Association ofCampNurses www.ACN.org

. . .working for healthier camp communities by supporting the practice of camp nursing. Our View In ThisIssue… Education &Camps Education Perspectives Worth Sharing: Interprofessional A SurpriseforSusanBaird! Super Sleuth Teaching CampStaff toGiveMedications Camp Collectionat Data Editorial: IsPublication Your NextStep? know thatyouhaveleftadeepimpactonthecampnursingprofession. of thosearound her. Thankyou,Susan,forallyouhavedoneACNand all relationships and future writingexperiences.Shehasbeenabeaconoflightandsource ofsupportfor the uniqueopportunitytoworkcloselywithSusanandhopecarryhervision,sharingspiritthrough benefit. instrumental to our organizational success. in manyimpactfulways.Herworkhasbeenfoundationalduringourformativeyearsandherinfluence mentored numerous individuals,encouragedandpromoted ourpublication,andservedACNmembers served as the CompassPoint editor for over 10 years. During this time, she has written many articles, behind thescenes,isnotpresent. Thatindividualisour services. fortunate tobepartofthisfamilycampleadersandhealthcare providers investedinqualitycamp hope theseprofessionals gainedknowledgeandanetworkofsupportthrough theevent.We feelso the successesandchallengesincamphealthservices.There were manyfirst-timeattendeesandwe weeks wehavemetnewfriends,reconnected witholdfriends,shookmanyhands,andconversedabout CompassPoint contributors.We wishherthebestandknowthatshewillcontinuetoimpactlives ...... If youwanttosendSusananoteofthanks,feelfree [email protected] Susan hasdecidedthattheJune2017editionof Although ACNmembersseemanyboard membersattheevent,oneindividual,whoworksdiligently The 2017CampNurseSymposiumisjustendingasweputtogetherourthoughts.Inthepastfew ...... Paula Lauer, President ACNandTracey Gaslin,ExecutiveDirector, ACN ...... –My(Our)View – CompassPoint continues to be our number one member 15 12 11 6 3 2 1

CompassPoint willbeherlast.Manyofushavehad Practice Updates Certificate inCampNursing:Certificate Changeisinthe Air! News Association ACN 2017SymposiumHighlights New Products, NewIdeas Camp Health–ClinicallySpeaking: Health CenterInventory CompassPoint editor, SusanBaird. Susanhas Tracey Gaslin Paula Lauer Much Appreciation Susan forBeingYou! March 2017 volume 27, number 1 March 2017volume27,number ...... CompassPoint. We hopeyou ...... 31 29 28 26 24 19 Volume 27, No. 1

Editorial: Is Publication Your Next Step?

How do you feel about settling down and writing to share audience. The oral presentation might even be considered your expertise with others? Some love the challenge, others a dress rehearsal for the written presentation. Audience avoid writing whenever possible. ACN's Executive Director questions inform the presenter about aspects that might need Tracey Gaslin recently wrote to a potential author saying, "I love enhancement or clarification. to write." and offering assistance with getting some important information into print. Past ACN Executive Director Linda Erceg Many readers and presenters have told me they want to was given the CompassPoint Writing Award at the recent ACN write but just don't know how to get started. They return home Symposium, in part for an article she wrote titled "Write Right." from a meeting, like the Symposium, and put their notes and Linda contributes regularly to CompassPoint and we are all the Power Point program aside. The work they've done falls into better for her sharing. Those fortunate enough to attend the the "someday, sometime" abyss. The incident from last season Symposium heard some timely and informative presentations. that would make a terrific case study somehow gets left at How amazing it would be if those same presenters would take camp. What is needed to get started? Here are a few things their presentations and convert them into manuscripts. that have helped me, and others, get writing!

I once had a Department Head, back in my oncology • Write from experience. You may need the literature to days, who was looking at my CV and pointed out that it was support or inform your content, but start with a subject you somewhat unbalanced, that I had far more presentations than know something about or that interests you. publications. You do all that work, he said, but sharing was • Develop a purpose statement. "The purpose of this paper limited because you stopped short of publishing. He was right. is to ____ readers about ___. Is the purpose to inform, A lesson I've never forgotten. When a presenter goes the next update, describe, or ___?" This statement guides the paper, step and turns a presentation into a manuscript to be shared keeps you from going astray, and helps you focus on which with a larger audience, like the CompassPoint readership, content should be included and which content is useful the article will then be indexed and retrievable by a broader and related but does not directly match your purpose. Continued on page 14

ACN Board ACN Board

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

CompassPoint is an official publication of the Association of Camp Nurses (ACN), a not-for-profit nursing organization. CompassPoint is published four times a year and is intended as an informational resource only. Neither ACN nor its staff can be held liable for the practical application of any ideas found herein. Readers are invited to submit items for publication to Susan Baird, Editor, via email at [email protected]. Contents may not be reproduced without prior written consent. Member dues and subscription fees are $60 annually. CompassPoint is a peer reviewed publication indexed in CINAHL. © 2017

2 March 2017

Data Collection at Camp Beth Schultz, DNP, MSN, BSN, RN

Abstract: Taking the time to collect data can provide insight into what challenges are routinely seeing in a specific camp setting. Being able to anticipate the needs to the campers, staff and camp nurses can decrease anxiety and increase positive outcomes in the camp setting. Basic data collection can be done by any camp nurse and is the basis for providing safe, up-to-date, patient-centered quality care by promoting teamwork and collaboration, and being involved in quality improvement in the.

The summer of 2016 was my second summer at Camp Staffing the Health Center: McCall, an all-boys, faith-based camp in the mountains of The Health Center is staffed by Registered Nurses or northwest South Carolina. I found my new camp adventure very Advanced Practice Nurses during camp sessions. We had a challenging and the Health Center much busier with a different total of 11 nurses who covered the 2016 summer sessions. set of camper and staff challenges than the all-girls camp I was They ranged from recently licensed nurses to nurses who have used to. Stocking and planning for my first summer experience more than 60 years of nursing experience. Some of the nurses was a guessing game, at best. Because of this, I decided that only work short, three day camps while others stay five days. gathering data throughout the second summer would help the During the three day camps, when adults accompany campers nurses gain valuable information to plan for future summers as to camp, the Health Center is staffed with one nurse. The camp well as maintain needed supplies throughout the camp season. nurse provides care on an as needed basis to campers, both I created a form to be used by the camp nurses each week adult and children, and staff during the camp session. The nurse to document what complaints were addressed, what supplies doesn’t administer medications to campers during the short were used and which medications were administered and also sessions as the adults who bring the campers are responsible what additional equipment was needed in the Health Center. for administering medications and taking care of basic needs. We modified the form as the summer progressed to better Health forms are collected during check in for both adult and meet our needs. We also gathered information about numbers child campers. During five day camps, when the camp nurse of campers each week and numbers of visits to the Health is responsible for passing medications to campers, there are Center. Initiating information gathering is a great first step in two nurses scheduled during the day and at least one nurse providing care using evidenced based practice, collecting data scheduled overnight. for research, and planning for the needs of the campers and Common Visits to the Health Center staff. This information can also be used to help camp staff Information was categorized by major body system address safety issues within the camp setting and provide for the ease of collection. valuable information to the nurses working in the Health Center. Integumentary: Stings, scraps and rashes which included Summer Statistics poison ivy had the highest number of visits, which resulted in 73 During the summer of 2016 there were a total of 1700 visits to the Health Center over the course of the summer. We campers on site: a combination of both adult and children, had several cases of stubbed toes and blistered feet, 10 visits. and 30 staff. Over the course of the summer, there were a Campers not wearing proper footwear for the activities in camp total of 410 documented visits to the Health Center by both was a big problem. All the campers go on a “big hike” during campers and staff. During the summer there were seven camps the week and we often have campers wearing shoes that are that were three day sessions and five camps that were five inappropriate. Another challenge at camp is campers wearing day sessions. Three day sessions are for campers who have wet bathing suits throughout the day and developing chafing adults attending camp with them. The adults are responsible which becomes extremely uncomfortable and painful, 17 visits. for taking care of daily medication needs. During five day camp This summer I am hoping to provide more education to staff sessions there are no adults in the camp other than the camp and also consider having powder in each cabin for campers to staff, and the camp nurses are responsible for administering use with staff supervision. medications to campers. There was an average of 35 campers Gastrointestinal: There were a total of 49 visits with GI a session receiving scheduled medications. The same staff symptoms with complaints of nausea, upset stomach, served throughout the summer and nurses administered abdominal pain and cramps being the most frequent. There scheduled staff medications as well. The staff are screened at were also nine visits for diarrhea and six visits for indigestion. the beginning of the summer by camp physicians. Screening Handwashing is a challenge at camp and often addressed by includes vital signs, a physical exam and a quick results urine the nursing staff. drug screen which is administered by the camp nurses.

3 Volume 27, No. 1

Musculoskeletal: Sprains/strains combined resulted in 41 that was uncontrolled by topical treatment for two different visits. We had one fracture, one contusion, three muscle pains, staffers, for a staffer who developed pink eye and for another seven leg cramps and four jammed fingers. The activities that who developed an infected hair follicle. are most popular at camp are precursors to musculoskeletal Medications/Treatments Administered: injuries in the active population of young boys. One of the items that we keep well stocked in the Health Neurological: Headaches accounted for 47 visits. There were Center is individual bottles of sports drinks. Although we are also one head injury, 1 concussion and 3 cases of dizziness. in the mountains of South Carolina, summer days can be Although not all headaches are related to neurological issues, extremely hot and even with water stations throughout camp having a concussion plan at a boys camp is vital when there and the encouragement of staff, campers can’t seem to stay are planned activities that can potentially lead to concussions. well hydrated. A cold sports drink right out of the refrigerator One of the first thoughts of the camp nurses when a camper or is often appealing to a camper or staffer no matter what their staffer complain of a headache and there has been no history primary complaint is. See Table 1 for frequently administered of injury is dehydration. medications. Eyes/Ears: Ear ache and otitis externa complaints were Essential Supplies addressed. We also 2 people with styes and 1 foreign body in Since we have physicians we can call for verbal orders, the eye. we do stock two different antibiotics in the Health Center. The Generalized Complaints: Body aches, anaphylaxis, weakness, camp nurse has the ability to relay assessment findings to the viral symptoms, nose bleeds, and mouth irritations were physician and receive a verbal order to administer antibiotics. noted under the “general” category. Management of diabetes We have epinephrine auto injectors across camp as well as accounted for 36 visits to the Health Center or care by the rescue inhalers. We have boxes of break and shake cold packs. camp nurse. By keeping track of supplies used we will better be able to stock the Health Center at the beginning of the summer. Another Care Providers way of tracking supplies is through Moore Medical. We order What Staffers Take Care Of: The camp staff carry first aid kids supplies at the beginning of the summer and again midway and do take care of minor complaints. Sting kill is an essential through the summer. Moore Medical will provide us with a list of supply and often restocked. The staff take care of minor scrapes what was ordered and when. This list helps us determine what and scratches throughout the day and have a supply of band we need to order for next summer. aids and first aid cream. They receive first aid training during camp training and some have had wilderness first aid training. Cleaning Out Supplies If there are supplies in the Health Center that have not Camp MD Called/Visits to the ED/Campers Sent Home: been used for several summers, consider getting rid of them. Two visits were made to the local emergency department for We had supplies that had not been used for several summers lacerations that required sutures, another for evaluation of and as hard as it was, they had to be tossed. Another option, a concussion. One camper was sent home after being stung if supplies are unopened and not expired, is to give them to a by yellow jackets and developing questionable anaphylaxis local agency that serves the homeless. symptoms. Another camper was sent home after developing Up until the summer of 2016, there was no central heat and a temperature of 101.8. The physician providing direction for air in the Health Center and the camp nurses were concerned the camp was called and prescribed treatment for poison ivy

