq., RN identified, compiled, edited, and submitted the Secretary: Jacqueline C. Armstrong, DNP, following articles. She completed extensive work MSN, APRN, FNP-BC, PMHNP-BC to bring this issue to fruition and we are grateful Better Together, Moving DNA Forward Treasurer: George Zangaro, PhD, RN, FAAN for her service. The term public health nursing After the unexpected departure of the Director-at-Large, Clinical Nurse: VACANT association’s previous Executive Director and public was coined by Lillian Wald in 1893, the same year DIRECTORS she founded the Henry Street Settlement and co- health crisis of COVID-19, the Delaware Nurses founded the Visiting Nurse Service of New York. Association became ripe for transformation in Membership Growth Directors New Castle County: Kathy Neal, PhD, RN The Delaware Nurses Association commends 2020/21. As of January 1, 2021, I am humbled to serve as your Executive Director for the Delaware Kent County: Sharon Mills-Wisneski, PhD, RN Delaware’s public, community, and school health Sussex County: Candace Hamner, MA, BA, RN nurses for their service to our neighbors throughout Nurses Association. I am committed to the the coronavirus disease 2019 (COVID-19) pandemic advancement, transformation, and strengthening of Professional Development Director Sandra Nolan, PhD, RN, HN-BC and beyond. We want to celebrate and uplift your this association that originated in 1911. I have the honor of working with nurses from across Delaware specialty nursing practice so that all Delaware Advocacy Director nurses can appreciate your vast contributions and and the nation to advance our profession and the Annamarie Flick, MSN, RN-BC, NE-BC accomplishments. Your service goes far beyond resultant impact on the health and wellness of those we serve. Editorial Director COVID-19 and the advancement of health for Karen Panunto, EdD, MSN, APRN Delawareans you achieve will continue indefinitely. I cannot do it alone. Through evolving Thank you for your expertise, service, and association membership, partnerships, Board of EXECUTIVE DIRECTOR compassion. Director roles, standing committees, and special Christopher E. Otto, MSN, RN, CHFN, PCCN, CCRN The first article comes from Kristin Bennett, committees the association can achieve remarkable [email protected] things that complement and amplify the work of MSN, RN, a tenured public health nurse with service ORGANIZATIONAL AFFILIATES across Delaware and the nation. Kristin has served Delaware’s 26,000+ licensed nurses. The continued on the Board of Directors for the Association of advancement and success of this association and Oncology Nursing Society-Delaware Diamond Chapter Public Health Nurses and continues to volunteer Delaware’s nurses depends on the diverse thought, communities.ons.org/delawarediamond her time through the Delaware Medical Reserve expertise, compassion, and engagement of our nurses, not solely on its’ positional leaders. Every Delaware Organization of Nurse Leaders Corps and numerous other groups. Kristin shares www.delawareone.org a chronology of public health nursing in Delaware nurse in every setting is a leader. starting in the 1920s. In concert, the following No matter what level of engagement you can Delaware Emergency Nurses Association www.de-ena.org article from Kate Smith, MD, MPH, Tim Gibbs, provide with your state nursing association, I will MPH, and myself showcases public health nursing ensure that I am accessible and responsive to your Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses. from the interprofessional lens and archives of the feedback. You do not have to hold an elected seat Delaware Academy of Medicine/Delaware Public or voting position on our board or committees to For advertising rates and information, please contact Arthur L. make an impact. Your new, reinstated, or renewed Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, Health Association. (800) 626-4081, [email protected]. DNA and the Arthur L. Davis Jacob Mills, BSN, RN and Jonathan Kroon, BSN, membership in the Delaware and American Nurses Publishing Agency, Inc. reserve the right to reject any advertisement. Associations makes all the difference. Your monthly Responsibility for errors in advertising is limited to corrections in the RN highlight a critical role of public health nurses, next issue or refund of price of advertisement. immunizations. Vaccinations have been at the membership dues, now as low as $15, go directly to funding staff and programs that advocate Acceptance of advertising does not imply endorsement or approval forefront of the scientific and public communities by the Delaware Nurses Association of products advertised, the for decades. The COVID-19 pandemic caused for you. Your investment in the association that advertisers, or the claims made. Rejection of an advertisement does significant disruptions in standard immunization represents ALL nurses ensures we continue building not imply a product offered for advertising is without merit, or that the legacy and collective impact of the nursing the manufacturer lacks integrity, or that this association disapproves practices for Delaware’s youth. Jacob and of the product or its use. DNA and the Arthur L. Davis Publishing Johnathan share the current science demonstrating profession. What is stopping you from joining? Let’s Agency, Inc. shall not be held liable for any consequences resulting talk about it: [email protected] or from purchase or use of an advertiser’s product. Articles appearing the impact and how to get back on track. in this publication express the opinions of the authors; they do not Jeanette G. Kernan, MSN, APRN and Jessi L. 302-733-5880. necessarily reflect views of the staff, board, or membership of DNA or Wyatt, MSN, MBA, APRN then discuss how public those of the national or local associations. health nurses are addressing the complex needs of Association Membership Editorial Director children with developmental delays and disabilities. You told us and we listened. We appreciate the financial Karen Panunto, Ed.D, MSN, APRN Jeanette and Jessi provide readers with an overview commitment of association dues and that you likely also The DNA Reporter welcomes unsolicited manuscripts by DNA of early intervention program origins, funding, and have membership in your specialty nursing/health groups. members. Articles are submitted for the exclusive use of The DNA After extensive analysis and decision-making, we are proud Reporter. All submitted articles must be original, not having been strategy. After that, you will hear from Lt. Governor published before, and not under consideration for publication Bethany Hall-Long, PhD, RN, FAAN on the critical to launch the following membership advancements. elsewhere. Submissions will be acknowledged by e-mail or a self- • LPN Membership addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. o Annual price of $75.00 with an introductory Articles can be submitted by e-mail to Christopher E. Otto, MSN, RN, price of $50.00 for all new LPN members. CHFN, PCCN, CCRN at [email protected] o Grants you membership in the Delaware Each article should be prefaced with the title, author(s) names, Nurses Association. educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of o LPNs need representation, advocacy, practice, the article. Include affiliations. Manuscripts should not exceed five (5) and leadership development opportunities at typewritten pages and include APA format. Also include the author’s the state-level. We are excited to develop a mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission new LPN Forum, committee seats, publication to use any copyrighted material; in the case of an institution, opportunities, etc. for Delaware’s 2,000+ permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary LPNs. for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation Executive Director’s Report continued on page 3 for articles. June, July, August 2021 DNA Reporter • Page 3 Executive Director’s Report continued from page 2 President’s Report • RN/APRN Membership o Two membership options to meet your needs: Leslie Verucci, MSN, APRN, ANP-BC It is aspiring to know that others have also noted this ■ Standard Membership (NEW): pay $174 a great work and the selfless contributions given and that year or $15 a month for full membership in President, Delaware Nurses Association, the Year of the Nurse and Midwife was extended by both ANA and DNA. 2021-2022 the World Health Organization and American Nurses ■ Premier Membership: pay $247 a year Association to not only include 2020 but also 2021. or $21.09 a month for full membership I am glad to return to the role Committees and community programs have come together in both ANA and DNA with additional of President of the Delaware to support health care professionals and communities discounts and benefits on numerous ANA Nurses Association (DNA), with grants, food, mental health, and wellbeing. We Enterprise programs, certifications, etc. carrying on the work Gary have seen businesses and individuals deliver treats and o Both membership options enable your Alderson, Esq, RN initiated and provide support to those on the frontlines building morale full voting participation in ANA and DNA to work with each of you as we and many times giving us the little push of love and governing bodies and access to continuing move forward. It has been a appreciation we needed to continue. The DNA is proud education, developmental, advocacy, trying year for the DNA as we to support and assist in many of these initiatives and recognition, and many other programs. worked to rebuild and still support our members and community. community activities. At a national level the Centers for Disease Control, American Nurses Association, Delaware A New Logo and Brand I want to thank the board Leslie Verucci Health and Social Services Division of Public Health, and Building upon 100+ years of service to Delawareans, members for all the hard work Delaware Medical Reserve Corp have provided assistance, the Delaware Nurses Association is proud to unveil an they have put forward this year and I sincerely believe we reference resources, and support for nurses on the hill updated logo and branding that aligns us with our partner, are coming out of this stronger and more involved than regarding COVID-19 and will continue until we see the light the American Nurses Association, and dozens of other ever before. I see a new and bright future for DNA, and we again. Work will then continue to make sure our healthcare state nursing associations. The refreshed logo and brand will continue to encourage Delaware nurses to get involved professionals recover and we are better prepared for future solidify our commitment to advancing the association to and support their state nursing association. impactful events. meet the needs of those we serve and ensure you feel the With evolving health care reforms, fast pace of The DNA is also committed to eliminating racial value of your membership. Check the DNA website and technology, and changes in how care will be provided in injustice, racism, hate, discrimination, and intolerance in emails for access to social media graphics, downloadable the future, we need nurses at the table protecting the role the nursing profession. In July of 2020, the DNA approved images, and more to display your Delaware nursing pride! of nursing and assuring no harm comes to the provider, the patient, and the community. The DNA offers plenty the establishment of a Special Task Force on Equity and we are working diligently on creating a charter, strategic plan, Strengthening Partnerships of opportunities for nurses to advance their profession and development of resources to support this endeavor. There are numerous specialty nursing and health- through volunteer positions on growing standing and Membership and support are needed to help design, related groups in Delaware doing extraordinary work in special committees. We also welcome and encourage ad- advocate, and implement solutions to health and social service to our community. Let us be stronger together. hoc involvement as specific issues arise. equity in our state. The Delaware Nurses Association Organizational Affiliate We reach out to each of you to consider membership The DNA is here and will continue to be here to assist program facilitates joint advocacy, development, and if you are not a member presently. If you are a member our nurses and the community in working towards positive recognition work. Thank you to the Delaware Organization THANK YOU. One major goal as we move into 2021 and change in the standards of our practice at both the state for Nursing Leadership, Delaware Diamond Chapter of beyond is to have all three of our counties come to the and local level. the Oncology Nursing Society, and most recently the table and encourage the nurses in more rural areas to share Again, this year has been challenging but with the Delaware Emergency Nurses Association for your active their concerns and the barriers they face in providing safe support of our members and all nurses, we have been and ongoing affiliations. Check out our website to connect and effective care. We want all nurses throughout the state able to continue work on multiple issues. Christopher with me personally to see how an affordable affiliation can to get involved. Otto, MSN, RN, CHFN, PCCN, CCRN is the Executive strengthen our efforts. The past year has been a very trying time in both our personal and professional lives and I want to send a huge Director for the DNA and is moving us in the right direction. We need a robust membership and nurses Evolved Board of Directors and Standing Committees heartfelt thank you to all the health care providers who engaging on multiple levels with the profession, After recent board and membership assembly approval, have worked so hard and dealt with so much over this time association, and community to succeed. Please consider I am pleased to announce the Board of Directors has period. The nurses in the State of Delaware have shown membership and if you have questions or concerns, evolved from 9 voting positions to 11 and most notably that nothing will stop us when we are called to serve. please feel free to reach out to Chris or any other board the creation of a Director-at-Large, Clinical nurse position Working with fears for ourselves and our families along member ([email protected]). Chris is continually on the board and executive committee. Our committee with the constant changes that occurred never became updating the DNA website (www.denurses.org) with chairs have advanced to directors and each membership an obstacle in providing safe and compassionate care. I lots of information and current issues within the state representative from Delaware’s three counties has a full applaud the great work that has been accomplished in that affect nursing and health. Please take a few minutes board vote. There is still opportunity for you to be involved. such a trying time. This work continues with the care of and check it out! Thank you for supporting the Delaware Contact me directly to discuss your interests and current patients, families, and communities but also the huge task Nurses Association, we are here for you! opportunities. of educating and vaccinating the entire community.

www.InterimDE.com Page 4 • DNA Reporter June, July, August 2021

A Brief History of Public Health Nursing in Delaware (1920-2020+)