Body System Most Frequently Administered Medications Respiratory OTC allergy medication Throat lozenges Integumentary Wound Wash Topical creams/ointments Sting Kill Antifungal powder Musculoskeletal Ice packs Pain reliever Neurological (headache) Ibuprofen Acetaminophen Eyes/Ears/Nose Eye Wash Swimmer’s Ear drops Gastrointestinal Antacids Anti-diarrheal medication Unclassified Diphenhydramine Table 1. Medications Given at Camp

4 March 2017 about the integrity of the supplies. An age old saying, “When in Planning for Camp 2017 doubt throw it out” should be applied to supplies in the Health As we prepare for the 2017 camp season, having the data Center. Frequently used supplies should not be over ordered we collected last summer will help us plan for staff training as if the integrity could be compromised. Reordering is better well as for nurse orientation and stocking the Health Center. This than ordering so much that it would take several years to use summer we will expand our staff training regarding identification up what is on hand. Consider mold spores in places that are and treatment of concussions. We will continue to encourage not climate controlled. Opened and partially used packages of hand hygiene, staying hydrated and educate campers and staff medications should be evaluated and perhaps discarded at the about proper footwear. end of the summer or donated, if appropriate. Conclusion Recommendations based on data collected Taking the time to collect data during the camp season Handwashing: Meals are served family style in the Dining Hall. provides valuable information to help the nurses anticipate the There are no handwashing stations outside of the Dining Hall. needs of the campers and staff. Data collection can also help When the nurses started collecting data, they noted several health care providers make decisions about what training needs complaints of upset stomach. Staff were educated about the to take place for the camp and health center staff as well as spread of gastrointestinal disease. Hand sanitizing stations what supplies need to be stocked for the season. Completing were set up outside of the Dining Hall and staff were asked to the data collection sheet at the end of each week took less promote camper use of the sanitizer before entering the Dining than 30 minutes and none of the nurses felt that it was too Hall. time consuming or involved. The camp nurses reviewed the log as well as any nurse’s notes that were completed. Having just Health Forms: Another challenge is that camper health forms completed the week the information of what supplies needed are not received prior to the first day of camp. During the 2016 to be restocked was readily available and was beneficial for the camp season two campers with Type 1 Diabetes presented on nurses coming to camp the following week. The information check-in day having had no prior contact with the camp nurses. gathered is shared with the camp director at the end of the camp One mom stating, “I talked with someone in the office and season unless the nurse feels the situation needs immediate was told this would not be a problem.” Diabetes is difficult to attention and in that case the information is shared that week. manage in our camp setting because the menu has many foods that are high in carbohydrates, the canteen has snacks that are Beth Schultz DNP, MSN, BSN, RN, chairs the Undergraduate Nursing typically high in carbohydrates and the staff are not expected Programs at Anderson University in Anderson, SC. She serves on the Executive Board of ACN, is a member of the Research Committee, and to specifically monitor what the campers are eating or buying recently worked as part of a group that revised of the Scope and Stan- from the canteen. The nurses working in the Health Center may dards of Camp Nursing Practice. She first served as a camp nurse in or may not have current experience managing Type 1 Diabetes 1992. on a daily basis. We do have one nurse that works in the local schools who had the most experience assisting kids with Camp McCall is an all-boys mission’s based camp in Sunset, South Carolina and is associated with the South Carolina Baptist Convention. diabetes management but the majority of the nurses are not The camp was established in 1959 and serves boys aged 6-18. familiar with carbohydrate counting and diabetes management in pediatric patients. Prior notification and discussion with the parent would have facilitated better preparedness. Footwear: Appropriate footwear is an ongoing challenge at camp. Campers are not required to wear closed toed shoes at camp and so we see many blistered feet and scraped up toes. This year a letter will go out to parents that specifically addresses appropriate footwear. This is especially challenging when they are taking hikes and playing group games that involve physical contact and running. The staff do not consistently wear close-toed shoes so encouraging and enforcing this practice is extremely difficult.

5 Volume 27, No. 1

Teaching Camp Staff to Give Medications Linda Ebner Erceg, RN, MS, PHN

Abstract: Camp nurses often request help from other camp staff to get medications to campers yet precious little has been written to guide this process. The following article addresses this need. It utilizes delegation principles and other literature to present a framework camp nurses can use to effectively design their camp-based medication instructions. Figures provide samples associated with this task. Risk-reduction strategies help limit liability exposures and collaboration with camp leadership helps assure a smooth medication teaching process.

Camp nurses often direct other camp staff – who are not instructional events about medication are more serendipitous: licensed – to give medications. It may be the tripping staff the home health nurse who teaches a family member to give an who take campers on extended excursions; at other times, older adult’s medication and, yes, the camp nurse who delegates it’s the person who is “covering” during the nurse’s day off or, medication responsibility to another staff member. This article perhaps, a cabin counselor whose camper needs a medication discusses that process for camp nurses. In so doing, it lays out upon waking. Each of these illustrates a time when a camp a suggested framework so camp nurses develop medication nurse delegates to non-licensed staff a task associated with instruction programs that meet camp needs and also respond medication administration. In the camp setting, the need for to impacting regulations and professional practices. staff other than the nurse to give medications to campers in Preparing to Teach Your Meds Course certain circumstances is a reasonably foreseeable event. There are things to consider that color the medication Teaching non-licensed camp staff about medications needs teaching process. Knowing about these ahead of time a framework that appropriately responds to the regulations, enables one to teach in a way that complements them and, guidelines and practices that impact both the teaching process consequently, saves time down the proverbial road. as well as the program’s outcomes (what the staff member First, know the regulations and/or standards that impact should be able to do after being instructed). Such a program medication course content, the teaching process, and/or has been created by the State of Colorado, albeit under the desired outcomes. For example, directives from some State broader umbrella of child care providers (Colorado Department Boards of Nursing (BON) may specify the credential of the nurse of Human Services, 2008). Other medication programs – like who teaches this content, what content should be included, those used by homes for developmentally delayed adults – may and/or if a course needs pre-approval from the BON. Some have been developed by entities or a State agency. But other States have regulations or guidelines for settings in which non-licensed people give medications to vulnerable (e.g., campers) populations. Even professional Standards such as ACN’s Scope & Standards of Camp Nursing Practice (2017) come into play. Familiarity with components such as these enable one to develop a course to complement such directives rather than wishing one had done so. Revisit the concept of “delegation.” The camp nurse will be delegating tasks associated with medication use; instead of the nurse doing this “nurse task,” s/ he will ask another staff member to do it. Consequently, meeting the elements of delegation is critical. While addressing those that occur between the nurse and staff member may be familiar (see Figure Figure 1. Delegation: Focus and Responsibility of the nurse and unlicensed assistive personal 1. Delegation: Focus and Responsibility (UAP).

6 March 2017

of the nurse and UAP), the elements that flow from a camp’s have the camp’s supervising physician sign these protocols administration may not be. (See the article, “Practice Updates,” in addition to the set signed for the camp’s nurses. Asking a p.19 for this information.) A camp nurse needs to know physician to “sign off” medication protocols for non-licensed to whom s/he may delegate (who has the camp hired to do staff includes informing the MD about the training and oversight this?), under what conditions that delegation may occur (e.g., such staff have or will receive. nurse’s day off; out-of-camp trips), and any camp-defined limits Consider what communication guidelines and processes (e.g., only daily meds; a certain list of over-the-counter meds (the rules associated with giving medications) will be used in original packaging). The nurse should also know that the when unlicensed, medication-trained staff are functioning. For camp has informed custodial adults that medications may be example, are there times when a staff member must consult given by personnel other than the camp nurse and under what the nurse before giving a medication? If Suzy is on the trip circumstances that might occur. Do not assume to understand and supposed to get an evening medication but she threw up these administrative elements. Talk with the camp director a couple hours ago, does this trigger a conversation with the so both nurse and director are clear about administrative nurse before giving that evening medication? If staff forget to decisions. And yes, some directors need the nurse’s help to give a routine medication at its assigned time, does that warrant make these decisions. That’s fine. The bottom line is that the a call? Rather than trying to capture every exception, perhaps nurse acts with the director’s direction and knowledge. the guideline can be more straightforward: “Staff are expected Another aspect of delegation requires one to capture to follow routine practices. Changes in routine or a change in a evidence that that delegatee (the person to whom the nurse camper’s health status means the staff member must consult delegates medication tasks) both understands what is being the camp nurse before medication is given.” asked and agrees to assume that responsibility. Build this into As the comments above aptly illustrate, there will be times the course. It might be done using a workbook that captures when away-from-camp staff and the nurse need to talk with one (documents) the process, it could be accomplished by having another. Determine those parameters so they can be written the delegatee sign an agreement that articulates the scope of into the medication course. These make good situational the assignment, or it may be captured by language used on a discussions and, consequently, help connect the camp nurse Certificate of Completion, a copy of which is kept by the nurse more closely to staff holding medication responsibility. With that or in the camp member’s employee file. in mind, also consider the method – how – conversations like Consider the scope of medication responsibility staff this happen. A staff member in town with a group of campers will be asked to assume and how that impacts what might doing a community service project may have ready access to be taught. That counselor given a medication in the evening a cell phone and supporting towers to use that technology but with instructions to give that med to a certain camper “upon the same staff person now at altitude in remote terrain may not. waking” has different education needs then the tripping staffer Indeed, communication modes may vary; what is appropriate out for a week in a remote, communication challenged setting for one setting may differ from what’s used in another. Prepare with a dozen teens, eight of whom take a daily medication, for that and consider the timing of those calls. If a staff member and two other staff. Sometimes medication instruction can be needs to talk with the nurse, is that possible at night? Are there straightforward; at other times, it’s more complex or nuanced. times during the day when the nurse is unavailable (e.g., when The point is to recognize the distinctions that color the depth passing morning meds) or may have limited availability? And and breadth of medication instruction needed by staff. don’t forget the infamous Plan B: if the usual practice isn’t Prepare the written medication protocol that will be used working, then what? and have copies for each person taking the medication course. These topics are items to consider and know prior to If their process is limited to giving personal prescriptions, the developing a medication course. Some impact how the staff written protocol might simply direct the staff member to follow member makes medication decisions, others impact how the directions on individual medication labels in addition to those program works, and still others protect everyone – the nurse, given by the camp nurse. When medication administration staff member and camp – from problems. includes over-the-counter remedies and/or rescue meds such Course Content as epinephrine, the protocols need to be more robust because Some course content is common to most, if not all, this now includes decision-making (e.g., determining dose medication courses taught to non-licensed people. These of acetaminophen based on weight of person). In drafting topics include: this protocol, it is recommended that the phrase “per labeled • The responsibilities and limits (boundaries) of the directions” be used to clarify dosages and conditions for using medication management role; the medication. Since medication is in the medical domain,