Kristin A Bennett, MSN, RN The Sheppard-Towner Act provided federal funds development and ameliorate conditions which disable to states for the promotion of maternal and infant children” (Commonwealth, 2005), and the Special health, allowing Delaware’s programs to expand PHN Supplemental Nutrition Program for Women Infants Kristin Bennett served in a variety services including “combined prenatal and child health and Children WIC (1974) (National WIC, 2018). of PHN roles within the Delaware conferences (clinics) for infants and pre-school children; In the late 1960s, the State Board of Heath began Health & Social Services, Division little mothers’ (babysitter) classes; midwife classes, expanded family planning services statewide (There, of Public Health, including Public Health Nurse, PHN Liaison, home visits on prenatal (obstetrical) and postnatal 1968; Beach, 1969). By the late 1970s, interested PHNs Clinical Nurse Specialist, Manager, cases, and on infants and pre-school children; (and) a attended certificate, and later graduate programs, to Community Services, and most diphtheria toxin-antitoxin campaign in the schools of move into advanced practice roles providing family recently Nursing Director (2006- Delaware” (Worden, 1958, pp. 39-40). planning and sexually transmitted disease treatment, 2016). As a retiree she continues secondary prevention services for those 50+ such as to enjoy volunteering as a PHN through leadership positions with 1930s-1940s the Senior Screening Program, and well-child care the Association of Public Health In 1935, Congress passed the Social Security Act under EPSDT. Nurses (APHN) and a Delaware which included Title V funding to states for maternal- Kristin A. Bennett Medical Reserve Corps volunteer. child health (MCH) services, making monies available 1980s-1990s She served as the DNA Legislative Cabinet chair in the later for employment of additional PHN staff, as well as From the onset of the AIDS epidemic, PHNs served 1980s. Kris can be reached at [email protected]. staff training. Thus, a Division of Public Health Nursing those with HIV and AIDS – through clinics, home visiting, was established under the Board in 1937, which made and later, case management in collaboration with a wide possible the coordination of nursing services across the array of agencies. Public health nurses (PHNs) have worked in county health units and the development of policies Delaware was at the forefront of adolescent health collaboration with community partners to protect and procedures (Worden, 1958). when the first School-Based Health Center was opened in and promote the health of Delawareans for over a In 1945, on the “first national observance of Public 1985 by the Division of Public Health (DPH) in Middletown century. This article will highlight the evolving focus, Health Nursing Day” Governor Bacon acknowledged High School, led by a DPH nurse practitioner. challenges, and roles and responsibilities of Delaware’s PHN challenges (“Babies continue to be born, children Public Health Nursing prioritized home visiting PHNs employed by the Delaware State Board of Health to have communicable disease, tuberculosis and social services to pregnant women, high-risk infants and / Delaware Health and Social Services, Division of Public diseases to spread”), and responsibilities (family health families with young children, linking with hospitals, Health (DPH) over the past 100 years. The author including “sickness care, disease prevention, and health clinics and agencies statewide to assure continuity acknowledges the tremendous contributions (not promotion,”) while lauding Delaware’s home front of care (Brown, R. 1985). Since the mid-1990s, PHNs only) of DPH public health nurses, (but also of) school PHNs, including those (26) under the State Board of have provided interdisciplinary home visiting services nurses, community health nurses, visiting nurses, Health, and others, for their contribution to Delaware’s reimbursed by Medicaid and developed a home visiting occupational health nurses, and others to public health level of health (PHN, 1945; Open, 1945). program offered to all Delaware first time parents through population-based nursing services. through a broad collaborative effort (Billington, 1995-a; 1950s-1970s Moore, 1996). 1920s Public health nurses, each assigned to a district within Services to Delaware’s most vulnerable children, Early in the 20th century charities funded visiting their health unit, provided generalized PHN services to those birth to age three at risk for developmental nurses to provide care for those in Delaware of modest their communities. PHNs conducted home visits, supported delays, were greatly expanded in the mid-1990s means (Helping, 1904). World War I and the 1918- clinics, assisted in epidemiological disease investigations, with the launch of Child Development Watch Early 19 influenza pandemic raised awareness of the value and provided group instruction to implement the programs Intervention Program, a statewide interagency of public health nurses (What Epidemic Taught, 1918; of an increasing number of divisions of the State Board of interdisciplinary collaboration, including a PHN Mobilize, 1919). Nurses were hired to provide specialized Health including “Maternal Child Health, Infant and Pre- manager, clinical nurse specialists and care coordinators public health nursing (PHN) services under the State Board School Health, Crippled Children’s Services, School Health, (Billington, 1995-b). of Health, the Tuberculosis Commission, and the Child Adult Health and Communicable Disease Control, including DPH had provided wellness, EPSDT, immunizations Welfare Commission. For example, in 1920 the State Venereal Disease and Tuberculosis” (Worden, 1958, pp. and minor illness care in clinics for decades, but now Board of Health employed a nurse “to supervise, educate 51). Later, PHNs added the work of Cancer Control, Heart collaborated to assure 24/7 primary care provided and instruct the midwives of the State” (Worden, 1958, p. Disease and Preventable Disease Control (Worden, 1958, by others. PHNs transitioned families from DPH to 9). In 1923 these agencies were combined into the State pp. 50-51). primary care practices, newly-opened Nemours clinics, Health and Welfare Commission, which soon became And – yes - Delaware’s PHNs participated in the Salk as well as to federally qualified (community) health known as the State Board of Health. Later that decade, vaccine trials in 1954 and in the vaccination of Delawareans centers (FQHCs). PHN collaboration with these valuable state PHN services were reorganized and significantly against polio in 1955-1956 and the years since (Worden, partners continues in many forms (Harriman, 1997). consolidated within county health units (Worden, 1958). 1958, p. 43). PHNs linked clients and/or provided much-needed 2000s-2020s health services funded through new federal programs In the 21st century PHN strengthened its commitment including: Medicare and Medicaid (1965), Early Periodic to community partnerships and health equity. PHNs Screening Diagnostic and Treatment (EPSDT, 1967), have continued to provide much needed well-child and Medicaid’s expansion to “promote healthy child immunization services to uninsured and underinsured

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Incentives include: • $20K Bonus • Relocation & Housing Allowance • Student Loan Repayment up to $32K • Temp Housing & MORE! This fantastic opportunity offers immediate openings in an existing hospital, with a brand new hospital opening in 2022! APPLY TODAY! For more information email [email protected] or call Karen at #210-651-4337. June, July, August 2021 DNA Reporter • Page 5 children (Yoo, 2006). PHN-School Nursing collaboration References Mobilize for peace. (1919, Jun 10). The Evening Journal / The here has been invaluable. PHNs “serve as the first line Beach, F.H. (1969, May 20). Becoming public function, News Journal, p.4. tuberculosis infection control to the community,” staff Planned Parenthood shifts. Evening Journal / The News Moore, R. (1996, Jan. 24). First-time parents get help, nurse will TB clinics, provide expert case management and contact Journal (Wilmington, DE), p. 25. visit soon after baby goes home. The News Journal, p. 2. Billington, M. (1995, Feb. 14-a). Nurses make house calls to National WIC Association. (2018). Special Supplemental investigations. (DHSS, 2021). Advanced Practice PHNs mothers; aim is to reduce infant death rate. The News Nutrition Program for Women Infants and Children (APRNs) provide reproductive and sexual health services Journal, p. 38. (WIC). https://www.nwica.org/overview-and-history. at state clinics and collaborate with partner FQHCs. PHNs Billington, M. (1995, Aug. 25-b). New Child Watch site holds Accessed 3/18/21. strengthened MCH home visiting with an evidence-based grand opening. The News Journal, pp. 21, 28. Open house program honors state public health nurses; model and increased interagency collaboration. Brown, R. (1985, Nov. 10). A special corps works to boost executive secretary of department reports many After 9/11, PHN disaster training expanded beyond babies’ chances. The Morning News (Wilmington, DE), activities by 125 women who care for and protect readying PHNs to staff Red Cross shelters during pp. 25, 33. Delawareans against disease. (1945, Jan. 26) Journal- The Commonwealth Fund. (2005). EPSDT Overview. https:// Every Evening / The News Journal, p.2. natural disasters to include preparing for a wider range www.commonwealthfund.org/publications/other- Public health nursing day set; Bacon asks observance Friday of scenarios from biological and chemical warfare to publication/2005/sep/epsdt-overview?redirect_source=/ to honor those at home. (1945, Jan.24). Journal – Every pandemics. This training strengthened PHNs’ leadership publications/publication/2005/sep/epsdt-overview Evening / The News Journal, p. 10. during point of distribution (PODs) and vaccination Accessed 3/5/21. Ratnayake, H. (2010, Jan. 31). School flu vaccines to end in exercises and events, and during the 2009 H1N1 Delaware Health and Social Services, Division of Public February, effort credited with slowing H1N1 virus. The pandemic including a PHN-led DPH-DOE collaborative Health, Tuberculosis Elimination Program Services. News Journal, p. 36. immunization program for Delaware’s schoolchildren https://www.dhss.delaware.gov/dhss/dph/dpc/tbservices. There is another way. (1968, Oct. 7). Evening Journal / The html Accessed 3/6/21. News Journal, p.22. (Kenney, 2009; Ratnayake, 2010). Harriman, J. (1997, Aug. 26) Exercising to their heart’s What the epidemic has taught the country. (1918, Dec. 14). Now, during the COVID-19 pandemic, Delaware’s content; A health program at Henrietta Johnson Medical Every Evening / The News Journal, p. 9. public health nurses support vulnerable communities Center is serious business. It only looks like a party. The Yoo, I-S. (2006, Aug. 8). Health careers: public health nurse, through leadership in contact tracing, targeted testing, News Journal, pp. 31-32. healing and counseling one-on-one, multi-faceted career and immunization outreach, while balancing other public Helping the needy, report of the superintendent of addresses problems society faces. The News Journal, p. 43. health nursing responsibilities. PHNs’ collaborative work, Associated Charities, work of visiting nurse. (1904, Oct. Worden, V.V., State of Delaware, State Board of Health. (1958) A to safeguard and promote the health of Delawareans, 26). The Morning News, p. 2. History of the Delaware State Board of Health 1879-1958, Kenney, E.L. (2009, Oct. 27). Swine flu vaccine coming to Chapter 2, Growth and Development, p.9, Chapter 10, continues to move forward - as detailed in the excellent classrooms, prioritization a nagging question for officials. Division of Maternal Child Health, Chapter 10, pp.39-43, articles by today’s public health nurses in this issue of the The News Journal, p13. Chapter 13, Division of Public Health Nursing, pp.50-51. DNA Reporter. Page 6 • DNA Reporter June, July, August 2021

Public Health Nurses in Delaware Katherine Smith, MD, MPH Timothy Gibbs, MPH Christopher earned his ADN from Delaware Technical and Community College, BSN from Wilmington University, and MSN Christopher Otto, MSN, RN, CHFN, PCCN, CCRN with focus in nursing innovation and health systems leadership from Drexel University. Chris is board certified in heart failure, progressive care, and critical-care nursing. He has been a Registered Nurse in Kate Smith earned her MD from Xavier University School of Delaware for 11 years with experiences in heart failure, intermediate Medicine and her MPH from Arcadia University. She is currently the care, critical-care, nursing excellence, Magnet® recognition program manager, clinical liaison, and student internship coordinator program, perioperative, and current neurosciences nursing. Chris for the Delaware Academy of Medicine/Delaware Public Health currently serves as both the Executive Director of the Delaware Association. She is also the copy editor for the Delaware Journal of Nurses Association and Registered Nurse at Christiana Hospital Health. Dr. Smith has led research projects on foreign and domestic in the neuro critical care unit. Chris recently accepted the position immunization practices, the role of women and sexism in American of Co-Lead of the Delaware Action Coalition. He is also a member of the Communications Committee of the American Association society, and the use of advance directives in Delaware. Her dual Christopher E. Otto degrees allow her a unique take on medical and public health issues, of Heart Failure Nurses. Chris is a member of the American Nurses and her dual citizenship adds an international perspective, allowing Association, Delaware Nurses Association, Delaware Organization for Nurse Leaders, Delaware her to act in ways that truly benefit citizens and society. Dr. Smith Diamond Chapter of the American Association of Critical-care Nurses, American Association of can be reached by email at [email protected] or at her office at Critical-care Nurses, American Association of Heart Failure Nurses, American Association of Men 302-733-5571. in Nursing, and Delaware Academy of Medicine/Delaware Public Health Association. Chris can be Katherine Smith reached at [email protected] or 302-733-5880.

Timothy E. Gibbs earned his BA from Earlham College and his History MPH from Arcadia University. In addition, he holds a certificate in “The work we are speaking of has to do with maintaining health by removing things nonprofit management from the University of Delaware and has which disturb it … dirt, drink, diet, damp, and drains.” – Florence Nightingale a Lean Six Sigma greenbelt from the Juran Institute and multiple certificates from the Dale Carnegie Institute. Mr. Gibbs has worked In the mid-1800s, many areas of major cities were populated by the poor and in the nonprofit sector for over 35 years in a variety of capacities including: founding Delaware’s first transitional care facility and destitute. This was as true in London as it was anywhere else, and a man named hospice for people with HIV/AIDS, helping to “wire” the Delaware William Rathbone set out to relieve the suffering of these areas by sending nurses in nonprofit sector at the birth of the internet, and overseeing multiple to help (American Nursing History, n.d.). Assisted by Florence Nightingale, Rathbone technology training programs. He came to the Delaware Academy set up a nurse training program at the Royal Infirmary. Once graduated, nurses were of Medicine in 2001 and became Executive Director in 2007. assigned to a geographic area, and were responsible for the health of everyone During that time, he has overseen the move of the Academy from Wilmington to the Newark Campus of ChristianaCare, refocused within that neighborhood; district nursing was born. the Academy’s lens on public health, and led the move to make Timothy Gibbs The term “public health nursing” was coined by New Yorker Lillian Wald to the Academy Delaware Affiliate to the American Public Health Association in 2013. In 2015 emphasize the value of a nurse who built their practice on an understanding of the the Academy/DPHA started publishing the Delaware Journal of Public Health, now indexed health issues that accompanied being poor in the 1800s (Buhler-Wilkerson, n.d.). Wald in SCOPUS and CrossRef. Mr Gibbs sits on several national leadership committees within the was one of the first to realize that illnesses amongst this population had more to do American Public Health Association, and is an honorary member of the Board of the Delaware Chapter of the American Planning Association. Tim can be reached at [email protected]. with what would later be termed the social determinants of health, and so she helped to shift nursing practice to one that looks at medicine with the eyes of the patient. June, July, August 2021 DNA Reporter • Page 7

This new concept included prescriptions for personal and public responsibility, and the Also in 1962, the University of Delaware established its Department of Nursing delivery of equally available health care. It also led to the creation of the Visiting Nurse within the College of Arts and Sciences (University of Delaware, n.d.). The first Association of New York (American Nursing History, n.d.). Bachelor of Science in nursing degrees were awarded in 1966, at which point the In time, public health nursing became more defined, and grew to include school program was accredited by the National League for Nursing and was elevated to the nurses, occupational health, and communicable disease control (see figure 1). College of Nursing. The College has gone through several major revisions and editions, and is now one of five departments or colleges within the College of Health Sciences. Figure 1. Public Health Nursing (American Nursing History, n.d.) Public Health Nursing Today The Delaware Office of Public Health Nursing is located within the Division of Public Health (DPH), and continues to serve statewide through clinics, community settings, and home visits (Delaware Division of Public Health, n.d.). DPH nurses work with schools, hospitals, health care providers, home care agencies, childcare centers, neighborhood organizations, and governmental agencies to protect and promote the health of all people in Delaware. They focus on eliminating, treating, and preventing disease (immunizations, communicable disease, chronic disease, the elimination of tuberculosis, HIV case management); child development (school nurses, lead poisoning prevention, sexual and reproductive health, home visits); and nurse training, recruitment, and education. Public health nursing today is defined as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (American Public Health Association, 2013). Nurses support public health through immunizations, infection prevention, environmental health, opioid epidemic response, rural health, school health, smoking cessation, and a multitude of other practices (American Nurses Association, n.d.). Most recently, nurses have been essential in the control and prevention of COVID-19 by staffing Delaware Nursing hospital units and assisting with testing and vaccination efforts. Before 1962, each of Wilmington, Delaware’s three hospitals had its own nursing The Delaware Academy of Medicine/Delaware Public Health Association is school (see Figure 2). In the late 1950s and early 1960s, the three hospitals made plans honored to have the Delaware Nurses Association sharing office space with us in to merge into the Wilmington Medical Center and agreed to charter the Nursing School the Ammon Center. Over the years we have committed to joint programming and of Wilmington (Delaware Academy of Medicine, Historical Archives, n.d.). Under the hope the future brings more opportunities for both organizations. The Academy/ direction of Mary Healy, the school was the first school in the region to offer a two-year DPHA is a big tent where the health and well-being of our community is paramount. nursing diploma and accepted students of any age and marriage status. To that end, we seek to engage a diverse membership of all degree types and there is no doubt that nursing is always welcome at our table. If the COVID-19 pandemic Figure 2. Nursing Class of the Delaware Hospital, 1946 demonstrated nothing else, it highlighted the critical importance of all frontline providers, especially our nurse leaders and colleagues. Now is the time to strengthen bridges for the betterment of our entire community.

References American Nursing History. (n.d.) Public health nursing. https://www.americannursinghistory. org/public-health-nursing Buhler-Wilkerson, K. (n.d.). What is a public health nurse? University of Pennsylvania. https:// www.nursing.upenn.edu/nhhc/home-care/what-is-a-public-health-nurse/ Delaware Academy of Medicine, Historical Archives. (n.d.). The Nursing School of Wilmington Collection, 1930-1984. https://delamed.org/programs/archives-and-history/historical- archives__trashed/historical-archives-the-nursing-school-of-wilmington/ University of Delaware. (n.d.). History of the School of Nursing. https://www.udel.edu/ academics/colleges/chs/departments/son/about/son-history/ Delaware Division of Public Health. (n.d.). Office of Public Health Nursing. https://dhss. delaware.gov/dhss/dph/chs/nursing.html American Public Health Association. (2013). The definition and practice of public health nursing. https://www.apha.org/~/media/files/pdf/membergroups/phn/ nursingdefinition.ashx American Nurses Association. (n.d.). Public health nursing. https://www.nursingworld.org/ practice-policy/workforce/public-health-nursing/ Page 8 • DNA Reporter June, July, August 2021

The Impact of a Pandemic on Childhood Immunization Rates: A Public Health Nursing Perspective Jacob Mills, BSN, RN requires a specific percentage of people to be vaccinated be administered during one visit to reduce the need for Jonathan Kroon, BSN, RN that correlates to the infectivity of that organism, such as multiple visits unless specifically contraindicated. To limit measles at 95% total vaccination status and polio at 80%. potential transmission of infection in the office setting, To complement this, the WHO recommends achieving herd patients may be asked to remain outside until ready to be Jacob (Jake) Mills is a Division of immunity through acquired immunity from inoculation, seen to eliminate crowded waiting rooms and to separate Public Health nurse. He is involved in the fields of tuberculosis, rather than through natural immunity by allowing an patients for sick visits from those for well visits. Several immunizations, and COVID-19 infectious agent to run rampant through any population. If offices used a drive-thru process for vaccination to ensure testing and vaccination. He children receive their regularly scheduled immunizations on safety during the pandemic and to limit transmission of graduated from Arcadia University time, herd immunity will be maintained even in the face of disease to staff and other patients. with a Bachelor’s in Biology in a global pandemic. Another strategy for general vaccination compliance 2016 and went on to Salisbury University to graduate with a BSN Unfortunately, maintaining adequate childhood would be to include an educational enrollment in 2017. Jacob started his nursing immunization rates has been a worldwide challenge requirement. This is already in effect in Delaware, as to career on the IMC/Medsurg during the COVID-19 pandemic. As of October 2020, enroll a child in a Delaware school system, the parents must units of Bayhealth’s Milford more than 68 countries had suspended immunization provide vaccination proof for MMR, (DTaP), Polio, Hepatitis Memorial Hospital and Sussex services (Lassi et al., 2021), causing over 80 million children B, and Varicella (Delaware Department of Education, 2020). campus. Jacob can be reached at Jacob Mills [email protected]. who have not even reached their first birthday to be Regardless that many Delaware schools transitioned from completely vulnerable to vaccine-preventable diseases. In in-person classes to hybrid settings with a mix of in-person addition, public health officials estimate that over 90 mass and remote learning opportunities in 2020, school nurses vaccination campaigns around the globe were suspended. and the Delaware Immunization Program continue to Not surprisingly, there are outbreaks of measles, diphtheria, enforce the vaccination standards to help these age groups Jonathan (Jon) Kroon is a Public and pertussis in multiple Middle Eastern countries, and achieve high levels of compliance. Health Nurse with the Division Africa has simultaneously responded to measles and Ebola While COVID-19 has chipped away at significant of Public Health. Jon has worked cases during the pandemic. public health advancements in childhood immunizations, in a number of clinical settings The United States’ childhood immunization rates have the Delaware Immunization Program continues to with DPH, including tuberculosis, not fared much better. Coming off a year in which the increase access to vaccines, particularly for underserved family planning, child health, immunizations, COVID-19 testing United States saw the most measles cases since 1992 (CDC, populations, by providing them at State Service Centers. and vaccination, and large- 2021), immunization rates in children have been severely Public health officials must balance the need to limit the scale emergency preparedness affected. Michigan implemented stay-at-home orders on spread of COVID-19 while maintaining key functions, a events Jon received his BSN March 23, 2020. Bramer et al. (2020) reviewed Michigan’s precarious balancing act. Since the safety of the public, from Messiah College and began immunization data from May 2016 to May 2020 and and certainly children, is always a top priority, public his nursing career in Bayhealth’s Milford Memorial Emergency found that vaccination rates declined in all cohorts studied health nurses, school nurses, and other professionals Department. Jon can be reached Jonathan Kroon ranging from one month to 24 months. The declines must identify and overcome immunization lapses. at [email protected]. occurred in every single regularly administered vaccine Maintaining focus on the current goal of responding to with the exception of the birth Hepatitis B dose, which is the pandemic while also brainstorming strategies for public administered in-hospital when a baby is born. Among health nurses and professionals to combat an identified Over the past year, one public health crisis has taken Michigan 16-month-olds, 70.9 percent were up-to-date lapse in immunizations is essential. This is just another precedence over all others: Coronavirus disease 2019 on their MMR (measles, mumps, rubella) immunizations in steppingstone to cross on the road to a true societal (COVID-19). An unfortunate consequence of the global May 2020. Without current MMR immunizations, children recovery. pandemic was the negative impact to routine and under two years of age are vulnerable to measles, with the preventive health services due to public health interventions potential for another outbreak. References to contain the spread of the SARS-CoV-2 virus. Childhood Across the globe, health professionals are asking how Australian Government Department of Health (2021). Historical immunizations (the terms immunization and vaccination to get children caught back up on their immunizations. coverage data tables for all children. https://www.health. will be used interchangeably) especially experienced a gov.au/health-topics/immunisation/childhood-immunisation- In Australia, the government introduced direct monetary coverage/historical-coverage-data-tables-for-all-children dramatic decline (Santoli et al., 2020). Since many science incentives, which later transitioned to tax incentives for Bramer, C. A., Kimmins, L. M., Swanson, R., Kuo, J., Vranesich, and health care professionals consider vaccines to be one families whose children were fully immunized (Diekema, P., Jacques-Carrol, L. A., Shen, A. K. (2020). Decline in child of the greatest accomplishments for humankind (Mao 2012). These incentives were focused not only on the vaccination coverage during the COVID-19 pandemic — & Chao, 2019), this impact is concerning. Therefore, it is families with children but also on the general practitioners Michigan care improvement registry, May 2016– May 2020. understandably concerning to note the detrimental effect who followed up to ensure that children stayed current on MMWR Morb Mortal Wkly Rep 2020, 69, 630–631. doi: the current global pandemic has had on preventing children their appropriate immunization timeline. Pre-pandemic, http://dx.doi.org/10.15585/mmwr.mm6920e1external icon. from receiving their regularly scheduled immunizations. CDC (2021). Measles cases and outbreaks. https://www.cdc. in 2016, the Australian Department of Health launched gov/measles/cases-outbreaks.html.Delaware Department of Public health nurses and officials use childhood a program where a fixed amount would be paid to the Education (2020). School Health Services / Immunizations. vaccination to drastically reduce the spread of disease. provider for each child between two months and seven https://www.doe.k12.de.us/Page/2871 Roughly 20 million illnesses are prevented from each birth years of age who was vaccinated and reported to the Diekema, D. S. (2012). Improving Childhood Vaccination Rates. cohort that is fully immunized, and morbidity rates of national vaccine registry (Immunize Australia Program, New England Journal of Medicine, 366(5), 391-393. https:// diseases in the United States such as paralytic poliomyelitis, 2018). To show the practical effects of these measures and doi:10.1056/nejmp1113008 diphtheria, and smallpox fell 100% since the introduction others, the Australian Government Department of Health Immunize Australia Program. (2018). Catch-up incentives for of reliable vaccines (Ventola, 2016). Ventola described two vaccination providers fact sheet. [Fact Sheet]. https:// (2021) reported the percentage of Australian two-year-olds www.health.gov.au/sites/default/files/catchup-incentives- factors that contributed to the high success rate associated considered “fully immunized” rose from 73.63% in 1999 vaccination-providers.pdf with these vaccines: the direct effect of immunity to the to 92.55% in 2020. A similar incentivization program in the Lassi, Z. S., Naseem, R., Salam, R. A., Siddiqui, F., & Das, person who received vaccination and the indirect effect United States would not only galvanize parents of newly J. K. (2021). The impact of the covid-19 pandemic on of herd immunity as increasing numbers of people are eligible children to receive appropriate vaccinations but also immunization campaigns and programs: A systematic fully vaccinated and protected for a lifetime. According to help those who have missed certain doses catch up. review. International Journal of Environmental Research and the World Health Organization (WHO), herd immunity In Delaware, there was an initial sharp decline in Public Health, 18(3), 988. doi:10.3390/ijerph18030988 prevents transmission to unvaccinated individuals, but this Mao, H. H., & Chao, S. (2019). Advances in Vaccines. Current childhood immunization rates from February through Applications of Pharmaceutical Biotechnology, 171, 155-188. is only viable when a certain percentage of the population May 2020. Childhood immunizations impacted include https://doi:10.1007/10_2019_107 has been exposed via vaccination or first-hand infection diphtheria/tetanus/pertussis (DTaP), polio, MMR, Santoli, J. M., Lindley M. C., DeSilva M. B., Kharbanda, E. O., (WHO, 2020). According to the WHO, each pathogen Haemophilus influenzae type b (HIB), Prevnar, and Hepatitis Daley, M. F., Galloway, L., Gee, J., Glover, M., Herring, A. Recovery has started, but fluctuations are occurring B., Kang, Y., Lucas, P., Noblit, C., Tropper, J., Vogt, T., month-to-month. Strategies to improve immunization rates Weintraub, E. (2020). Effects of the COVID-19 Pandemic involve provider outreach to identify children with missed on Routine Pediatric Vaccine Ordering and Administration Full-Time Nursing Faculty -United States, 2020. MMWR Morb Mortal Wkly Rep well-child visits for in-person appointments while adhering 2020, 69, 591–593. doi: http://dx.doi.org/10.15585/mmwr. to infection control measures during the pandemic. In The Division of Nursing and Health Sciences, invites applicants for 9-month, full- mm6919e2external icon. time positions in medical surgical, mental health, and community health nursing. the summer of 2020, the Division of Public Health (DPH), Ventola C. L. (2016). Immunization in the United States: Qualifications: Master’s degree in area of specialization and current clinical through the Immunization Program, ran a public awareness Recommendations, barriers, and measures to improve experience required. Doctoral degree in nursing or related field and teaching campaign on childhood immunizations to remind parents compliance: Part 1: Childhood vaccinations. P & T: A Peer- experience preferred. Eligible for RN licensure in PA and DE, and have an appreciation and guardians to schedule wellness visits and update their Reviewed Journal for Formulary Management, 41(7), 426– for and congruence with the Catholic Franciscan Mission of the University. children’s vaccinations before the school year. 436. WHO (2020). Coronavirus disease (COVID-19): Herd immunity, Send a letter of application and CV, the names, addresses, phone numbers, and Vaccination status of all children and adolescents during lockdowns and COVID-19. https://www.who.int/news-room/ email addresses of at least three references to: each interaction, whether in-person or virtual, should be q-a-detail/herd-immunity-lockdowns-and-covid-19 NEUMANN UNIVERSITY, David W. Brownlee, VPHRRM, Human Resources Office, reviewed to ensure timely vaccine catch-up. When the [email protected] EOE M/F/D/V opportunity for an in-person visit occurs, all vaccines should June, July, August 2021 DNA Reporter • Page 9