7 Volume 27, No. 1

• General information about non-parenteral but other content should be practiced. What are these for your medications such as: course? Consider, for example, pouring a liquid medication and  Reasons why people take medications; noting its meniscus or instilling ear or eye drops. These and  The “Rights” of medication administration; other aspects of the medication process benefit from practice  Reading, understanding and following label prior to doing them “for real.” Build an initial practice into the directions; course. Then consider having the learner repeat the skill with  Timing medication doses (include the camp’s clients under the nurse’s direct supervision (See Figure 2). This policy as to the window of time allowed for complements the delegation process; specifically, observing medications scheduled at specific times); a person do a skill, correcting/adapting as needed, and then  Noting therapeutic effects; moving toward doing it without direct oversight. Note, however,  Procedures for storing and carrying that the camp nurse retains the responsibility to supervise del- medications; egated tasks. That means even apparently solo action should  Securing medications and records; and have an evaluative component. Consider how this might be ac-  Monitoring for side and/or untoward effects complished and include it in the education process. and, if noted, what action(s) to take. When teaching the course, show the actual medications • What to do when a medication error occurs. staff will be using. This helps learners recognize various meds But other content is camp-specific. For example, the and, given case studies and the meds protocol, helps teach staff medications that a camp authorizes and the written protocol to to determine not only what medication(s) might be given but support those meds will vary from camp to camp. Regardless, also at what dose. When doing this, consider including some no matter what meds are included, staff need education about mock prescription meds with pharmacy labels. An enterprising them. In addition, documentation methods vary but the need to camp nurse once talked about having the camp’s pharmacy provide documentation is common to all medication systems. prep empty medication containers with mock labels for Items like these – the practices that support the medication commonly given medications such as those used for allergies, process – should be carefully considered. They must “work” asthma control, AD/HD and so forth. The nurse sorted colored for all parties, the camp, the camp nurse, and the staff member. M&Ms and placed red ones in one container, yellow in another Consequently, consider consulting with the director and and so forth. She then had her learners practice reading the affected staff when developing them. Such in-put is informative labeled directions, giving those “meds” to other students, and and best obtained during the time of program development. documenting their action using the actual forms they’d be using Revisit the items under the preparation section above. on the trip. Some of that should be included in course content, so build Include Education about Documentation it in. This often boils down to Healthcare providers are held to documentation standards various rules, guidelines and associated with their level of credential and education. Nursing explanations such as (a) when documentation should reflect the nursing process but care the nurse must be consulted, – like giving a medication – done by people with first aid, (b) how soon medication wilderness first responder or other credentials needs to reflect documentation must be com- the accepted standard of that credential. Know what credential pleted, and (c) the “rule” that staff have and, at minimum, match expectations, including those medication tasks may not be associated with documentation, to that credential. Notice the “at passed to another staff mem- minimum” clause. It is advisable to teach documentation during ber unless the nurse pre-ap- one’s medication course because the scope of medication proves that action. The more responsibility asked of camp staff is typically beyond the scope assisting staff understand the of most first aid credentials. This is a critical understanding! A reason behind decisions, the review of various first aid texts and training curricula contain more likely they are to meet precious little about medications. Content that does appear expectations, so provide ra- tends to be associated with rescue medications like epinephrine tionale in addition to giving or maintenance of chronic conditions (e.g. insulin for diabetes Figure 2. Observing staff rules and guidelines. care; albuterol for asthma management). Camps, in asking staff shoulder-to-shoulder as they Some medication course with first aid credentials to take on medication responsibilities, perform a medication task is content lends itself to sit- must understand that often means the staff person will function a classic way of verifying that down teaching and learning beyond the scope of their first aid credential. This gives more they can perform.

8 March 2017

will be the most challenging. All of us have been “talked at” or suffered near- death from PowerPoint. It’s no surprise that research – as well as experience! – puts those strategies at the bottom of the learning totem pole (Gallo, 2014; Gray, 2013; Miller, 2014). Also consider that the meds course instructor – the nurse – typically won’t be around when staff make use of course content. Consequently, learners not only need to know certain things but, more importantly, need to appropriately apply (use) that knowledge. So make the course interactive from the start. One camp nurse talked about developing a series of scenarios that Figure 3. Administration helps support consistency. This sample is set up by the nurse, moved learners from simple medication includes an area for “Nursing Notes,” and provides space to document therapeutic effect decision-making to more complex and other observations. incidents. In so doing, she “chunked” credence to teaching that includes documentation processes. Keep this in mind while developing your medication course. Make the course explicit about medications as well as the processes, like documentation, that support safe practices. What should be taught about documenting meds? Recall the adage “Write Right!” to highlight this content. It refers to capturing classic information about who, what and how much, when, where and why and is illustrated by the Client-Specific Medication Order Card (see Figure 3). This method is initiated by the nurse who “sets up” a card for each camper in the group. The nurse fills in basic information for routine, daily medications that person takes and, as seen at the bottom of the card, any pertinent notes from the nurse to the staff. The nurse then sits with the medication-designated staff member and goes Figure 4. Teaching medication content takes time and you want through the content on each card. This explanation is best done learners to stay focused, so consider the setting’s comfort, the with the actual medication at hand so the staff member can see timing of breaks and, perhaps, the need for snacks. the container (read the label), the med, and application of the the learning in a way that allowed brief (5-10 minutes) times documentation process. Strategies like this not only capture for her to present information needed by the staff to address medication information but also inform staff about effects in a their scenario. Their successful resolution triggered interest way that doesn’t rely on their memory. for more complexity and/or challenge. The chart below(Figure Documentation may also be worked into the nurse’s 5) illustrates these points, although the progression from oversight of delegated medication responsibilities. Since the simple to more complex scenarios is more abbreviated than delegating nurse retains the responsibility to ascertain that the recommended: task was appropriately done, documenting that medications With scenarios and course materials in hand, one then were given, the date/time that occurred, and any observations teaches the course. Consider the first course a pilot program; provide evidence to the oversight process. this makes it clear to everyone that course effectiveness will be Teaching the Meds Course assessed and assumes the potential for curriculum adaptation. Before meeting face-to-face with learners, gather Also consider teaching in phases. Perhaps Phase I is classroom supplies, arrange the course’s date/time and location, know based. It makes use of scenarios like those above and teaches the credential(s) of attending staff, and develop the learning information needed to successfully assume the medication strategies used to support course content. That last element role. Phase II, on the other hand, has a practice focus. It places

9 Volume 27, No. 1

Figure 5. Sample Medication Scenarios Illustrating Progression from Simple to More Complex Scenario’s Scenario Instructor’s Role Learner Outcomes Complexity

How to use client’s health Access client health form + form & protocols + assessing It’s lunch time during your day-long hike. 11-yr old refer to protocols + select client + selecting appropriate Simple Rusty says he has a headache and asks for a couple and dose medication + analgesic & its dose + how Tylenol. document + assess med’s & what to document + effectiveness. prevention.

Your 4-day canoe trip is going well. You just gave Precautions associated Michelle her morning dose of Ritalin but you Medication security with controlled substances inadvertently spill two pills onto the ground while procedures + handling Simple + discarding or rescuing closing the container. You know “just enough” & discarding meds + medication + consultation medication was in that container for the trip. Now consultation with camp nrs. needs. what? Checking client’s health form Info specific to a client Your group has finished supper on the second day of & med protocols regarding + range of med doses in a 3-night camping trip. 13-yr old Nellie has cramps cramps + assessing client + Moderate protocols + utilizing non- (dysmenorrhea). She got 400 mg ibuprofen an hour non-pharm interventions for pharm interventions + ago but is still in lots of pain. Now what? dysmenorrhea + how/when boundaries of med role. to contact camp nurse. You’ve got campers on a horse-back riding trip for Adverse effects + client Noting side effects + a couple days. 12-yr old Josh is almost done taking assessment + determining addressing & documenting Moderate an antibiotic for his strep throat. He comes for his the urgency for consultation the rash + determining the bedtime dose and shows you a rash on his arms and + caring for the rash. urgency for a nurse consult. neck. Now what? Your day campers are with you at the “rustic” site about 2 miles from camp learning campfire cooking skills. The group is out collecting firewood when a Triage + changing client Triaging a changing situation Jack and Jill come running back. They’ve just been profiles + emergency + prioritizing actions + Complex stung by bees; Jack has three stings and Jill – who medications & procedures emergency medication(s) has a known anaphylaxis to bee stings – has two. + prioritizing actions + administration + activating, Both show swelling & redness at the site of their evacuation decisions. communicating with EMS. stings. You notice that Jill also has reddish splotches on her neck and arms. the staff member with the nurse for a shoulder-to-shoulder Expect to Evaluate, Revise & Update experience with medications. One experience may be helping When a nurse delegates a task, the nurse retains the to pass routine, daily medications while another might bring responsibility to determine that the task was completed as the staff member into the Health Center during office hours to requested. Doing this for medications given by assisting staff demonstrate decision-making skills for common health needs at times when the nurse may not be at the same location is (e.g., medications for cold symptoms, sore throat, headache) challenging. It’s why one might teach in a way that allows using their protocol. the nurse to observe staff doing the task at times when the nurse is around (e.g., help give daily medications; demonstrate decision-making during office hours). It’s also why one sets up feedback loops such as documentation reviews and post-trip conversations with both the staff member giving medications and campers (or other staff) who experienced the process.