Seeing the Big Picture: Leadership and Systems Thinking to Ensure Quality and Safety Mary A. Dolansky, PhD, RN, FAAN healthcare (Melnyk, et al., 2021) These realities of empathy to take care of each other. The resilience our complex environment and healthcare worker demonstrated by these nurses as they returned day The COVID-19 pandemic has rocked our world burnout prompted the introduction of the Quadruple in and day out under these circumstances highlighted and opened the door for leadership to emerge. Aim improving the work life of healthcare providers their leadership qualities in helping to achieve the Leadership is essential in the daily work of nurses in (Bodenheimer & Sinsky, 2014). The fourth aim is Quadruple Aim. direct care to ensure quality. What is quality care? especially important now as nurses’ work stressors Systems thinking, another key to quality and safety, is Well, the Institute of Medicine (now the National have been exacerbated during COVID-19. defined as an awareness of both individual patient needs Academy of Medicine) back in 1999 defined quality Leadership is integral to seeing the big picture and systems needs; this approach empowers nurses to as care that is safe, timely, efficient, efficacious, and systems thinking. Leadership is at the core of the intervene at both levels (Dolansky & Moore, 2013). This equitable, and patient-centered (STEEEP) (2001). work of nurses in direct care. The Center for Creative is reinforced by the American Association of Colleges of These underlying principles are the foundation for Leadership lists 10 essential skills for leadership: Nursing’s re-envisioned Essentials: Core Competencies the Triple Aim, coined by the Institute for Healthcare integrity, ability to delegate, communication, self- for Professional Education to reflect the importance Improvement, aiming for better population health, awareness, gratitude, learning agility, influence, systems-based practice (2021). For example, a nurse better patient experience of care including quality empathy, courage and respect (Leadership, 2020). provides care to prevent pressure injuries to his or her and satisfaction, and reducing the per capita cost of Nurses possess these essential skills. During COVID-19 patients and also engages in a quality improvement care (Berwick, et al., 2008). Nurses roles in achieving there are endless stories of nurses in direct care project to reduce the number of pressure injuries on the Triple Aim is difficult with the complexities who led with these qualities. They had the courage a unit. Another example is not blaming a nurse who of healthcare often resulting in healthcare to stand up when supplies were low, the learning makes a medication error but the nurse participating in a worker burnout and dissatisfaction. Burnout and agility to build systems for COVID-19 testing and root cause analysis to identify the system factors leading dissatisfaction contribute to disengagement and vaccinations that avoided constraints, the know- to the error. Some facilitators of systems thinking include the possibility of errors and thus threatens quality how to delegate to expand care delivery, and the providing time to work on interprofessional teams to solve problems and working in a healthcare organization that embodies a just culture in which individuals are not blamed for gaps in quality. Nurse leaders providing direct care who use systems thinking take the time to be reflective and encourage a team approach. They understand the complex interrelationships among various factors impacting the quality of care in their work setting. They are able to see the views of others, stand up and share their views, and speak out to address system problems. You are the leader at the frontline of care and you make the difference in quality and safety. Kudos to all of you using your leadership and systems thinking skills to ensure that the Quadruple Aim is achieved.

References American Association of Colleges of Nursing. (2020). The essentials: Core competencies for professional education. https://www.aacnnursing.org/Education-Resources/ AACN-Essentials Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759 Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713 Dolansky, M. A., & Moore, S. M. (2013). Quality and safety education for nurses (QSEN): The key is systems thinking. OJIN: The Online Journal of Issues in Nursing, 18(3), 1-12. https:// 10.3912/OJIN.Vol18No03Man01 Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. The National Academies Press. https://doi.org/10.17226/10027. Leading Effectively Staff. (2020, December 18). What are the characteristics of a good leader? Center for Creative Leadership. https://www.ccl.org/articles/leading-effectively- articles/characteristics-good-leader/ Melnyk, B. M., Tan, A., Hsieh, A. P., Gawlik, K., Arslanian- Engoren, C., Braun, L. T., Dunbar, S., Dunbar-Jacob, J, Lewis, L., Millan, A. & Wilbur, J. (2021). Critical care nurses’ physical and mental health, worksite wellness support, and medical errors. American Journal of Critical Care, 30(3), 176-184. https://doi.org/10.4037/ajcc2021301

Visit nursingALD.com today! Search job listings in all 50 states, and filter by location and credentials. Browse our online database of articles and content. Find events for nursing professionals in your area. Your always-on resource for nursing jobs, research, and events. Page 10 • DNA Reporter June, July, August 2021

Adjusting Your Money Mindset Money is a powerful force in our lives. We’re to occupy the driver’s seat, normal emotional states can financial lives around after a failed business, job loss, required to think about money—how much we sometimes turn into feelings of anxiety. It’s not that it’s stock tumble, tax trouble or any number of other have, how much we want, how to get more of it— wrong to feel a certain way, it’s just that certain powerful financial fiascos. Focusing on what you can do now, on a regular basis. Undoubtedly, how we think about emotions can prevent you from making reasonable choices. with an open mind about the future, can free you money influences our emotions and behaviors. For Stop playing money mind games without much from a history you’d prefer to forget. these reasons, if you’re serious about improving your possibility of winning. If you find yourself in any of Curtail the time spent thinking about money. financial life, it can be helpful to examine your money these mental exchanges, you might be setting yourself There’s an appropriate amount of time to devote mindset, look for patterns that may interfere with your up with challenges down the road. to money matters, and then there’s the extreme of personal goals, and replace what hinders you with • I’ll be happy when I make more money. continuous, non-productive dwelling on dollars and more productive habits. Working toward your financial goals is crucial, cents. If you find yourself mulling over financial mistakes Acknowledge the influence of your personal but it’s also important to enjoy successes you’re or fantasizing at length about winning the lottery, it’s history. Because our financial lives are inextricably experiencing today. time to switch gears. Try to gain insight into what you linked to our family of origin and upbringing, we’re all • Money is the only thing that matters. really hope to accomplish (or avoid) by allowing money bound to have a complex and layered relationship with Money is important as a means to an end. to monopolize your thoughts, and step back to see the money. If you grew up in poverty, you may have an However, worshipping money at the expense of futility of your preoccupation. Next, identify actions you underlying sense of never having “enough.” If you are people, nature, art and ideas is likely to lead to can take that will be more successful at helping you accustomed to abundance, you may never have learned loneliness and disappointment. reach your goals. Give yourself permission to problem how to manage money wisely. Of course, neither of • Money is meaningless. This kind of thinking solve or daydream for short bursts of time, but then get these scenarios may be true if you had someone who can also be harmful, because it can feed back to the business of living. taught you good money habits. The purpose of looking reckless spending and de-motivate your work Enlist a financial ally. A skilled financial advisor back is to see if you have any ingrained stumbling life. Money should be treated with respect and will be very familiar with the mental, emotional and blocks that can sabotage your best intentions to earn not frittered away. behavioral landmines you may be grappling with as what you’re worth, save adequately, spend responsibly you work to establish a strong financial foundation or be more philanthropic. If you see room for Let go of the past. Stop beating yourself up for for your life. They can provide you with the tools improvement, awareness paves the way for change, as your financial mistakes. It’s better to reframe regrets as to plan, save, and invest, within your timeframe needed or desired. opportunities to learn and grow. Don’t shut the door on and budget, according to your personal goals. But Evaluate your emotional response to money. your past, but don’t let it convince you that you don’t you can also look to your advisor for guidance and Is your emotional state tied to your assets? Does your deserve another chance, or that you can’t change the encouragement as you sharpen your mental game bank account define you? When you allow money present or the future. Plenty of people have turned their with regard to personal money management.

Christopher Malmstrom, CRPC, APMA, is a Financial Advisor with Point to Point Wealth Planning a private wealth advisory practice of Ameriprise Financial Services, LLC in Wilmington, DE. He is a profound supporter of Delaware Nurses and partner to the Delaware Nurses Association. To contact him, visit his website www.ameripriseadvisors.com/christopher.malmstrom or call 302-995-7526. His office is located at 5195 W Woodmill Drive, Suite 27, Wilmington, DE 19808-4067.

Investment advisory products and services are made available through Ameriprise Financial Services, LLC, a registered investment adviser. Ameriprise Financial Services, LLC. Member FINRA and SIPC. | © 2021 Ameriprise Financial, Inc. All rights reserved. June, July, August 2021 DNA Reporter • Page 11

The Public Health Nurse’s Role in Early Intervention

Jeanette G. Kernan, MSN, APRN supports that are available to babies and young assessment. “A family-directed assessment must be Jessi L. Wyatt, MSN, MBA, APRN children with developmental delays and disabilities conducted by qualified personnel in order to identify and their families” (2019, para.1). Depending on the families’ resources, priorities, and concerns and the child’s needs, early intervention services might the supports and services necessary to enhance Jeanette Kernan has been an include family training, counseling, and home visits; the family’s capacity to meet the developmental Advanced Practice Registered occupational, physical, or speech therapy; hearing needs of the family’s infant or toddler with a Nurse (APRN), Supervisor, Family loss services; nursing, nutrition, social work, and disability (IDEA, 2017b). IDEA identifies that the Service Coordinator, and assistance with service coordination; assistive family-directed assessment must: Evaluator for Delaware Department of Health and Social technology devices and services; and transportation 1) be voluntary on the part of each family Services (DHSS), Division of Public (CDC, 2020). member participating in the assessment Health (DPH), Birth to Three Before Part C services begin, an Individual 2) be based on information obtained through an Early Intervention Program - Family Service Plan (IFSP) is developed with a team assessment tool and also through an interview Child Development Watch (CDW) approach. This team includes the parents and all with those family members who elect to since 2010. She earned her BSN in 2008 and her MSN in 2010 the providers and public health nursing team who participate in the assessment from Wesley College. ​In addition will be working with the child and the family (ECTA, 3) include the family’s description of its resources, to her role as a Public Health Jeanette G. Kernan n.d.a). The IFSP is formulated to describe the child’s priorities and concerns related to enhancing the APRN, Jeanette has also served as the Clinical Coordinator for present level of development, the family’s strengths child’s development (2017b, para. 30). Wesley College’s Nursing Department since 2009. Jeanette and needs, the specific services to be provided to brings to her current roles a variety of nursing experience, varying from pediatric home health care, long-term care, the child and the family, and the plan to transition to The next step is the creation of an Individualized and school nursing. Alongside of her current role as an APRN public school (CDC, 2020). Family Service Plan (IFSP). The IFSP is a written with CDW, Jeanette has also been instrumental in providing An integral part of the EI program is to involve document that defines a child’s areas of concern public health nursing during the current pandemic – assisting public health nursing in providing services to eligible and details the services that the child and family will in working at community COVID-19 testing events and mass- children and their families. For children and families receive (IDEA, 2017c). The IFSP also defines goals vaccination events throughout the State of Delaware. Jeanette can be reached at [email protected] referred to EI programs, the nurse plays an important for a child’s development (IDEA, 2017c). Again, the role in carrying out the IDEA definition of nursing knowledge and expertise that the public health services. These services include: nurse can provide and contribute to the creation 1) the assessment of health and well-being and maintenance of the IFSP is so irreplaceable that Jessi Wyatt has worked for the for the purpose of providing nursing care, in many instances, public health nurses will provide Delaware Department of Health including the identification of patterns of consultative services to other staff members, when and Social Services (DHSS), human response to actual or potential health medical concerns or queries arise. Division of Public Health (DPH), problems The role of the PHN is an important one amongst Birth to Three Early Intervention 2) the provision of nursing care to prevent health the EI team. They provide a variety of services and Program – Child Development Watch (CDW) since 2012. During problems, restore or improve functioning, and resources to the EI team, as well as the children that time Jessi has served in a promote optimal health and development and families that the Program serves. The work of multitude of roles, including: 3) the administration of medications, treatments, PHNs within EI programs have had positive results Advanced Practice Registered and regimens prescribed by a licensed care for this population. PHNs have improved child Nurse (APRN), Supervisor, provider (2017a, para. 36). developmental outcomes, reinforced and supported Family Service Coordinator, and Evaluator. Jessi is a BSN graduate parent-child connections and relationships, and from Wesley College in 2011, Jessi L. Wyatt Public Health Nurses (PHNs) serving in Delaware’s foster a caring family atmosphere. Even with these a dual Master’s graduate of Wilmington University in 2014, EI program are tasked with ensuring these federal results, there is a continued need for research in a earning a MBA and MSN with a focus in Leadership, and a mandates are carried out statewide. A PHN is variety of areas, including evaluating the enduring MSN graduate of Wesley College in 2018. In addition to often involved in a client’s case from the moment effects of EI work, determining the most efficient her role as a Public Health APRN, Jessi has also served as an Adjunct Faculty Member for Wesley College’s Nursing they are referred to the EI program. Upon referral means in which PHNs can deliver services, and Department since 2016. Jessi brings to her current role a receipt, a PHN or a team of PHNs “triage” the case, appraising results of family functioning (Blann, variety of nursing experience, varying from step-down critical researching medical conditions, performing medical 2005). Alongside of their fellow EI team members, care to critical care nursing. Alongside of her current role record reviews, collaborating with referral sources, PHNs continue to be at the forefront of this needs as an APRN with CDW, Jessi has also been instrumental in and performing other clinical skills to best determine assessment. providing public health nursing during the current pandemic – assisting in working at community COVID-19 testing which Family Service Coordinator (FSC) from the For more information or to make a referral to the events and mass-vaccination events throughout the State of EI program would best meet the needs of the child Delaware Birth to Three Early Intervention Program, Delaware. Jessi can be reached at: [email protected] and family. Program coordinators have a variety of contact CDW at 302-283-7140 (New Castle County) backgrounds, ranging from social work, education, or 302-424-7300 (Kent and Sussex counties). or nursing, and all have one focus in mind: early intervention. References Public Health Nursing is vital to the management If a family is interested in participating with Blann, L. (2005). Early Intervention for children and of childhood development during the first years the voluntary EI program, there are several steps families: with special needs. American Journal of Maternal Child Nursing, 30(4), 263-267. https://doi. of life. This is apparent in the Birth to Three Early taken to move the child through the intervention org/10.1097/00005721-200507000-00011 Intervention Program, Child Development Watch process. The first step is a Multi-Disciplinary Centers for Disease Control and Prevention. (2019, (CDW), an early intervention (EI) program that Evaluation (MDE), completed using a collaborative December 9). What is “Early Intervention”?. https:// serves Delaware’s eligible young children and team approach. Team members consist of the www.cdc.gov/ncbddd/actearly/parents/states.html their families. Services are provided through the family and/or caregivers, other specialists - such as Centers for Disease Control and Prevention. (2020, Delaware Department of Health and Social Services, the FSC, an Advanced Practice Registered Nurse, December 31). Individuals with Disabilities Education Division of Public Health. While the program is Speech Language Pathologist, Physical Therapist, Act (IDEA) Services. https://www.cdc.gov/ncbddd/cp/ locally administered through the State of Delaware, treatment.html Occupational Therapist, and a Child Development Early Childhood Technical Assistance Center. (n.d.a). the Program is federally funded under Part C of the Specialist or a Pediatric Physician. The child’s Individualized Family Service Plan (IFSP). https:// Individuals with Disabilities Education Act (IDEA) Primary Care Physician and any additional medical ectacenter.org/topics/ifsp/ifspprocess.asp (Early Childhood Technical Assistance Center [ECTA], specialists or providers are also considered a part of Early Childhood Technical Assistance Center. (n.d.b). n.d.b). the team. The evaluation team uses evidence-based Part C of IDEA. https://ectacenter.org/partc/partc. Congress established Part C of the IDEA in 1986 and approved developmental tools to evaluate five asp#:~:text=The%20Program%20for%20Infants%20 in recognition of an urgent and substantial need to: areas of development: cognitive, social/emotional, and,2%20years%2C%20and%20their%20families 1) enhance the development of infants and toddlers Individuals with Disabilities Education Act. (2017, May 2-a). adaptive, communication, and motor. The PHN Sec. 303.13 Early intervention services. https://sites. with disabilities; 2) reduce educational costs by contributes to this team in a unique way, in that ed.gov/idea/regs/c/a/303.13 minimizing the need for special education through medical counseling, guidance, and management Individuals with Disabilities Education Act. (2017, July early intervention; 3) minimize the likelihood of techniques and strategies are often included as part 12-b). Sec. 303.321 Evaluation of the child and institutionalization and maximize independent of the nursing assessment when evaluating these assessment of the child and family. https://sites. living; and 4) enhance the capacity of families to clients and families. ed.gov/idea/regs/c/d/303.321 meet their child’s needs (ECTA, n.d.b). According Following the MDE, if a child qualifies for the EI Individuals with Disabilities Education Act. (2017, July 12- to the Centers for Disease Control and Prevention c). Sec. 303.342 Procedures for IFSP development, program based on the federal and state eligibility review, and evaluation. https://sites.ed.gov/idea/regs/ (CDC), EI programs are defined as “services and criteria, the team conducts a family-directed c/d/303.342 Page 12 • DNA Reporter June, July, August 2021