10 March 2017

Along with evaluation comes course revisions and updates So prepare well, teach solid content and make driven by change. Perhaps the protocols neglect a need or a demonstrating skill as important to learners as “knowing” better medication is identified for something. Camp personnel stuff. Then keep in touch with other camp nurses who teach change; new staff need to be brought up-to-speed and returning medication courses; share learning strategies and teaching ones ought to demonstrate retained knowledge and skills. content. Camp policy may change or new software gets brought into the Health Center. Campers will certainly change; some return References with new conditions, others may present entirely new situations Association of Camp Nurses (2017). The scope and standards of (e.g., camper with hemophilia who self-infuses while on a camp nursing practice. Fisherville, KY: Association of Camp Nurses. trip). Consider the camp’s calendar and, at minimum, annually Colorado Department of Human Services (2008). Guidelines for review the medication course. Determine if it still meets camp medication administration: An instructional program for train- and client needs, then adapt where needed. ing unlicensed personnel to give medications in out-of-home Teaching camp staff about medications can be quite child care, schools and camp settings. Accessed 10 Novem- ber 2016 at https://coloradocprpros.com/wp-content/up- rewarding. Perhaps they’ve never stopped to consider the loads/2016/05/MAT-Student-Handbook-2008.pdf. difference between analgesics and why one might be better Gallo, C. (2014). Talk like TED. New York: St. Martin Press. in some situations than another. Maybe no one has pointed Gray, P. (2013). Free to learn. New York: Basic Books. out that scored tablets can be split with assurance that equal Miller, M.D. (2014). Minds online. Cambridge, MA: Harvard Univer- amounts of medication are in both halves. Or they’ve not noticed sity Press. the curve of a poured liquid medication and stopped to wonder if dose is read at the height of the meniscus or where the liquid Linda Erceg, RN, MS, PHN, coordinates the Certificate in Camp Nursing touches the sides of the med cup. Maybe they’ve never taken program for Bemidji State University, Bemidji, MN. With over 30 years time to read labels of over-the-counter medications to discover as a camp nurse at the Concordia Language Villages and as ACN’s former executive director, Linda’s experience and a deep connection that some meds are simply blends of two or three others. to the Camp World contribute to her CompassPoint submissions. She Perhaps they haven’t considered the impact of temperature chairs the Healthy Camps III committee, has a column in ACA’s Camp- on medication containers or the need to address medication ing Magazine, and is preparing to re-write The Basics of Camp Nursing security. There are typically lots of “Ah ha!” moments during with co-author Myra Pravda. Email Linda at [email protected]. medication courses, moments that brings a certain satisfaction to the camp nurse.

Super Sleuth By Barbara Hill, RN, MSN, CNE, CMSRN For Females Only A 15 year old female comes to the health center complaining of “cramps” along with the start of her “period.” It hurts most in the abdominal area, and also in her lower back, hips and upper thighs. While in the Health Center she vomited and had an episode of diarrhea. And in addition, she experienced a profuse nosebleed today lasting 20 minutes. History reveals her doctor has put her on naproxen for her cramps. She relates she does not want to be on “the pill” for her cramps.

The answer is on page 30

11 Volume 27, No. 1

Susan - For all you do, we want you to know the impact of your work.

12 March 2017

13 Volume 27, No. 1

Continued from page 2 • Contact the Editor of one or more publications you think would be the best route to the readers that are your intended audience. Send an email inquiry stating the topic you plan to write about and a few sentences about Is There a Super the direction the paper will take. The Editor knows what papers are already in some stage of development and can Sleuth Hiding in You? guide you by telling you whether there would be interest and may give you some direction about content. No editor Really? will guarantee publication but this initial contact will surely be helpful. When your paper is ready, it will not arrive at the editor's address out of the blue.

Maybe you would like to consider writing a • Make an outline. It need not be detailed, perhaps just a list "Guest Spot" working with the but sufficient to lend direction, guide your writing and keep you on target. Editor to present one situation. • If you have a problem getting started, remember that there is no rule you have to start at the beginning. Begin with a You would? Really? section that you feel confident about, perhaps relating the incident you are writing about or the background literature section. Stop struggling with the opening section, if that's Contact the Editor at troubling you at the moment, and get something down.

[email protected] or • Reach out to others for encouragement and critique. A at 508-888-3249 colleague can be helpful in keeping you on track. You may identify someone else who wants to write and that can be to discuss some possibilities mutually beneficial by encouraging and giving feedback to each other. and get your sleuthing Take the chance. Dive in and take the first step toward talents working. becoming a published author. Susan B. Baird, RN, MPH, MA Editor

ACN’s 2017 Scope & Standards of Camp Nursing Practice

Order Yours Today – Don’t Go to Camp Without It!

Why? What’s the Big Deal with This Version? • New Standards like Communication (#9), Inclusivity & Culturally Congruent Practice (#8) and Environmental Health (#17). The Scope & Standards of Camp Nursing Practice

• Increased Breadth – MESH needs are incorporated; ranges from Third Edition, 2017 addressing individual needs to community health needs. • Competencies in place of former “measurement criteria.” • Revised Scope of Camp Nursing statement. • Expanded Glossary.

Association of Camp Nurses Be Updated Before Your Camp Session Begins www.ACN.org

Working for Healthier Camp Communities by Because You’re Held to these Standards. Supporting the Practice of Camp Nursing.

Order Your Copy by Going to ACN’s Online Camp Nurse Store at www.ACN.org -- Today! Member price $7.50, Non-members $9.00

14 March 2017

– Perspectives Worth Sharing – Interprofessional Education & Camps Ellen Buckner, PhD, RN, CNE, AE-C, Latreice Means, BSN, RN, CPN, and Celeste Alfes, DNP, MSN, RN

Abstract: Interprofessional education (IPE) immersion experiences can contribute substantially to development of core collaborative competencies. Camps can provide immersion opportunities and maximize ways professionals may interact during such experiences. Studies show how transformation for practice occurs through building relationships and trust across disciplines. Examples from litera- ture depict multidisciplinary specialty camps and camps specifically designed to promote collaborative interprofessional education.

Interprofessional education (IPE) is an innovative concept camps include respiratory therapists. Diabetes camps rely on in nursing and healthcare provider education today. Nursing diabetes educators as key providers with practitioners from schools can partner with other health professions, including medicine, nursing, nutrition, exercise/recreational therapy, and medicine and health-related departments, to create opportuni- allied health. In all these camps, interprofessional providers ties for children and youth but also to create processes for their work side-by-side, bond with their campers and are touched students to work collaboratively. The World Health Organization by the experience. Lifetime friendships and transformed prac- characterizes IPE as important in developing a “collaborative tice are outcomes. practice-ready health workforce that is better prepared to re- One example of an interprofessional-sponsored camp is spond to local health needs (WHO, 2010).” Camps are excellent Camp Conquest, a pediatric burn camp hosted at Children’s settings for such IPE to take place. Harbor in Alabama. After children are treated at Children’s of In 2011 core competencies in interprofessional education Alabama’s Burn Center, their recovery lasts long beyond dis- were developed with specific areas of 1) values and ethics of charge. Camp Conquest makes possible a sense of normalcy interprofessional practice, 2) roles/responsibilities, 3) interpro- as children meet people just like them. Interprofessional-spon- fessional communication, and 4) teams and teamwork (IPEC, sored camps rely on partnerships. Camp Conquest has active 2011). These competencies give direction for interprofes- contributions from firefighters, healthcare providers, adminis- sional experiences that are expanding rapidly. There is a rec- trators, social workers, and child life therapists. Community ognized difference between interprofessional education and agencies sponsor fundraising for the camp throughout the year. interprofessional practice with the goal to be a fully collabora- Interview with Latreice Means, Nurse Educator for tive practice. In camp health, nurses have long been part of the Burn Center, Children’s of Alabama a larger multidisciplinary team to include camp administration, Camp Conquest started in 2000 as staff of the Burn Center local healthcare providers, and emergency medical services. recognized a need for pediatric burn survivors to have a fun In some camps, especially those with special needs popula- outlet and network with other children from similar situations. tions, collaboration has included physicians, medical students, Camp Conquest allows pediatric burn survivors ages 7-16 respiratory therapists, physical therapists, art therapists, music the opportunity to improve their self-esteem, develop relation- therapists, recreational therapists, students and faculty. Given ships, and build confidence in a fun, safe environment. Over that interprofessional teams are in our DNA as camp nurses, the years, the Alabama Fire College, various fire departments, how have interprofessional education models facilitated growth and Fire Fighter Associations have formed relationships with to a new level? Two types of interprofessional collaborations the camp. Since caring for burn patients requires a multidisci- were found in the current literature. One is the intentionally in- plinary approach, staff members are recruited broadly. Mem- terprofessional camp that draws partners from community and bers recruit other nurses, social workers, chaplains, physical healthcare agencies in dialog and common work. The second and occupational therapists from the burn unit, med/surgical is specific interprofessional education immersion camps to de- units and emergencey department. In addition, nursing stu- velop student interprofessional team collaboration. dents and child life specialists are involved. Students from sev- Interprofessional-sponsored camps eral Alabama universities show a special interest in our patient Interprofessional-sponsored camps are camps with a population and participate as counselors. Camp Conquest is a deliberate intent to partner with a range of stakeholders ap- member of the International Association of Burn Camps (IABC). propriate to that population. Camps for children with diabetes, With respect to interprofessional collaboration, the child asthma, cancer, burns or a host of other chronic conditions life specialists develop activities focused on psychosocial as- collaborate with numerous professions to create the camp en- pects. Occupational and physical therapists create activities to vironment. Burn camps often partner with firefighters. Asthma address the survivor’s range of motion and physical abilities.