The Importance of Public Health Nursing in Policy Development

Lt. Governor Bethany Hall-Long, Ph.D., RN, FAAN share their expertise. Being a member of the Delaware Nurses Association (DNA) and other nursing or community groups, which can lobby and apply political skills to influence all stages of policy, including agenda setting, adoption, implementation Lt. Governor Bethany Hall-Long, Ph.D, RN, FAAN has served as Delaware’s 26th Lt. Governor since January 2017 and is the current and evaluation is key. Chair of the National Lieutenant Governor’s Association. Formerly, Public health policy and politics has been front and center during COVID-19 Dr. Hall-Long served as a Delaware State Senator from 2008-2017 and the 2020 election cycle. Nurses this year “brought to life” the need to apply and a State Representative from 2002-2008 where she focused political strategies such as making phone calls, sending letters and emails, using on issues involving behavioral health, cancer, education, and the social media/TV Ads as resources to connect with elected officials to expand COVID environment. Dr. Hall-Long has been a member of the University of Delaware Nursing Faculty for twenty-five years. Currently a Professor testing, prevention, and vaccinations. Nurses vividly told their stories on the need of Nursing and Joint Faculty in Urban Affairs, her public and private for PPE, social isolation, hygiene, and having mental health resources. Many of funded research and community service record with at-risk groups you have joined me in signing up for the Delaware Medical Reserve Corps (DMRC) such as pregnant teens, diabetics, the homeless, and the mentally ill, and are volunteering countless hours at public health testing, and vaccine events. makes her a nationally recognized health scientist. Dr. Hall-Long is a These and other actions role model the value of nurses in public health more than member of the Delaware and American Nurses Association. Dr. Hall- Long can be reached at [email protected]. Bethany Hall-Long ever, especially as we advocate to address the inequities with COVID-19 among our vulnerable populations and communities of color. During my years in the Delaware House of Representatives and Senate, I As a Professor of Public Health Nursing and a statewide elected policymaker, I worked with nurses and nursing organizations on a myriad of issues, including know firsthand that nurses are the essential “glue” of our healthcare system. APRN independent practice and reimbursement, economic development, chronic According to consecutive polls by Gallup, the public rates nurses as the profession disease prevention, workforce expansion, school-based wellness centers, behavioral with the highest honesty and ethical standards (Saad, 2020). During the coronavirus health, women’s issues, pay equity, gun violence prevention, anti-discrimination, disease 2019 (COVID-19) pandemic, the world has witnessed the central role nurses environmental protection, telehealth, and social determinant expansion. The latter play to care for patients and protect our communities. Caring for the public’s health two have been important during COVID-19 for access to care and overall health. at the front lines requires nurses to meet people where they are, and this also Telehealth was passed with testimony before the General Assembly offered by a “demands” that nurses be at policymaking tables of hospitals, behavioral health couple nurse champions of persons with Parkinson’s disease, who could not get to a clinics, occupational health settings, long term care facilities, schools, government, doctor’s office. Support for telehealth and related insurance coverage has ultimately and other care settings. Health promotion, disease prevention, surveillance, and become critical during COVID-19. treatment are critical public health essentials, including epidemiologic response and Nurses benefit by having a policy mentor or serving as a mentor. I was fortunate to recovery as seen in the COVID-19 pandemic. be mentored by Dr. Hazel Johnson Brown, the first African American US Army General It is important nurses be engaged in the policy and political process in order and first black Chief of the Army Nurse Corps, to teach me the need for nurses in to help set policy agendas and to influence resource allocation, programs, and public health policy. Next, nurses are encouraged to learn to apply scientific data or positively impact the overall health system. The saying, “If you are not at the table, clinical stories while contacting officials to assist with legislation or regulations. Finally, you are on the menu” is especially true for the nursing profession as nurses strive for join advocacy or interest group(s) that support public health and nursing. I hope that professional full scope of practice and tackle critical issues such as equity, cultural nurses will “be at the table” and communicate with local, county, state, and federal competence, and access to quality of care. It does not mean all nurses have to elected officials - send emails, make calls, and maximize social media to share your run for office or become lobbyists. Nurses are encouraged to be active and not to policy ideas or the challenges facing your patients and communities. remain on the sidelines, but to get in the “political game” and be advocates and Nurses have the skill set to run for office as good listeners and as problem solvers who are accustomed to hearing both sides. That’s politics. It’s about a “tug of war” over resources. Nurses are often caught in the middle, between parent and child, or in care disputes. It takes reflection to mediate between competing forces and allocate limited resources. When I hear nurses say, “I couldn’t stand to do it,” I say, “Take a step back. You’re already doing it.” In Delaware, we are a small state of neighbors and while focusing on public health issues we can leave partisan politics aside and focus on issues impacting us all. Examples are shared concerns over the opioid crisis, costs of health care, clean water protections, cancer risk reduction, infant mortality and maternal child health access, insuring the uninsured, early intervention and education, stress reduction, exercise, immunizations, jobs, and higher education. I have used all my public health nurses’ knowledge base and research scientist skills as Lieutenant Governor, and I encourage other nurses to get involved and be at the policymaking table. Please act now and become engaged with public policy and politics and support the public’s health.

References Delaware Division of Public Health. (n.d.). Coronavirus Response. https://coronavirus. delaware.gov/vaccine/ Delaware Health and Social Services: Division of Public Health. (n.d.). Delaware Vaccine Request. https://vaccinerequest.delaware.gov/s/ Mason, D., Gardner, D. Outlaw, F. & O’Grady, E. (2016). Policy & Politics: In Nursing and Health Care (7th ed.). Elsevier: St Louis Saad, L. (2020). U.S. ethics ratings rise for medical workers and teachers. Gallup. https:// news.gallup.com/poll/328136/ethics-ratings-rise-medical-workers-teachers.aspx

To access electronic copies of the DNA Reporter, please visit http://www.nursingALD.com/publications June, July, August 2021 DNA Reporter • Page 13 The APRN’s Role in Providing Pediatric Immigrant Care

Holly K. Schiavone, MSN, RN, APRN, of life. A culturally competent provider’s focus is not rubella vaccine (MMR) is not routinely administered in CPNP-PC, CNL how to interact with people so that they will comply most developing counties. Zoster and Human papilloma with a medical regimen, but to work with them to virus (HPV) vaccines are not required for immigrant increase mutual understanding, share information children (Humiston et al., 2017). Holly K. Schiavone, is currently a Mental health concerns in children immigrating to Pediatric Nurse Practitioner for and knowledge, strengthen a person’s control of the Delaware Division of Public their health, and construct more healthful decisions. the U.S. depend upon a child’s country of origin and Health (DPH) at the Hudson Supporting the concept of culturally competent care, those areas with the highest risk (such as disrupted State Service Center’s Child it is recommended to always use a trained medical health care systems, conflict zones, or those under- Health, Immunization Clinic translator when necessary to provide culturally and resourced). Resources vary among those entering the in Newark, Delaware. Prior to country. Specific mental health issues can promote becoming a nurse, Holly was a linguistically appropriate services as it maintains registered respiratory therapist confidentiality, reduces errors, and increases quality. isolation from family, community, country, culture, with a Bachelor of Science in Health care providers should be aware of traditional and language and exacerbate depression and Allied Health from Widener healing and cultural practices among some immigrant anxiety. Immigrant children may have been exposed University. She obtained a BSN populations. Patients may not disclose their use of to violence and Post Traumatic Stress Disorder from Widener University and Holly K. Schiavone in their home country or during their journey to was employed at The Children’s herbal and traditional treatments unless they are asked Hospital of Philadelphia, The Hospital of the University directly. Some immigrant families use traditional forms the U.S. Developmental assessments should be of Pennsylvania, and Nemours, Alfred I. duPont Hospital of protection for infants such as prayer, amulets, kohl, routinely done as recommended by the American for Children. She obtained an MSN from the University of or myrrh. Some families use traditional practices such Academy of Pediatrics’ 2006 guidelines. Language Alabama and obtained Clinical Nurse Leader (CNL) credentials. as cupping, coining, and uvulectomy; on exam these development is expected to be the same for children She also obtained a Post Master’s Certificate in Pediatric in monolingual families as well as bilingual families. Primary Care Nurse Practitioner from Drexel University. Holly treatments may be observed as abuse (Linton & Green, is a member of North American Pediatric Nurse Practitioners, 2019, p. 7). All children with developmental concerns should be Certified Pediatric Nurse Practitioners- Primary Care, The health assessment must include a detailed referred as soon as possible for further evaluation American Association of Nurse Practitioners, and Sigma Theta history, current signs and symptoms, medications (Foy, 2017). Tau International Honor Society of Nursing. Holly has been (including prescribed, over-the-counter, and herbal); Children immigrating from countries with a high an Adjunct Nursing Faculty at Widener University School burden of tuberculosis (TB disease of greater than of Nursing, and an instructor of Pediatric Advanced Life allergies; and family medical history. Social history Support, Advanced Cardiac Life Support. She has seen many includes family structure and supports, current living 40 cases per 100,00), or with a history of close immigrant children from all over the world at DPH’s clinic at situation, travel, safety, family support, educational contact with someone with TB disease, should have the Hudson State Service Center. Holly can be contacted at and occupational history, and use of substances such a Mantoux tuberculin skin test (TST) or interferon- [email protected]. as alcohol, tobacco, illicit drugs, and other substances gamma release assay (IGRA) for mycobacterium from county of origin (e.g., betel nuts in Thailand; tuberculosis. Previous Bacillus Calmette-Guerin One of the fastest growing populations in the United Khat in East Africa). Past medical history should (BCG) vaccine may influence the results of the TST States (U.S.) are children of immigrant families, who include significant medical or mental health illnesses/ yet should not influence interpretation of the IGRA are contributing to the growth of a diverse pediatric conditions, injuries, hospitalizations, and dental and (Loeffler, 2017). population. vaccination histories. Immigrant children deserve optimal health services Children immigrate to the U.S. with or without their A thorough examination should include from culturally competent providers, enabling them to parents and demonstrate remarkable resilience in doing an assessment of nutritional status, growth, develop into healthy young adults. Ensuring complete so, despite the many challenges they face. They may be development, and sexual maturity (Dunn, 2013). health assessments while taking each child’s unique refugees or asylum seekers forced from their homes Nutrition and growth may be affected by a child’s background into account can enhance trust between and seeking to escape conflict or violence. They can be country of origin, access to food and health care, family and provider and build the foundation for displaced from their country because of environmental language and cultural barriers, presence of infectious stronger overall health communication. factors or unrest (whether it be civil, political, or social diseases, and vitamin/nutritional deficiencies. All in origin). Others seek to escape persecution due to physical examinations should include a child’s weight, References their nationality, race, religion, or political affiliation, and height/length, head circumference (for children three Dunn, A. M. (2013). Cultural perspectives for pediatric primary care. In Pediatric primary care (5th ed., pp. 33– some search for better health care, educational or work years or younger) and body mass index (beginning at 41). Saunders. opportunities; or to reunite with family members. two years of age). Further evaluation (laboratory or Foy, J. M., MD. (2017). Care of children with mental health Immigrant children should be evaluated by a health other testing) should be pursued as determined by problems. In Textbook of pediatric care (2nd ed., pp. care provider as soon as they arrive in the U.S. In addition physical findings. Common vitamin and nutritional 346–356). American Academy of Pediatrics. to the normal and expected health care necessities of all deficiencies which may influence growth and Humiston, S. G., MD, Atkinson, W., MD, Rand, C., MD, & children, there are some special considerations for children development in immigrant children include iron, Szilagyi, P., MD. (2017). Immunizations. In Textbook entering the U.S. The following will provide some initial vitamin A, vitamin D, Zinc, B12, and iodine. Catch-up of Pediatric Care (2nd ed., pp. 160–167). American Academy of Pediatrics. guidance for health care providers. growth can be delayed secondary to several barriers Linton, J. M., & Green, A. (2019). Providing care for children in When caring for children in immigrant families, previously mentioned (Shetgiri et al., 2017). immigrant families. Pediatrics, 144(3), e20192077,1–21. health care providers need to be cognizant of the If the child’s vaccinations cannot be determined, Loeffler, A. M., MD. (2017). Tuberculosis. In M. N. Lobato role culture plays. Cultural competence is the ability vaccines should be provided. Considerations include MD. (Ed.), Textbook of Pediatric Care (2nd ed., pp. 2718– to communicate and interact effectively with people country of origin, record of vaccination documentation, 2732). American Academy of Pediatrics. of different cultures and socioeconomic backgrounds and child’s age. Vaccines administered outside the Shetgiri, R., MD, Magge, H. N., MD, Geltman, P. L., MD, & beyond one’s culture of origin. It is based on empathy, U.S. can be accepted if their schedule is like that Flores, G., MD. (2017). Caring for families new to the United States. American Academy of Pediatrics Textbook respect, and knowledge and requires a basic recommended in the U.S. Only written vaccination of Pediatric Care (2nd ed., pp. 575–589). American recognition and valuing of culture as a distinct way records should be accepted. Of note, measles-mumps- Academy of Pediatrics. Page 14 • DNA Reporter June, July, August 2021 Advancing Disease Surveillance: Public Health Nursing and Infectious Disease Epidemiology Malikah Taylor, MPH, MSN, RN community-acquired infections. Epidemiology contributes to nursing practice through collaboration in health technology assessment, surveillance and control, risk, screening, and prevention (Muhall, 1996). Conversely, many of the steps of an epidemiologic investigation mirror the health care team’s process when attempting to identify and Malikah Taylor has filled multiple roles at the Division of Public Health since 2018. She first served as an intern, then as a nurse contain nosocomial infections within the hospital. The nursing process (assessment, consultant for the Office of Preparedness. Now she is a Public Health diagnosis, planning, implementation, and evaluation) is used to direct and deliver quality Administrator II, Section Chief, Infectious Disease Prevention and care and education (Younas, 2017; Stonehouse, 2017). Control. Malikah also works part-time as an emergency room nurse Figure 1 lists the 10 steps to perform a field investigation before employing public at the V.A. Hospital in Wilmington, where she cares for the nation’s health resources (Centers for Disease Control and Prevention, 2018). The identification, veterans and volunteers with faith-based organizations to provide health screenings and health education programming for at-risk isolation, containment, immunization, and alerting suspected cases of potential communities in Philadelphia and abroad. Malikah can be reached at infectious disease hosts enable prompt detection, and slow disease spread (Nelson, (302) 744-4877 or email: [email protected] 2014).

Malikah Taylor Figure 1. Ten steps to perform a field investigation before employing public health resources.

Patient advocacy, multi-tasking, clinical knowledge, and compassion are the hallmark Step 1 Prepare for fieldwork and build your team. signs of the nursing profession. Nurses are the backbone of health care organizations Confirm the diagnosis through interviews, clinical data analysis, and Step 2 and the eyes and ears of health care practice. Registered nurses are the most significant lab testing. component of the U.S. workforce, with over three million nurses nationwide. In 2019, Determine outbreak status, eliminating reporting errors and more than 85 percent are employed as bedside nurses who deliver quality health care Step 3 comparing the number of observed cases to the number of expected to individual patients and families, treating illness and disease (Bureau of Labor Statistics, cases for a given period. 2021). Only 8% of nurses work in non-health care settings such as education and Identify and track cases through case definitions that will evolve as government. the investigation progresses. The case definition is fluid consisting of Step 4 The field of public health nursing uses the specialized knowledge and experience of signs, symptoms, lab findings, an epidemiologic period, and a specific nurses to manage trends in the health care needs and inequities of the communities setting that may be revised throughout the investigation. they serve. The public health nursing specialty promotes and protects populations’ Step 5 Review and tabulate data of investigation findings. health using knowledge from nursing, social, and public health sciences (American Consider the proper timing to implement control measures aimed at Public Health Association, 2013). Public Health Nurses (PHNs) promote health through Step 6 education of risks and symptoms of disease onset and management (U.S. Bureau the source and directed to at-risk communities. of Labor Statistics, 2021). Health promotion and disease outreach depend on the Step 7 Develop and test hypotheses. autonomy and innovation of public health nurses. Graduate education prepares Step 8 Plan for additional studies. PHNs for the systems-thinking that enables them to advocate for programming and Step 9 Implement and evaluate preventive control measures. policies that address health disparities. Increasing education in research and disease investigations is paramount. Step 10 Disseminate findings. The Affordable Care Act shifted the focus of health care from the individual, patient- specific, episodic care, towards health management of groups of people, emphasizing Source: Centers for Disease Control and Prevention, 2018. primary and preventive care (Ariosto et al., 2018). Continuing education for nurses does not include epi/biostats, thus creating a division in health care between the An essential tenant of public health is to plan and allocate resources to focus on the scientists and the clinicians. Nursing experience enhances epidemiology as it connects management of infectious diseases in a community. Infectious diseases are generally pathophysiology and disease management with the science of public health. The preventable but pose a public health threat in the United States because of their potential relationship is symbiotic in that understanding how a disease is manifested and treated to emerge through outbreaks (el Bcheraoui et al., 2018). Building stronger collaborative informs how it will spread and change over time. An understanding of the risks and teams or diversifying the skill set of team members improves the quality of infectious incidence of disease within a community is essential and can impact the direct care disease investigations and strengthens the impact of the guidance that state health and quality of education received during the secondary and tertiary phases of health departments provide to individual health care organizations. promotion (Aristo et al., 2018; National Institute of Health, 2017). PHN incorporation As the rate of emerging infectious diseases increases, it will become increasingly in investigatory teams improves the capacity of the public health workforce to build important to provide both targeted guidance and public health programming to control a culture of health as the United States strives to meet the new “triple aim” goals of infectious disease spread throughout all states and tribal lands in the U.S. (Rebmann & health care reform: advancing population health, lowering health care expenditures, Carrico, 2017). Disease investigation and management are most efficiently managed and improving the patient experience of care (Kub et al., 2017). with both nursing care and epidemiologic information. Nurses help improve the health Nursing science is based on etiology, the intrinsic, extrinsic, or idiopathic cause care environment for patients and staff, and when appropriately engaged in disease of a disease in an individual. Unlike nursing, epidemiology is the study of illnesses prevention and surveillance, can enhance population health. that impact a population. Epidemiologic research illustrates disease prevalence, References current trends, and its impact on society and our economy (Bartlett & Judge, 1997). American Public Health Association. (2013). Public Health Nursing Section. The definition Epidemiology is the next step to nursing science, investigating the root cause of an and practice of public health nursing: A statement of the public health nursing section. epidemic. Essential questions are: Who is sick? What are the symptoms of the disease Washington, DC: American Public Health Association https://www.apha.org/w/media/files/ displayed? Symptom onset? How was the person exposed? The who, what, when, pdf/membergroups/phn/nursingdefinition.ashx and where are the building blocks of an investigation, from which recommendations Ariosto, D., Harper, E., Wilson, M., Hull, S., Nahm, E., & Sylvia, M. (2018). Population health: A can be made to limit the spread of disease in the community. Nurses must understand nursing action plan, JAMIA Open, 1(1), 7–10. https://doi.org/10.1093/jamiaopen/ooy003 epidemiology to successfully diagnose and treat disease and prevent both hospital and Bartlett, P. C., & Judge, L. J. (1997). The role of epidemiology in public health. Revue scientifique et technique (International Office of Epizootics), 16(2), 331–336. https://doi.org/10.20506/ rst.16.2.1020 Bureau of Labor Statistics, U.S. Department of Labor. (2021). Occupational Outlook Handbook, Registered Nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.html Centers for Disease Control and Prevention (CDC). Epidemic Intelligence Service: Conducting a NursingALD.com can point you Field Investigation. https://www.cdc.gov/eis/field-epi-manual/chapters/Field-Investigation.html el Bcheraoui C, Mokdad AH, Dwyer-Lindgren L, et al. (2018). Trends and Patterns of Differences in Infectious Disease Mortality Among U.S. Counties, 1980-2014. JAMA, 319(12), 1248–1260. right to that perfect NURSING JOB! https://doi.10.1001/jama.2018.2089 Kub, J., Kulbok, P. & Miner, S. & Merrill, J. (2017). Increasing the capacity of public health nursing to strengthen the public health infrastructure and to promote and protect the health of communities and populations. Nursing Outlook, 65, 661-664. https://doi.10.1016/j. outlook.2017.08.009. Mulhall A. (1996) The application of epidemiology in nursing practice. In: Epidemiology, nursing and Healthcare. Palgrave, London. https://doi.org/10.1007/978-1-349-13579-0_6 NursingALD.com National Institutes of Health. (2017). Population Health Interventions: Integrating Individual and Group Level Evidence (R01). https://grants.nih.gov/grants/guide/pa-files/PA-16-146.html. Free to Nurses Nelson, K. (2014) ‘Epidemiology of Infectious Disease: General Principles’, in: Nelson, K., Williams, C. and Graham, N. (ed.) Infectious disease epidemiology: theory and practice, 3rd edition, Privacy Assured Jones & Bartlett Learning. Rebmann, T. & Carrico, R. (2017). Consistent Infection Prevention: Vital During Routine and