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There are various team-building exercises over the course of Interprofessional Education & Team Building Camps the camp. The camp offers swimming, boating, fishing, arts Moxham and colleagues (2016) described an interprofes- and crafts, basketball, and movie night. One popular activity sional education (IPE) experience in Australia with findings on is drum circle as a time for sharing. The campers sit around the growth of the IPE team with respect to mental health re- a large drum and are able to express their fears, burn experi- habilitation. The IPE participants of the Recovery Camp were ences, or simply things they are grateful for in life. The fact that undergraduates from nursing, exercise science, psychology, the firefighters use their vacation time to be a part of the camp dietetics, and faculty facilitators from mental health nursing speaks volumes to the impact the camp has on them. All of the and therapeutic recreation. Consumers (campers) ranged from participation is voluntary. The camp provides staff the chance age 22-63 and were stable living in community with a variety of to see the children outside of the hospital settings. It truly is a mental health conditions. The Recovery Camp was designed heart-warming experience. Everyone leaves the camp with a to be a multidisciplinary clinical learning experience that was feeling of pride and true gratitude to be a part of something so different from standard inpatient clinical placement. During the special. The camp has different empowering themes each year. Recovery Camp consumers (campers) shared their lived expe- For example, past themes have been Superheroes, Firefighters, rience with students and provided a unique contribution to the Military honors and Olympics. It is our hope each child walks IPE students’ understanding of the roles of clinical caregivers. away feeling comfortable in their own skin, realizing they are The students and campers explored concepts of stigma and not alone. recovery. Their IRB-approved study resulted in qualitative find- ings from learning reflections by students. The major themes Interprofessional Core Competencies were 1) understanding and empathy, 2) development of Camps can also provide immersion experiences for multi- practical skills such as empathetic communication and holis- ple professions to work collaboratively. The IPEC defines inter- tic approach, 3) therapeutic relationships developed through professionality as “the process by which professionals reflect group activities and effective role modeling, and 4) importance on and develop ways of practicing that provide integrated and of lived experience. Campers were effective educators for cohesive answer to the needs of the patient/client.” It requires students by sharing life experiences they may not have been interaction and knowledge sharing and has potential to trans- willing to disclose in a hospital setting. IPE students noted how form our ways of working (IPEC, 2011). Examples of interpro- their education had been enriched by the consumers (camp- fessional competencies include: ers). Students also reported significant learning from each other 1. Place the interests of the patients and popula- as they reflected on daily experiences and applied those to pro- tions at the center of interprofessional health care fessional processes. The conclusion was that the IPE/Consum- delivery. er camp had provided an experiential, immersive, and powerful 2. Respect the unique cultures, values, roles/responsi- growth experience for IPE students. bilities, and expertise of other health professions. In another IPE immersion camp experience, practicing 3. Develop a trusting relationship with patients, fami- professionals in Florida (USA) attended Geriatric Boot Camp, lies, and other team members. a short term (half-day) IPE activity that covered a range of ge- 4. Recognize one’s limitations in skills, knowledge and riatric core concepts: dementia, medication management, pal- abilities. liative care, ethics, and general overview of older adults. The 5. Engage diverse healthcare professionals who com- camp increased understanding and also increased level of plement one’s own professional expertise…to meet comfort in caring for older adults. Following the experience at- specific patient care needs. tendees reported sharing the information with others in practice 6. Listen actively, and encourage ideas and opinions of and with patients/family caregivers. IPE participants reported other team members. engaging with additional interprofessional colleagues in care 7. Describe the process of team development and the for older adults. IPE participants reported learning from the roles and practices of effective teams. team approach and hearing of other professionals’ perspec- According to University of Toronto Framework (2008, tives (Solberg, Solberg, & Carter, 2015). 2011), immersion is the middle of three stages of interprofes- Boland, Scott, Kim, White, and Adams (2016) discuss the sional development. Camps have and are continuing to emerge significance of immersion experiences for interprofessional as ways of providing immersion opportunities and maximizing education competencies for graduate level practitioners. Par- ways that professionals may interact during such experiences. ticipants were from family medicine residency, graduate phar- In selected examples research has documented the findings macy, doctoral level psychology and doctoral level nursing. A from such interprofessional educational immersion. medical anthropology student observed the team-based expe-

16 March 2017

riences. Their side-by-side training was found to be transfor- an actual Sikorsky S-76 helicopter. Although a language barrier mative in the lives of participants. Quantitative and qualitative was encountered for some participants, the overall collabora- data were collected during the training to examine effects on tive learning environment was found to support safe and effec- self-confidence in team-based skills. Games, scenarios, role tive critical care transport globally. Future opportunities include play of hospital rounds, handoffs using SBAR (an acronym for use of this model for education of civilian air medical crews, as situation, background, assessment and recommendation, a pre-deployment training, and for research related to team build- technique that can be used to facilitate prompt and appropri- ing, standardization of handoffs, and collaborative practice. ate communication), and quality improvement were topics for Interview with Celeste Alfes, Director of Center for interaction. Team skills increased significantly during the expe- Nursing Education, Simulation, and Innovation at rience and qualitative comments reflected participants’ growth. Case Western Reserve University. Curricular elements of games, role clarification exercises, and Our annual Flight Camp started in 2003 as part of the Na- team practice contributed to this transformation. tional Flight Nurse Academy. The Academy changed its name Finally, at an annual interprofessional Flight Camp, par- in 2011 to the Dorothy Ebersbach Academic Center for Flight ticipants one year included nurses and health professionals Nursing at Case Western Reserve University, Cleveland OH. from Puerto Rico (Alfes & Rowe, 2016). The annual weeklong Dorothy graduated from the Frances Payne School of Nursing interprofessional training was open to any health care provider in 1954 and had served as part of the Women’s Airforce Service working in an acute care setting. The one-week experience Pilots (WASP) unit in WWII, where she tested newly repaired provided approximately 30 contact hours. The interdisciplinary planes as well as towed targets for combat training. Dorothy’s educational experience focused on critical care concepts but love of flying, nursing and service led to the generous endow- also incorporated training experiences with simulation on high- ment that has allowed the flight center to continue its mission. fidelity manikins. Training included didactic, skills and a disaster The camp is open to any health care provider working in an simulation. Participants worked as teams using a fully articulat- acute care setting including nurses, nurse practitioners, physi- ing, high-fidelity helicopter simulator built inside the frame of cians, EMT, EMS, respiratory therapists, and medics. Faculty members have a minimum of 10 years of experience, and many have 25+ years of experience in critical care transport. Partici- pants are recruited from multidisciplinary organizations includ- ing Air Medical Services, Air and Surface Transport Nurses As- sociation, and Association of Critical Care Transport. Each year we incorporate a mass casualty simulation that is implemented on the last day of camp to help attendees apply what they have learned in the previous days. The simulation involves planning from faculty, community ground crew providers, local flight teams, and often our Campus EMS providers. Attendees are trained in interprofessional teams; there are no break-out ses-

Flight Camp offers interprofessional training incorporating: 1) Teamwork in transportation, 2) “Taking flight” inside the simulator, and 3) interdisciplinary participations.

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sions specific for one group of providers, everyone participates outcomes including engaging with other professions in their as a member of a team. This past year, the disaster drill focused practice settings. on triaging and managing tornado victims and allowed interpro- fessional flight camp participants to apply their knowledge and References skills learned from the camp’s lectures, labs, and simulation. Alfes, C. M., & Rowe, A. S. (2016). Interprofessional flight camp. The simulator has been a tremendous interprofessional Air Medical Journal, 35(2), 70–72. https://doi.org/10.1016/j. amj.2015.12.008. learning tool, providing faculty with a structured environment Boland, D. H., Scott, M. A., Kim, H., White, T., & Adams, E. (2016). for training related to stressors of flight, patient packaging, Interprofessional immersion: Use of interprofessional educa- radio communication, crew resource management, and situ- tion collaborative competencies in side-by-side training of ational awareness. Students from all backgrounds become ef- family medicine, pharmacy, nursing, and counseling psychol- ogy trainees. Journal of Interprofessional Care, 30(6), 739–746. ficient managing time-sensitive critical conditions and perform- https://doi.org/10.1080/13561820.2016.1227963. ing advanced procedures with limited clinical resources while in Moxham, L., Patterson, C., Taylor, E., Perlman, D., Sumskis, S., motion. Flight Camp continues to achieve the goal of educating & Brighton, R. (2017). A multidisciplinary learning experience MSN students, but also creates an exciting atmosphere by in- contributing to mental health rehabilitation. Brain Injury, 39(1), viting other nurses, respiratory therapists, paramedics, nurse 98–103. https://doi.org/10.3109/09638288.2016.1146358. practitioners and physician assistants who either currently work Solberg, L. B., Solberg, L. M., & Carter, C. S. (2015). Geriatric care boot camp: an interprofessional education program for health- in or are interested in pursuing a career in critical care transport. care professionals. Journal of the American Geriatrics Society, The daily interaction of the participants during skills exercises, 63(5), 997–1001. https://doi.org/10.1111/jgs.13394. simulations and lectures is definitely enhanced with so many Interprofessional Education Collaborative Expert Panel [IPEC] different backgrounds collaborating and bringing their own ex- (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Inter- periences and observations together. Over the last fifteen years professional Education Collaborative. http://www.aacn.nche. we’ve had the opportunity to also bring together flight crews edu/education-resources/ipecreport.pdf from across America, which generates communication related University of Toronto. (2008, 2011). A framework for the devel- to how weather, terrain and other variables impact daily work opment of interprofessional values and core competencies. environments. International participants and members of the University of Toronto Interprofessional Education Curriculum/ Program. University of Toronto, Office of Interprofessional Ed- armed forces have also attended. In 2015 we had a large con- ucation. http://www.rehab.utoronto.ca/PDF/IPE.pdf. tingent of Puerto Rican nurses from all different medical spe- World Health Organization [WHO] (2010). Framework for Action on cialties attend. Interprofessional Education & Collaborative Practice - Adapting to the critical care transport environment is chal- WHO_HRH_HPN_10.3_eng.pdf. http://apps.who.int/iris/bit- stream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf?ua=1 lenging and complex for interprofessional crew members. Our annual flight camp is one way to bring together interprofession- Ellen B. Buckner PhD, RN, CNE, AE-C is Professor and Chair of Under- al providers to learn, practice, and implement patient-centered graduate Nursing Program at the College of Health Sciences Ida V. care in a safe nurturing learning environment. There is a need Moffett School of Nursing, Samford University in Birmingham, AL. She to incorporate and evaluate more simulation and team train- served from as Research Chair of ACN from 2001-2012. Dr. Buckner ing activities for effective crew resource management. Future can be reached at [email protected]. research should explore and innovate methods to prepare Latreice C. Means BSN, RN, CPN, is Nurse Educator, Quarterback/Burn competent and safe interprofessional providers for the future of Center, Children’s of Alabama. She can be reached at Latreice.Means@ critical care transport. Figures 1-3 show Flight Camp teams in childrensal.org. Information on Camp Conquest is available through action and the helicopter simulator. https://www.facebook.com/CampConquestofAlabama .