Easy to Use Emerging Infectious Diseases Care. OJIN: The Online Journal of Issues in Nursing, 22(1). https:// doi.10.3912/OJIN.Vol22No01Man01 Stonehouse, D. (2017). Understanding the nursing process. Healthcare Assistants, 11(8). https://doi. E-mailed Job Leads org/10.12968/bjha.2017.11.8.388 Younas, A. (2017). The nursing process and patient teaching. Nursing Made Incredibly Easy! 15(6), 13-16. https://doi. 10.1097/01.NME.0000525549.21786.b5 June, July, August 2021 DNA Reporter • Page 15 Will Your Next Prescription be for the Pharmacy or the Farmacy? Joanne Evans, MEd, RN, PMHCNS-BC, With over three million nurses, it seems we could make • Host a free online 10-day (McDougall) plant- ISNA Member a dramatic change in health care for people in the US, based program https://www.drmcdougall.com/ including Indiana, if we shared information about plant- health/education/free-mcdougall-program/ or Reprinted with permission from based nutrition. We all work in a wide variety of settings host a free 21-day (PCRM) online plant-based Indiana The Bulletin, February 2021 including hospitals, (state, local and private), ambulatory program – including menus, recipes, cooking clinics, outpatient offices, home healthcare, regulatory classes, and additional Information - https:// Almost 2500 years ago agencies, organizations, schools, residential care and etc. kickstart.pcrm.org/en Hippocrates said “Let food be I have volunteered to conduct several 21-day plant- your medicine and medicine be based programs utilizing the Physicians Committee There are several groups available specifically for nurses your food.” These words are still for Responsible Medicine (PCRM) which is a free on- interested in learning more about plant- based nutrition. relevant today. Some diseases line Kickstart program. The results were published PCRM hosts the Nurses Nutrition Network which provides are acute while others are in the American Journal of Nursing and the Holistic educational programs for nurses. https://www.pcrm.org/ chronic. Those that are chronic Nursing Association Journal. I collected lab work on good-nutrition/nutrition-for-clinicians/nurses-nutrition- may include heart disease, two occasions which supported the research already network. The American College of Lifestyle Medicine has hypertension, diabetes, asthma, published. Some people dropped up to 59 points in a nurses’ support group and has presentations open to arthritis, COPD, kidney disease cholesterol in 21 days while others also lost weight, all nurses. https://lifestylemedicine.org/What-is-Lifestyle- improved their energy and were sleeping better. and some cancers. Joanne Evans Medicine. There is also a new health care professionals The leading causes of death In talking with nurses around the country, there seem group forming in Indiana focusing on PBN and lifestyle to in the US from disease are heart disease, followed by to be many reasons nurses do not share information prevent and reverse chronic diseases. cancer, chronic lung disease, stroke, Alzheimer’s, diabetes about plant-based nutrition. They reported the following: There are about 110,00 nurses in Indiana. Our patients and chronic kidney disease. Diabetes is actually the fastest • Feel they do not know enough and were worried need to have a choice on how they will resolve their growing chronic disease in the US. In 2017, Indiana was they could not answer patient’s questions chronic health issues and nurses can educate patients ranked 6th in the country with diabetes being the leading • Think it was too difficult so they hear for the first time that there is a nutritional cause of death and 13th in the country with heart disease • Did not know who to refer patients to option to prevent and reverse many chronic diseases. as the leading cause of death. • Thought it may be too expensive Patients should be given all the options to make educated In 2014, they counted over 6600 medication • Thought patients may not be interested decisions about their health. Sometimes it starts with prescriptions plus over the counter medications. We can medication while they are making nutrition and lifestyle only imagine what the number is today. According to the When I spoke with nurses around the US, they shared changes. Eventually it may be the nutritional changes data from the National Health and Nutrition Examination that this form of nutritional information was not given alone that reverse the chronic disease process. Nurses Survey in 2015–2016, 45.8% of the U.S. population used to them in nursing schools. All the nurses interviewed have an opportunity to educate people to be healthier in prescription drugs. Nearly 40% of older adults take five or for my book, Cultivating Seeds of Health With Plant Indiana. Let 2021 be the time that it happens! more prescription drugs. All these medications have side Based Nutrition, Nurses Share Educational Approaches effects including nausea, fever, chills, headaches, itching, to Prevent and Reverse Chronic Disease (available on Resources wheezing, tightness in chest, vomiting, red and irritated Amazon) learned about PBN after graduation from eyes and the list goes on and on. Pharmaceuticals are their nursing programs. Some learned about it after Some examples of breakfast might be the following: actually the ones that benefit the most from people being their own illness and others when a family member • Cold cereal – with soymilk or rice milk with sick. became ill. Several nurses saw their patients taking peaches, berries or another fruit Is it possible that some of these chronic diseases could the recommended medications and they were still not • Whole grain toast with jam and fruit be prevented or reversed by nutrition? There has been getting well. Others recognized that “everything in extensive research for well over 40 years showing how moderation” was not working. Another group of nurses • Oatmeal with non-dairy milk with cinnamon and food can be used to treat and sometimes reverse many read the China Study by Dr. Colin Campbell or saw the raisins movie Forks Over Knives, both of which convinced them chronic diseases. There is continual research showing that • Blueberry buckwheat pancakes and meat-free that PBN was the way to treat many chronic diseases. plant-based nutrition: bacon • Prevents and reverses heart disease, diabetes and Once nurses become knowledgeable about plant- some cancers based nutrition, they have many options to share this information including: For lunch, you might consider: • Decreases cholesterol and reduce blood sugar levels • Talking with colleagues about plant-based • Veggie burger with whole grain bun and salad • Decreases obesity and complications from being nutrition (PBN) • Bean burrito, fruit overweight • Having plant-based food at all meetings and • Soy yogurt, fruit, vegetable soup, whole wheat • Improves mood, sleep, energy, depression, conferences bread anxiety • Hosting monthly pot lucks with colleagues and • Hummus wrap with whole wheat pita, shredded • Reverses many chronic diseases community groups (post Covid) carrots, cucumber, tomato • Increases work productivity • Show movies on PBN and discuss the information provided Some options for dinner might include: In a research study in five corporate locations in • Ask more detailed questions about nutrition on • Black bean chili with cornbread, salad, greens the US, those practicing plant-based nutrition (PBN) intakes with patients including • Whole grain pasta marinara with mixed showed improvement in body weight, blood sugar - How many fruits did you eat in past 24-48 vegetables, salad levels, and emotional state including depression and hours anxiety. In another study, diets that were higher in • Fajitas with peppers, onions, tomatoes, beans, - How may vegetables did you eat in past 24-48 plant foods and lower in animal foods were associated broccoli hours with a lower risk of cardiovascular morbidity and • Beans and rice with salsa, corn, salad mortality in a general population. The more people - How many portions of dairy food did you eat I past 24-48 hours adhered to a healthy plant-based diet, the lower their Resources for learning about plant-based nutrition risk of cardiovascular disease. In regards to obesity, - How many portions of meat did you eat in are the following: research shows that those who followed a plant-based past 24-48 hours • Becoming Vegan, Express Edition: The Everyday diet had more weight loss compared to those who - Have them complete a nutritional assessment - Guide to Plant-based Nutrition, Brenda Davis, RD followed a vegetarian and non-vegetarian diet that http://4leafsurvey.com and Melina Vesanto, MS, RD included diary, eggs, fish, or meat at two-month and • Have care plans include PBN six-month intervals. • The China Study. Startling Implications For Diet, What specifically is plant- based nutrition (PBN)? What • Have discharge summaries include PBN Weight Loss and Long-Term Health. T. Colin does it include? • Request PBN guest speakers in educational Campbell, PhD and with Thomas M. Campbell II, MD • Vegetables – dark greens, dark yellows and settings for undergraduate and graduate level • How Not to Die: Discover the Foods Scientifically orange, sweet potato etc. nursing programs Proven to Prevent and Reverse Disease, Michael • Whole Grains – pasta, rice, corn, whole grain • Incorporate PBN into all discussions about chronic Greger MD. FACLM and Gene Stone bread, tortilla etc diseases • How Not To Diet, Michael Greger MD • Fruit – whole fruit which is better than juice due • Join a community PBN group or start one • The Starch Solution, John McDougall MD to fiber • Collaborate with other health care providers • The Vegan Starter Kit: Everything You Need to • Legumes – beans, peas, lentils, tofu, soymilk, interested in PBN Know About Plant-Based Eating, Neal Barnard MD chick peas etc. • Encourage hospitals to have plant-based foods at • Prevent and Reverse Heart Disease, Dr Caldwell • Nuts and seeds all meals Esselstyn • limited processed foods • Monthly lunches with discussions on various PBN • avoiding oil, flour and sugar topics (post Covid) Pharmacy or Farmacy continued on page 16 Page 16 • DNA Reporter June, July, August 2021

Pharmacy or Farmacy continued from page 15

Some good cookbooks are: • Dr. Neal Barnard’s Cookbook for Reversing Diabetes: 150 Recipes Scientifically Proven to Reverse Diabetes Without Drugs, by Neal Barnard MD and Dreena Burton • The China Study Cookbook by Leanne Campbell, PhD • Engine 2 Cookbook by Rip Esselstyn and Jane Esselstyn • Forks Over Knives–The Cookbook: Over 300 Recipes for Plant-Based Eating All Through the Year, by Del Sroufe, Isa Chandra Moskowitz, Julieane Hever MS, RD, CPT, Darshana Thacker, Judy Micklewright • The Get Healthy, Go Vegan Cookbook: 125 Easy and Delicious Recipes to Jump-Start Weight Loss and Help You Feel Great, Neal Barnard, MD • How Not to Die Cookbook, Michael Greger, MD • The McDougall Quick and Easy Cookbook: Over 300 Delicious Low-Fat Recipes You Can Prepare in Fifteen Minutes or Less, John McDougall, MD and Mary McDougall • Prevent and Reverse Heart Disease Cookbook, Ann Crile Esselstyn and Jane Esselstyn

Nurses interested in websites might consider: • Dr. Greger - https://nutritionfacts.org - updated research on nutrition and disease – many short videos • American College of Lifestyle - https://www.lifestylemedicine.org • Dr. McDougall - www.drmcdougall.com – free newsletters, testimonials, current research, Starch Based Solution Certificate Program, 10-day residential programs • Physicians Committee for Responsible Medicine - www.pcrm.org – free monthly Kickstart programs, newsletters, current research, multiple languages, handouts for offices • Forks Over Knives - https://www.forksoverknives.com/ - recipes, plant-based news, meal plans, success stories, cooking course • Plantrician Project - https://plantricianproject.org/vision - list of plant-based doctors, peer review journal, conferences, cooking class, research and more

Nurses looking for apps may be interested in: • 21-DayVegan Kickstart – PCRM • Dr. McDougall Mobile Cookbook • Forks Over Knives • Michael Greger - Dr. Gregers’ Daily Dozen

Some good plant-based movies are: • Forks Over Knives – especially for diabetes, heart disease and chronic health issues • Code Blue – focusing on medical training and health care system • Game Changers- focus on vegan athletes • Cowspiracy – focus on the environment • Food Inc – food supply and industry • Eating You Alive − food connected to chronic disease • Meat the Truth − livestock farming and the environment

Joanne Evans MEd, RN, PMHCNS is an advanced practice nurse and has been practicing for almost 50 years. She is certified in plant-based nutrition by two national organizations and has been a speaker at many national, state, and local nursing conferences. She has published on this topic in several journals in nursing organizations. She recently published Cultivating Seeds of Health With Plant Based Nutrition, Nurses Share Educational Approaches to Prevent and Reverse Chronic Disease which is available on Amazon. She can be reached at [email protected].

References American Association of Nurse Practitioners Journal. A whole-food plant-based experiential education program for health care providers results in personal and professional changes. Oct 2019. A. Lessem, S. Gould, J. Evans et al. American Journal of Nursing, March 2017 – A Plant-based program – Nurses experience the benefits and challenges of following a plant-based diet American Journal of Holistic Nursing, April 2015 - Plant-based nutrition: Will your next prescription be for the farmers market OR the pharmacy Martin CB, Hales CM, Gu Q, Ogden CL. Prescription drug use in the United States, 2015– 2016. NCHS Data Brief, no 334. Hyattsville, MD: National Center for Health Statistics. 2019. https://www.cdc.gov/nchs/products/databriefs/db334.htm Katcher, H.I., Ferdowsian, H.R., Hoover, V.J., et al. (2010) A worksite vegan nutrition program is well accepted and improves health-related quality of life and work productivity. Ann Nutr Metab, 56(4), 245-52 Agarwal, S., Mishra, S., Xu, J., Levin, S., Barnard, N.D., (2015) A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: The GEICO Study. Am J Health Promot 29(4), 245-54. Trapp, C., Barnard, N., Katcher, H. A Plant-based diet for type 2 diabetes. (2010, February, 25). Diabetes Educator. https://journals.sagepub.com/doi/10.1177/0145721709357797 Roberts, W.C., (2010) It’s the cholesterol, stupid! Am J Cardiology. 106(9),1364-6. Esselstyn CB, Jr., et al. A way to reverse CAD? J Fam Pract 2014;63(7):356-64. Turner-McGrievy, G.M., et al. (2015). Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. Nutrition 31(2), 350-8. June, July, August 2021 DNA Reporter • Page 17 New, Renewing, & Returning Members