Conclusions Celeste M. Alfes DNP, MSN, RN, is Associate Professor and Director of The Center for Nursing Education, Simulation, and Innovation at Interprofessional camps are significant because the camps the Frances Payne Bolton School of Nursing at Case Western Reserve provide integrated opportunities for growth in relationships University. Her research interests center on incorporating simulations, among healthcare disciplines. Having participated jointly in the interprofessional, and standardized patient experiences to strengthen IPE camp experience, participants have overcome distance clinical reasoning and performance outcomes. Dr. Alfes partnered with and isolation in “silos.” They have built trust and experienced faculty from medicine and bio-medical engineering to develop the cen- ter. She can be reached by email at [email protected]. The Center is “best practices” in providing team-based care. Through direct now recruiting attendees for the 15th Annual Flight Camp to be held hands-on activities professionals and students experienced July 15-19th, 2017 in Cleveland, Ohio. The Center website is https:// team collaboration and developed comfort, skills, and confi- nursing.case.edu/students/learning-resource-center/. dence. The experiences described growth in appreciation of others’ backgrounds and contributions. IPE students reported

18 March 2017

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

Camp Nursing Delegation: Are Your Practices Up-to- Date? Have you seen the recent updates about nursing delegation? These warrant review since camp nurses delegate various healthcare tasks and often do so to camp staff who are “unlicensed assistive personnel” (UAPs). Delegation might include giving routine and/or daily medications to campers when on out-of-camp trips, instructions for “covering” the Health Center during the nurse’s time-off, and – in some camps – tasks such as feeding, catheterizing, range-of-motion exercises, monitoring blood sugars, and/or supervising the use of pneumatic vests or peak flow meters. Most readers are familiar with delegation from nurse to delegatee; however, a 2015 panel convened by the National Council of State Boards of Nursing (NCSBN) to examine the concept using a contemporary evidence base resulted in the clarifications represented by Figure 1. There are a few areas Figure 1: Model of Nursing Delegation as presented by the that warrant consideration by camp nurses. National Council of State Boards of Nursing (2015). Available at First, there are delegation responsibilities for the employer/ https://www.ncsbn.org/1625.htm. nurse leader of people whose job, in turn, requires that they delegate. As illustrated by Figure 1’s blue circle, these employer the more critical because camp directors typically hire staff responsibilities include determining “nursing responsibilities that for jobs in which such delegation is assumed (e.g., healthcare can be delegated, to whom, and [under] what circumstances.” In provider for trips); the nurse doesn’t select this person(s). addition, employers/nurse leaders are directed to support that However, the delegating nurse has the responsibility to make decision with written policies and procedures. Such directives sure the person to whom s/he delegates is capable of doing the define a camp nurse’s delegation boundaries and, as a result, task. See the potential tension between the hiring supervisor’s guide the camp nurse’s delegation process. The “written” part decision and that of the delegating nurse? It usually comes of this needs attention at most camps. to a head when the nurse, in educating the delegatee about Another change is an improved articulation of the the task, determines that the director-selected individual isn’t relationship between the delegating nurse and the person capable for some reason. Knowing – ahead of time – how a to whom s/he delegates (the delegatee). Both parties have director and nurse will address this is critical to keeping camp responsibilities as illustrated by Figure 1’s content in the nurse’s processes working smoothly. gold circle as well as content in the delegatee’s rose-colored Since most camp nurses are supervised by a non-nurse, circle. Indeed, the NCSBN directs that these actions also be typically the camp director, educating one’s supervisor about documented to capture evidence that messages were both their role in the delegation process is important. Readers are delivered and understood by the delegating nurse and camp encouraged to do so before the next camp season begins. Give staff member (delegatee) (American Nurses Association & yourself and your director/nurse leader the time needed to not National Council of State Boards of Nursing (2013). only make necessary decisions but also consider strategies to “Evaluate outcomes of and maintain accountability for address impacts on the camp’s standard operating procedures. [the] delegated responsibility” is a task for the delegating camp In addition, expect ACN to update its Practice Guideline nurse. This isn’t new; nurses have had this accountability for a about nursing delegation. In view of the NCSBN updates, long time. What is made explicit, however, is the feedback loop ACN’s current version(2013) is too narrow to appropriately between the delegating nurse and the camp’s administration guide camp nurses. The Guideline needs to reflect the nurse’s (aka: employer/nurse leader). For example, if a camp director collaboration with camp leadership to address overarching expects the nurse to delegate certain tasks under certain decisions that influence delegation actions, clarify who holds conditions, the director should be talking with the nurse about decision-making responsibilities in the delegation process, and that responsibility at the time of hire. Both parties have to be distinguish between delegation to licensed as opposed to non- comfortable with the camp’s delegation framework. This is all licensed personnel.

19 Volume 27, No. 1

Can I Do That? Decision-Making in Nursing Practice If you’re like most camp nurses, you also make decisions all Figure 2. the time. You decide who to admit to the Health Center or send Nursing Practice’s Decision-Making Framework for physician assessment. You decide who is on the day’s “No Is the activity, intervention or role prohib- Swim” list and you determine at what point symptoms indicate ited by the Nurse Practice Act and rules/ an outbreak. You decide what staff need to know about camper regulations or any other applicable laws,  YES health. You determine when a camper’s health need rises to the rules/regulations or accreditation stan-  STOP point where parent contact is needed . . . the list goes on. And if dards or professional nursing scope and you’re like many camp directors, you sometimes wonder, “Can standards? my nurse do that?” But what about those decisions that fall into a gray, not-so-  NO clear area? For example, can a camp nurse choose to give an Is performing the activity, intervention or  NO herbal remedy? Are herbals within a nurse’s scope of practice? role consistent with evidence-based nurs-  STOP If so, must it be given only to consenting adults or may it also be ing and health care literature? given to campers? Can the nurse note a camper’s challenging  YES behavior and change an “as needed” medication so it’s given Are there practice setting policies and pro-  NO on a routine basis? Can the camp nurse take a phone order cedures in place to support performing the  STOP from a physician who is not licensed by the State in which the activity, intervention or role? camp is located? Decisions like these pepper camp nursing  YES practice, perhaps not on a daily basis but often enough to make Has the nurse completed the necessary us wonder, “Can I do that? Am I allowed?”  NO education to safely perform the activity, in- A tool exists to help make these decisions. Developed  STOP tervention or role? by representatives from a host of nursing organizations and published in The Journal of Nursing Regulation (Ballard,  YES Haagenson, Christiansen, Damgaard, Halstead, Jason, Joyner, Is there documented evidence of the O’Sullivan, Silvestre, Cahill, Radtke, and Alexander, 2016), nurse’s current competence (knowledge,  NO the resulting decision-making flowchart (Figure 2) has been skills, abilities and judgements) to safely  STOP adopted by the National Council of State Boards of Nursing. perform the activity, intervention or role? More importantly, however, it can help camp nurses and  YES their supervisor(s) make decisions about what is – and isn’t – Does the nurse have the appropriate re-  NO allowed. Consider replicating the decision tree and posting it sources to perform the activity, intervention  STOP in the Health Center. When questions arise, consult the camp or role in the practice setting? director as well as the Association of Camp Nurses. Make one  YES of your “good” decisions to seek clarity when questions arise Would a reasonable and prudent nurse about your camp nurse decision-making.  NO perform the activity, intervention or role in  STOP Consider STIs at Camp Too this setting? According to a recently published article in CDC’s Emerging  YES Infectious Diseases, sexually transmitted infections (STIs) “are Is the nurse prepared to accept account-  NO the most commonly reported nationally notifiable diseases in ability for the activity, intervention or role  STOP the United States” (Pearson, Tao, Kroeger & Peterman, 2017;pg and for the related outcomes? 367). From 2010 to 2014, there was a two-fold increase in the  YES number of chlamydia and gonorrhea cases presenting at urgent The nurse may perform the activity, intervention or role care centers; there was also more than a three-fold increase to acceptable and prevailing standards of safe nursing in persons with diagnosed STIs who sought care during those care. same years. Women diagnosed with chlamydia made the most urgent care visits whereas the most visits made by those with Information from Ballard, Haagenson, Christiansen, Damgaard, Halstead, Jason, Joyner, O’Sullivan, Silvestre, Cahill, Radtke, and diagnosed gonorrhea were men. Alexander (2016). Does your camp practice consider the potential for STIs? Do your exam processes include surveillance for STI symptoms indicated? Given the prevalence of STIs in today’s world, and client questions designed to explore this potential when especially among young adults, and the tendency of campers

20 March 2017

Camps without Health Center computers should make that Interested in Infectious (Communicable) Diseases? known to hired personnel prior to their camp arrival and discuss Arrange your free access to CDC’s Emerging the camp’s record-keeping so the professional’s expectations Infectious Diseases journal at match what they’ll find. https://wwwnc.cdc.gov/eid/. According to the Vanderbilt study, using software to document healthcare at camp was more common among Once you submit your email address, the journal’s Table camps serving a special population (n = 44; 73% had Health of Contents is sent monthly. It contains links that make it Center computers) than camps not primarily serving a special easy to read articles of interest to you. population (n = 238; 47% had Health Center computers). Only 10% of camps using computers named a specific software; the and staff to view their Health Center as their urgent care most commonly identified were CampMinder (9 camps) and center, it may be time to update your practices. Work with your CampDoc (5 camps). camp director when doing so. STIs are “reportable” diseases; The study also showed diversity in methods used to consequently, your director has an interest in how tactfully the document healthcare within the same camp. Documentation diagnosis is handled with parents and other stakeholders. done by Health Center staff varied from that done by tripping staff or by staff using in-camp first aid kits or provided by staff Research about Camp Health Records leading away-from-camp day excursions or even from Health Some interesting factoids were gleaned from a Vanderbilt Center staff when they provided care out of the Health Center. research team’s publication about camp health records This typically resulted in incomplete health records for a given (Kaufman, Holland, Weinberg, & Rosenbloom, 2016). The person as well as scattered records, an aspect that made descriptive study, done in 2012, utilized data from 298 gathering reliable injury-illness data challenging. Variations like responding camps out of the 953 ACA accredited camps that this indicate the need for those in leadership positions to review were contacted (31% response rate). The study’s objectives and update their camp’s health record processes. were to “determine how camps create, store, and use camper Inadequate record keeping practices included failure to health records” as well as “raise awareness in the informatics document assessment data, failure to document evaluation community of the issues experienced by [camp] health data, and – most common – inadequate documentation of providers” (pg 1154). The results inform camp professionals medication administration. Litigation is often triggered by these too, especially those making decisions about their camp’s kinds of errors; consequently, readers in position to improve processes. Points of interest included: these in their own camps are urged to do so. Whether hand- • 49.3% of respondents said there was no computer written records or using a computer-based system, a healthcare available at the Health Center; professional’s record keeping must reflect that professional’s • 14.8% of respondents said there was no computer scope of practice. For camp nurses, that means documentation available anywhere at camp for Health Center staff; that reflects the nursing process. • 41.1% of respondents reported no internet access. Consider reading the Vanderbilt study, especially if your Since the numbers above were drawn from 2012 data, role includes making policy and procedure decisions for camp. one might interpolate that more computers as well as more The publication’s six tables are filled with information. Table internet access is currently available – then again, maybe not. 6, in particular, presents quotes from respondents about the Given society’s growing expectation that health records are more practical issues association with documentation (e.g., computerized, if not “sharable” among providers, the time has time needed, electronic vs. paper records, medication charting come for all camps to (a) put a computer in the Health Center, challenges, follow-up information). And like all good studies, perhaps even more than one, and (b) make sure it has adequate this one discussed its limitation, not least of which is that camps internet bandwidth. That can be tough for programs located in with computer access may have been more likely to complete rural or remote areas where the lack of cable or satellite access the survey. remains in the future. Given time, perhaps technology access will improve; currently, however, it’s a real challenge for some More about Disease Management camps. Most readers understand the concept of “herd immunity.” Also consider that most healthcare providers come to It’s based on the premise that having a certain percent of a camp knowing about and using computer-based record population effectively immunized for a given illness means the keeping in other practice settings. Indeed, hand-written records pathogen associated with the illness is less likely to emerge. are becoming more and more rare. These professionals often Because it’s less likely to emerge, an immunized population assume technology will be available at the Health Center. becomes somewhat protective for those who cannot be

21 Volume 27, No. 1

its influence. We may not be able to eliminate fatigue but we Table 1. can certainly improve its impact upon our camp communities. Herd Immunity Threshold (HIT) For Selected Diseases Interestingly, we don’t have effective immunizations for Disease HIT more common communicable diseases such as the common Diptheria 83-86% cold, strep throat, norovirus, and so forth. In these situations, a camp’s best defense rests on time-tested control strategies, Measles 92-95% particularly keeping resistance high among susceptible people Mumps 75-86% (like being well-rested) and breaking the chain of communicability Pertussis (whooping cough) 92-94% through practices such as hand-washing, cough/sneeze Rubella 83-86% etiquette, and maintaining an arm’s length distance between Varicella (chicken pox) 90% people. Are your camp’s practices up-to-par? Experienced camp nurses know the wisdom of noting an Information from UNICEF’s “Data Analysis Activity: Herd outbreak before too many campers and staff “go down” with the Immunity” (2015) at https://www.teachunicef.org/sites/ illness. But these same nurses also know that noting the start default/files/Data_Analysis.pdf. immunized, thus creating herd immunity. Consequently, an important camp nursing data point is knowing what percent of one’s campers and staff are immunized. That percent can be calculated by reviewing the immunization records on health forms. But keep in mind that herd immunity is also influenced by how contagious a particular pathogen might be, the effectiveness of the immunization itself (efficacy), and the susceptibility of individuals. That’s why, as seen in Table 1, there’s variation in the herd immunity thresholds (HITs) for various diseases. It’s also why camp nurses continue to push hydration, nutrition, appropriate exercise and adequate rest. That last influence is so critical and too easily minimized during busy camp life. Since fatigue is such an insidious factor, consider it when campers and staff present with various illnesses and injuries. Did fatigue contribute to that injury or illness? Gather some data. Start by determining how many injuries and illnesses seen by the camp nurse have fatigue as a contributing, if not causative, factor. Then set goals to improve

22 March 2017

of an outbreak is tricky. That’s because presenting symptoms References seen day in and day out at the Health Center are shared by both American Nurses Association and National Council of benign diagnoses and communicable illnesses. Today’s sore State Boards of Nursing (2013). Joint Statement on Delegation. Retrieved June 1, 2013, from http://www. throat may simply be the result of too much shouting during nursingworld.org/MainMenuCategories/Policy-Advocacy/ last night’s campfire, not strep. And an upset stomach may Positions-and-Resolutions/ANAPositionStatements/ simply be “nerves” because of the evening’s drama production, Position-Statements-Alphabetically/Joint-Statements-on- Delegation-American-Nurses-Association-ANA-and-National- not a norovirus. On the other hand, perhaps those “benign” Council-of-State-Boards.html. symptoms are indicating an outbreak? How can one sort it out? Association of Camp Nurses (2013). Nursing delegation to Russell, Katz, Richgels, Walsh and Grant tackle this question unlicensed assistive personnel in day and resident camps. in their article, “A Framework for Modeling Emerging Diseases Available online at http://www.acn.org/edcenter/acn_practice_ to Inform Management” (2017). While they focus on zoonotic guidelines_for_camp_nurses_in_the_us.php. diseases – those diseases of animals that can be transmitted Association of Camp Nurses (2013). Communicable disease control in the camp setting. Available at http://www.acn.org/edcenter/ to humans – the paradigm they use for predictive modeling has acn_practice_guidelines_for_camp_nurses_in_the_us.php. application to the camp world. Interestingly, it complements Ballard, K., Haagenson, D., Christiansen, L., Damgaard, G., what has been currently published about communicable Halstead, J.A., Jason, R.R, Joyner, J.C., O’Sullivan, A.M., disease control in the camp setting (Association of Camp Silvestre, J., Cahill, M., Radtke, B., and Alexander, M. (2016). Scope of nursing practice decision-making framework. Nurses, 2013; Erceg, 2011) and is illustrated by Figure 3. The Journal of Nursing Regulation, 7(3), 19-21. interplay of factors that augment the impact of a communicable Chen, D.L. (Ed) (2015). Control of communicable diseases manual. disease is curtailed by the strength of factors that lessen that Washington, DC: American Public Health Association. impact. As illustrated in the Figure’s example of a common Erceg, L.E. (2011). Communicable disease management in the cold, the outcome is under some control by camp practices but camp setting. Available at http://www.acn.org/edcenter/ communicable_disease_management_strategies_for_the_ one cannot typically eliminate all potentials. camp_setting-1.pdf. Camp nurses and leaders are encouraged to review their Kaufman, L., Holland, J., Weinberg, S., & Rosenbloom, T. (2016). camp practices in view of minimizing outbreaks. A significant Medical record keeping in the summer camp setting. Applied tool to support fact-finding about individual diseases continues Clinical Information, 7, 1154-1167. Available online at http:// to be Chen’s Control of Communicable Diseases Manual (2015) dx.doi.org/10.4338/ACI-2016-06-RA-0098. and the CDC website (www.CDC.gov). The latter reference is National Council of State Boards of Nursing (2015). Delegation. Accessed 16 January 2017 at https://www.ncsbn.org/1625. particularly excellent when coping with emerging diseases, htm. especially those from mosquitos, ticks and other animals, Pearson, W. S., Tao, G., Kroeger, K., & Peterman, T. A. (2017). whereas Chin’s Manual is a solid go-to source for information Increase in Urgent Care Center Visits for Sexually Transmitted about established outbreaks such as conjunctivitis, plantar Infections, United States, 2010–2014. Emerging Infectious Diseases, 23(2), 367-369. https://dx.doi.org/10.3201/ warts, strep throat, and chicken pox. eid2302.161707. Russell, R. E., Katz, R. A., Richgels, K., Walsh, D. P., & Grant, E. (2017). A Framework for Modeling Emerging Diseases to Inform Management. Emerging Infectious Diseases, 23(1), 1-6. https://dx.doi.org/10.3201/eid2301.161452. UNICEF (2015). Data analysis activity: Herd Immunity. Available online at https://www.teachunicef.org/sites/default/files/Data_ Analysis.pdf.

Linda Erceg, RN, MS, PHN, coordinates the Certificate in Camp Nursing program for Bemidji State University, Bemidji, MN. With over 30 years as a camp nurse at the Concordia Language Villages and as ACN’s former executive director, Linda’s experience and a deep connection to the Camp World contribute to her CompassPoint submissions. She chairs the Healthy Camps III committee, has a column in ACA’s Camp- ing Magazine, and is preparing to re-write The Basics of Camp Nursing with co-author Myra Pravda. Email Linda at [email protected].