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Northeast Treatment Center, (NET), one of the Gaudenzia is hiring and would love largest behavioral health and social service for you to be a part of our team! agencies, offers support and hope to individuals and families at times of great stress in their lives. We are currently offering a sign-on NET is recruiting qualified nurses to fill rewarding bonus for our nursing positions! positions at multiple locations in DE & PA! Full-time and part-time opportunities available for Registered Nurses, $IGN ON BONUS! Licensed Practical Nurses, and Nurse Managers at our locations throughout Delaware, Maryland and Pennsylvania. Kirkwood Recovery Center (Wilmington, DE) is hiring full and part time Join a team recognized for saving lives by stepping into healthcare's most RN’s and LPN’s for any of the three (8 hour) shifts...7-3, 3-11 or 11-7. innovative spaces with us! We are an employer of choice in the field of treatment Access Point (Philadelphia, PA) is hiring full and part time RN’s and LPN’s for Substance Use Disorders and welcome new ideas and capabilities. The future for any of the three (8 hour) shifts...7-3, 3-11 or 11-7. is what you make it! To learn more about Gaudenzia and our Nursing openings NET Steps (Northeast Philadelphia, PA) is hiring full time and PRN LPN’s please contact Aaron Smith: for M-F 5a - 1p and/or 7a-3pm and 5am-1:30p Sat-Sun. [email protected] 610.213.2197 Send resume and position of interest to [email protected]. https://www.gaudenzia.org/careers/ or apply via our website: www.netcenters.org... join our team! Equal Opportunity Employer Page 18 • DNA Reporter June, July, August 2021 Advocacy Updates Annamarie Flick, MSN, RN-BC, NE-BC, Advocacy Director *Note: status of bills is reported at the time of this article’s submission, June 1, and the Delaware General Assembly remained in session until June 30. For up-to-date status of The 151st Delaware General Assembly convened bills, please review the Advocacy section of the DNA website. starting January 12 and remained in session until June 30, 2021. The Advocacy Committee of the Delaware Nurses House Bills 21 & 141 – APRN Legislation Association completed significant review of all bills and Most notably this session was the introduction of two pivotal pieces of policy commented on those that affected the practice of nursing, affecting the practice of our Advanced Practice Registered Nurses in Delaware. healthcare delivery, and/or social determinants of health for House Bill 21 seeks to adopt the multi state licensure compact model for APRN Delawareans. Members of the committee and leaders of the licensure as adopted by the National Council of State Boards of Nursing in August association spoke at committee hearings, connected with 2020. House Bill 141 is a companion bill to House Bill 21 that accomplishes many legislators, and worked with partners to ensure nurses were things: removes collaborative agreement requirements, adopts full practice authority informing policy decisions and advocating for advances that language, grants full practice authority to APRNs upon licensure, and restructures align with our Code of Ethics for Nurses, Nursing: Scope & the APRN Committee of the Delaware Board of Nursing to include APRNs only. Annamarie Flick Standards of Practice, and Nursing’s Social Policy Statement. The Delaware Nurses Association worked tirelessly and closely with key partners Our elected officials were extremely busy both virtually, hybrid, and eventually to move this critical legislation through the Delaware General Assembly. DNA thanks returning to in person sessions at Legislative Hall in Dover, DE. There were Dr. Pamela Zickafoose, EdD, MSN, RN, NE-BC, CNE, FRE, the Delaware Division of over 500 pieces of legislation (this figure also includes concurrent resolutions, Professional Regulation, Delaware Board of Nursing, Representative Melissa Minor- recommendations, and proclamations) that the 151st Delaware General Assembly Brown, MSN, RN, and over a dozen other supporting groups for their work on HB drafted and introduced in this session. The Advocacy Committee and Board of 21 and HB 141. Please view the APRN Legislation webpage on the DNA website for Directors of the Delaware Nurses Association is committed to ensuring these policies current status of both bills. advance the health of Delawareans through the art and science of nursing. I am humbled to present you with an overview of the legislation we reviewed and took a Senate Bill 1 – the Healthy Delaware Families Act position on. Another key focus for DNA during this past legislation session was Senate Bill 1, known as the Healthy Delaware Families Act. DNA joined the Delaware Cares Advocacy Allies & Committee Meetings Coalition prior to the bills release in support of universal paid family and medical The Advocacy Committee of the Delaware Nurses Association is nearly full with leave for all Delawareans. The Delaware Cares Coalition is a group of over 50 health, members from across the state and our organizational affiliates. That does not mean we social, religious, business, and advocacy groups supporting this landmark policy. don’t have a role for interested nurses. Do you want to get more involved with advocacy DNA discussed and joined because we know that choosing between your job and work but can’t commit to the full committee? Do you want to make a broader impact addressing a family or medical need does not equal health equity for Delawareans. on nursing and health policy at the state level? We are serious about advancing policies that address social determinants of health The Advocacy Ally is a unique and new role that is connected closely with the and social equity, guided by our Code of Ethics for Nurses. Advocacy Committee. The Advocacy Ally is a non-voting member of the Advocacy Committee and has no requirements for meeting attendance. The role is for novice or House Bill 20 – Free Feminine Hygiene Products in Delaware Schools experienced nurses that want to be involved and generate impact. Your responsibilities Status: signed by Governor Carney on April 8, 2021 include: Supported by DNA • Maintain current awareness of Delaware bills that DNA has reviewed and Summary: This bill requires all public and charter schools which have students in developed an official position statement on. grades 6-12 to provide free feminine hygiene products in 50% of the bathrooms • Occasionally attend DNA Advocacy Committee Meetings as able. used by students who can have a menstrual cycle. This bill also requires schools to o The Advocacy Committee meets the 4th Monday monthly at 6:00pm via publish on its website and post in its common areas the locations of the bathrooms Zoom. where the hygiene products are provided. Finally, this bill provides that each school o All Delaware nurses and students are welcome to attend for observation as must consult with its school nurse regarding the products to be provided. well! o Check out the DNA website “Events” listing for meeting information. House Bill 33 – Related to Physician Assistant Relationships • Compose letters of support or opposition and send to Delaware legislators. Status: signed by Governor Carney on April 13, 2021 • Raise awareness of DNA advocacy activities via your professional and personal Supported by DNA nursing networks. Summary: This bill changes the relationship between physicians and physician • Identify a particular area of subject matter expertise you may have and be willing assistants from supervisory to collaborative, in recognition of the evolving role of to provide expert testimony as needed and able on behalf of DNA. physician assistants and reflecting the education, training, and experience required for licensing, which emphasizes the team-based practice model. Interested in learning more and potentially serving in this role? House Bill 35 – Establishes a Department of Education Behavioral Health Connect with us via email or phone: [email protected] or 302-733-5880 Professional of the Year Status: signed by Governor Carney on February 17, 2021 Supported by DNA Summary: This bill establishes a Behavioral Health Professional of the year award program throughout the State. Through this legislation, the state will formally honor and recognize the work behavioral health professionals, such as, school counselors, social workers, licensed clinical social workers, school psychologists, and school nurses.

Senate Bill 108 – Requires an Ultrasound and Fetal Heart Tone Auscultation Prior to Terminating a Pregnancy Status: in Senate Committee Not Supported by DNA Summary: This bill requires a physician to offer a patient ultrasound imaging and auscultation of fetal heart tone services before terminating a pregnancy and provides civil and criminal penalties for the failure of a physician to comply with this requirement.

House Bill 62 – Limits Excessive and Unconscionable Prices for Prescription Drugs Status: in House Committee Supported by DNA Summary: This bill is based on a Model Act to Prevent Excessive and Unconscionable Prices for Prescription Drugs developed by the National Academy for State Health Policy. It prohibits manufacturers from raising the price of prescription drugs outside of certain market conditions that might justify a price hike. It is specifically limited to the prices charged to consumers in the State of Delaware for generic and off-patent drugs. It authorizes the Attorney General to investigate price Change lives in a meaningful way. Help us rebuild families torn increases identified by State agencies above a certain threshold. Manufacturers or apart by the disease of addiction. Apply today! distributors may be fined up to $10,000 per day for sales which violate the Act. Each www.RCABracebridgeHallNurses.com sale of a drug excessively and unconscionably priced constitutes a separate violation. A manufacturer or distributor is prohibited from withdrawing a generic or off-patent drug for sale in this State to avoid application of the Act. June, July, August 2021 DNA Reporter • Page 19

House Bill 39 – Out of Network Health Insurance Coverage House Bill 160 – Preserving Telehealth Provisions in Delaware Code Status: in House Committee Status: passed Senate and House of Representatives, awaiting Governor’s Supported by DNA signature Summary: This bill requires that inadvertent out-of-network services be included Supported by DNA in individual and group health insurance policies as well as group and blank health Summary: This bill, known as the Telehealth Access Preservation and insurance policies. This bill defines inadvertent out-of-network services are those Modernization Act of 2021, continues and enhances Delawareans’ access to services that are covered under a policy or contract of health insurances but are telehealth and telemedicine services and, through the adoption of the Interstate provided by an out-of-network provider in an in-network facility, or when in- Medical Licensure Compact, ensures that telehealth services can be provided network health care services are unavailable or not made available to the insured through qualified medical practitioners in a streamlined and efficient pathway in the facility. Inadvertent out-of-network services also includes laboratory testing to licensure that meets the health care delivery system needs of the 21st century. ordered by an in-network provider but performed by an out-of-network laboratory. With respect to telemedicine and telehealth, this Act consolidates the existing law relating to telehealth within a single new chapter applicable to all health- House Bill 100 – Mental Health Services Unit for Delaware Elementary Schools care providers authorized to practice telemedicine and participate in telehealth Status: in House Committee and makes permanent the telehealth flexibilities put in place for the Covid-19 Supported by DNA pandemic. The Act carries through many of the changes embodied in the Summary: This bill establishes a mental health services unit for Delaware elementary Covid-19 telehealth legislation passed by the 150th General Assembly in 2020 schools. The unit is at a ratio of 250 full-time equivalent students grades K-5 for a (HS 1 for HB 348 with HA1, signed 7/17/20), which will otherwise expire on July full-time school counselor, school social worker, or licensed clinical social worker. 1, 2021. Additionally, a unit ratio of 700 full time equivalent students for grades K-5 for employment of a full-time school psychologist. This Act defines “mental health services” Senate Bill 15 – Minimum Wage for Delawareans as prevention, response, and coordination services delivered to students in elementary Status: passed Senate, currently in House of Representatives committee schools. Supported by DNA Summary: This bill provides for gradual increases in the Delaware minimum House Bill 48 – Primary Care Provider Loan Repayment Program wage to $15 over a period of several years. Status: in House Committee Supported by DNA Senate Bill 12 – Expanding SEED to Adult Delaware Residents Summary: This bill establishes a Health Care Provider Loan Repayment Program Status: passed Senate, currently in House of Representatives committee for new primary care providers to be administered by the Delaware Health Care Supported by DNA Commission. Under the loan repayment program, the Health Care Commission may Summary: The purpose of this act is to open The Delaware Student Excellence award education loan repayment grants to new primary care providers of up to $50,000 Equals Degree Act (SEED Act) to adult Delaware residents, who are not recent per year for a maximum of four years. high school graduates. Currently, about 56% of Delawareans age 25-64 lack a post-secondary degree. This expansion of the SEED grant program will Senate Bill 60 – Medical Marijuana Prescribing by APRNs and PAs encourage adult learners to return to school to enhance their knowledge and Status: passed Senate and House of Representatives, awaiting Governor’s signature skills and increase their job opportunities. Adult individuals with a high school Supported by DNA diploma or less education were significantly impacted by Covid-19-related job Summary: This bills allows advanced practice registered nurses and physician loss. This legislation can help to mitigate the effects of the pandemic on those assistants to recommend medical marijuana for adult patients. adults.

House Bill 95 – Insurance Coverage of Epinephrine Autoinjectors for Individuals Senate Bill 107 – Insurance Coverage for Medically Necessary Insulin 18 and under Pumps Status: passed Senate and House of Representatives, awaiting Governor’s signature Status: passed Senate, currently in House of Representatives committee Supported by DNA Supported by DNA Summary: This Act requires that individual, group, State employee, and public Summary: This bill requires that individual, group, State employee, and public assistance insurance plans provide coverage for epinephrine autoinjectors for individuals assistance insurance plans provide coverage for a medically necessary insulin who are 18 years of age or under and must include at least one formulation of pump at no cost to a covered individual. epinephrine autoinjectors on the lowest tier of the drug formulary developed and maintained by the carrier if the insurance plan has tiers. Senate Bill 120 – Primary Care Services Reformation Status: passed Senate, in House of Representatives committee Senate Bill 55 – Epinephrine Autoinjectors in Higher Education Institutions Under investigation by DNA Status: passed Senate and House of Representatives, awaiting Governor’s signature Summary: This Act is a substitute for Senate Bill No. 120. Like Senate Bill Supported by DNA No. 120, this Substitute continues recent efforts to strengthen the primary Summary: This bill creates emergency access to epinephrine that allows an care system in this State by doing the following: (1) Directing the Health Care institution of higher education to acquire and stock a supply of epinephrine Commission to monitor compliance with value-based care delivery models autoinjectors if an employee or agent has completed a training program. This and develop, and monitor compliance with, alternative payment methods Act allows the individual who has completed the training program to provide an that promote value-based care. (2) Requiring rate filings limit aggregate unit epinephrine autoinjector to someone experiencing anaphylaxis for immediate self- price growth for inpatient, outpatient, and other medical services, to certain administration or administer an epinephrine autoinjector to someone experiencing percentage increases. (3) Requiring an insurance carrier to spend a certain anaphylaxis. percentage of its total cost on primary care. (4) Requiring the Office of Value- Based Health Care Delivery to establish mandatory minimums for payment House Bill 87 – Restructuring the Human Trafficking Interagency Coordinating innovations, including alternative payment models, and evaluate annually Council whether primary care spending is increasing in compliance with the established Status: passed Senate and House of Representatives, awaiting Governor’s signature mandatory minimums for payment innovations. (5) In Sections 2 and 3 of this Supported by DNA Act, revising the appointment process for members of the Primary Care Reform Summary: This bill increases the membership of the Human Trafficking Interagency Collaborative who are not members by virtue of position to comply with the Coordinating Council to 24 members by adding representatives from the House requirements of the Delaware Constitution. of Representatives, the Senate, the Criminal Justice Council, the Department of Transportation, and the Division of Professional Regulation, a person who has been a Senate Bill 76 – Provision of Fentanyl Testing Strips victim of human trafficking, and a person who has prior experience working with Status: passed Senate and House of Representatives, awaiting Governor’s victims of human trafficking in a legal or advocacy capacity. signature Under investigation by DNA House Bill 69 – Pilot Program for Residential Drinking Water Purification Summary: This Act authorizes the distribution of testing strips to determine System the presence of fentanyl or fentanyl-related substances. Fentanyl testing strips Status: on the House of Representatives ready list could be distributed to the community along with opioid overdose reversal Supported by DNA medication as a harm reduction strategy in the opioid addiction crisis. Summary: This bill establishes a two-year residential drinking water purification system pilot program to be administered through the Department of Health and Social Senate Bill 87 – Provision of Access to a Patient’s Delaware Health Services with funding through the Drinking Water State Revolving Fund. Information Network Records to Delaware’s Organ Procurement Organization (Gift of Life) House Bill 111 – Insurance Discrimination Prevention for Individuals on PrEP Status: passed Senate, in House of Representatives committee Status: passed Senate and House of Representatives, awaiting Governor’s signature Under investigation by DNA Supported by DNA Summary: This Act requires the Delaware Health Information Network Summary: Individuals who are at very high risk of getting HIV can take pre-exposure (“DHIN”) to provide the Gift of Life program – the State’s approved organ prophylaxis (“PrEP”) medication to reduce the risk of HIV transmission. PrEP medication procurement organization, or “OPO” – with access to data on potential reduces the risk of HIV transmission by up to 99% if taken daily. This Act prohibits anatomical donors when the data is needed to determine the suitability for discrimination because an individual takes PrEP medication in the issuance or renewal of organ, tissue and eye donation for any purpose identified in Delaware’s Uniform disability, long-term care, and life insurance. Anatomical Gift Act.