23 Volume 27, No. 1

– Camp Health - Clinically Speaking – Health Center Inventory Doris Nerderman, RN, BSN

Inventory: A complete list of everything that is in 3. Type/Length: Needs will vary for the active sports camps place. versus camps that are less active and camps that are only Sounds pretty clear cut and fairly easy, doesn’t it? But, a few days versus several weeks. determining what belongs on the list can prove to be the big 4. Access to Supplies: If you are back in the woods with no challenge easy access to supplies you may need to keep a larger Last year, I had the unusual assignment of helping to stock than a camp that is close to the pharmacy/store and determine the inventory needs of a new camp. Needless to say can easily restock in a timely fashion. These days when I thought a lot more about inventory than I ever had before. I most camps can order on line and get items fairly quickly, thought a lot about how to determine just what and how much it may make more sense not to keep as many supplies as was needed so we wouldn’t come up short or break our budget camps once did. with unnecessary items. The criteria used to determine what supplies are needed can prove to be elusive and even after it 5. Storage Space: Depending on how big your health center has been determined, needs can change from year to year. I is or what storage space is available your purchasing referenced the list I used at the previous camp I had worked choices may be affected. Consider both on season and off at but very quickly realized that although there are some items season space. If the health center is not winterized, storage that are commonly used in all camps, camps need different space may be very limited in the off season and you will items and in different quantities. I thought a lot about what want to keep stock to a minimum, particularly items that our health services would need, but also the criteria for why will be damaged if not properly stored. they would be needed and, from that beginning, developed a 6. Budget: Depending on how high (or low) your budget comprehensive inventory for our camp’s needs. Perhaps the is might determine purchasing decisions. Some supply criteria I used might prove helpful to others. companies will give a discount if supplies are purchased at the beginning of the summer and in larger amounts Criteria Affecting Inventory and by buying early you can save yourself some money. If Most camp nurses will not have to create from scratch an you do this though you need to have a good idea of what entire inventory but still I think this list will give some food for will be used so things aren’t wasted. You might choose thought and can be used to determine if additions, removals to buy more items like bandages that will last for future and/or changes should be made. summers and be very conservative with those items with Some of the criteria include: an expiration date or that require special storage in the off 1. Camp size: The number of items in an inventory will be season. very different if your camp has 50 kids versus 500. 7. Likelihood of use: This is where gathering data comes in 2. Population: Items needed will vary substantially based very handy. By being able to look at past years’ needs you on age, gender, type of camp, health needs and even are able to determine if all those ace wraps you used last economic level of campers participating. For instance, year was typical or an anomaly. for the 28 years that I was at an all boys/non medical 8. Product expiration: It is best to really have a good handle camp, the need for such items as tampons/peri-pads, on items that have a limited shelf life or need special IV solutions, or G-tube supplies were minimal. This past storage. By being knowledgeable about use of these summer that changed significantly when I was at a coed items, you will keep to a minimum the number of items that camp for children with medical issues. Needs are also are left at the end of the season that will not be good for a different in day versus resident camp or in a younger versus future summer. In some cases, loss t cannot be prevented older camper population. In some camp settings, it may be but you want to keep it at a minimum because you are beneficial to have more personal hygiene items and extra literally just throwing money away. clothing, footwear and bedding available to cover needs of campers whose families forget or are unable to provide them

24 March 2017

Lessons Learned 6. Throughout summer, keep storage areas organized with One of the rewarding aspects of camp nursing is that we like items together and clearly marked so that it is easy to learn from our own experience as well as the experiences of know what items you actually have. This will decrease the others. What we experience one season becomes the lesson chance that items will be overlooked or lost in the shuffle for the next season. The list that follows are lessons learned of season preparation and more ordered midseason only over the years regarding inventory. They worked for me and to have a lot left over at end of year. hopefully will be helpful to you. 7. During the season, enlist help from health center staff to 1. At the end of the season it is easier to stock the first aid monitor inventory. Encourage staff to report when an item kits (except for perishable items) before doing inventory. is getting low while limiting who can actually purchase Then count the kits rather than the items in the kits. Any items to certain key staff. additional needs will be determined based on kits being 8. Create a workable inventory system or list. I found that it full. This also makes it much easier the next summer to was easier to keep separate lists for different categories of stock first aid kits--a real timesaver. items. 2. When possible, don't adjust inventory based solely on one a. Stock medications summer’s usage. For example, just because you needed b. First aid supplies a lot of a particular item this year does not automatically c. Medical Equipment mean that next year you should start the season with a lot. d. First Aid Kits This is especially true if it is an item with a limited shelf life. e. Personal Hygiene Supplies This year may have been a fluke and you don’t want to end f. Clothing/Bed Linens/Pillows up throwing supplies away at the end of the summer. g. Office supplies/Equipment h. Kitchen Supplies/Food 3. When ordering items with expiration dates, request items i. Cleaning/Laundry Supplies with dates as late as possible. I tried to do this so items j. Tool kit could be utilized for at least two summers. 4. On big ticket items (like Epi-pens), having a two-year usage Conclusion significantly helps the budget. If you are able to arrange it Keep in mind that when all is said and done, maintaining an so you only have to replace half the stock every year, you inventory is not an exact science. There are different influences will be able to maintain the budget limit from year to year. every summer that can impact what is used and not used. However, by developing a good inventory approach that works 5. At the end of the season, evaluate medical equipment for you and reevaluating it each season, you will find that the as well as supplies. Consider if you have enough of a staff will have the supplies needed to provide comprehensive certain item. For example, maybe you came up short on care when needed without having a lot of waste. check-in days and it would be helpful to have more of this item. Check to make sure equipment is in working order. Doris Nerderman, RN, BSN, spent 28 summers at NH’s YMCA Camp If an item is not working, can a replacement part put the Belknap. Doris is a member of CompassPoint’s Editorial Board and is a equipment in working order or will a replacement item need former ACN Board member. Doris spent the summer of 2016 in Pinck- ney, Michigan at Camp North Star Reach, the ninth camp in Paul New- to be purchased before the next year? Perhaps the item is man’s Serious Fun Foundation for ill children. [email protected]. still under warranty and you can contact the company for repair/replacement. Pay attention to items that have parts that expire. For example, batteries/defibrillator pads for AED’s have expiration dates. Check these in the fall so you are aware of what needs to be replaced before expiration date. At the end of the season, remove batteries from equipment. Batteries will sometimes leak and can damage equipment. Also track the number/type of batteries that you have. Some pieces of equipment require specialized batteries that may be harder to obtain in a timely manner.

25 Volume 27, No. 1

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

From the ACA Exhibit Hall in Albuquerque, NM Watch some full-length samples and you’ll instantly see why day camps, overnight camps, parks & recreation, and summer American Red Cross: At schools all choose EOT to complement their on-site training. the American Red Cross, https://www.expertonlinetraining.com training people how to re- spond to and prepare for Camp Doc: CampDoc.com is the lead- emergencies is our core ing electronic health record system for mission. We offer a range of health camps! Designed by camp doctors, and safety classes that teach you nurses and directors, our secure, easy- new skills, keep you knowledgeable, to-use web- confident and ready to respond in al- based solution most any emergency situation. With manages health courses to cover all key areas of forms, allergies, training, available online and in class- medications rooms across the country, Red Cross and illness/ classes deliver the training you seek, injury track- when, where and how you need it. ing for your camp throughout the http://www.redcross.org summer. CampDoc.com can provide camp health staff instant access to vi- Wow Butter: WOWBUT- tal medical information, decrease the TER Foods is a small family time and energy spent during initial camper check-in, reduce business, owned and oper- risk and liability, and help keep safety in the forefront of camp ated by the Mahon family. operations. http://www.campdoc.com We started over 20 years ago with the idea of creating And from other sources of interest unique natural foods grown on our very own farms where Opioid Misuse: At my camp? No way! Well, maybe not at we could provide superior your camp but it is in every nurse’s scope of practice to work quality products by complet- together to reduce the effects of Opioid misuse. Read FDA ing every step of the process from “Field to Table” all in one Commissioner Robert Califf, M.D.’s recent essay on this public facility. We also wanted to work towards ensuring the future via- health crisis. Posted on January 19, 2017 by FDA Voice. This is bility of our family farm and at the same time help support other a call to action–decide what you will do. local neighboring family farms. http://www.wowbutter.com What is Be the Beat®? Al- Expert Online Training: Our 27 though designed for schools, Be Gifted Faculty have written and host- the Beat® is a great program for ed more than105 video training mod- camps. The site provides free ules in six categories: Leadership, tools and resources to help start Youth Development & Play, Mental and sustain CPR and AED pro- Health & Behavior, Physical grams. Download materials to teach the two simple steps to & Emotional Safety, Supervi- Hands-Only CPR, heart health lesson plans, and assets like sion, and Creative Literacy. posters and stickers. cpr.heart.org/.../Programs/BeTheBeat/ This virtual library, called UCM_473195_Be-The-Beat.jsp “Leadership Essentials” has How’s your Neti Pot IQ? Has a parent brought along a Neti awesome content for new Pot for their camper’s use? Along with other nasal irrigation staff, returning staff, program systems, these devices use a saline, or saltwater, solution to staff, and supervisory staff. treat congested sinuses, colds and allergies. They’re also used

26 March 2017

to moisten nasal passages exposed Nurse Work: Issues Across Time to dry indoor air. But be careful. Ac- and Place; another AJN Book of the cording to the U.S. Food and Drug Year by four leading nurse historians. Administration (FDA), improper use Patricia D’Antonio RN, PhD, FAAN; of these neti pots and other nasal Ellen Baer RN, PhD, FAAN; Sylvia rinsing devices can increase infec- Rinker RN, PhD; and Joan E. Lynaugh tion risk. Need a review on perti- RN, PhD, FAAN: Through time and nent use and safety information? Go place, experts chronicle the rich va- to FDA.gov. and then to the FDA’s Consumer Updates page. riety of nurses’ work by presenting Updated: January 24, 2017 actual accounts of clinical practice experiences. Tracing the evolution Summer Safety: Burn Preven- of nursing from the role as family tion Materials: NASN and Shriners caregiver to roles in clinical practice today, the contributors ap- Hospitals for Children® are work- proach this history by focusing on four thematic categories: ing together to prevent burn injuries • Who does the work of nursing? through the Be Burn Aware educa- • Who pays for the work of nursing? tion and awareness program. Much • What is the real work of nursing? of this material can support burn • How have our nursing predecessors struggled with the re- safety programs at camp. A variety lationship between work and knowledge? $100.00 of age-appropriate, complimentary burn prevention materials, including Nursing Care of Adoption and activity books and fact cards are available at shrinershospital- Kinship Families: A Clinical Guide sforchildren.org/nasn. One activity book is for ages 3-7, an age for Advanced Practice Nurses by range where such teaching materials are hard to find. Karen J. J. FOLI ,PHD, MSN, RN, Spring Reading...Off the Beaten Path FAAN: Beginning with an overview of adoption and kinship parenting, American Indian Health and this book also discusses the specific Nursing, Margaret P. Moss, PhD, psychosocial and health care–related JD, RN, FAAN, Editor was an AJN needs of adoption and kinship fami- 2016 Book of the Year winning a lies using detailed case studies to First and Second Place Award: illustrate a variety of conditions and Written by and for nurses, this is circumstances, along with guidance on how nurses should the first text to focus exclusively on intervene. A clinically focused section within the case study American Indian health and nursing. chapters covers assessment, interventions, referrals, and fol- The text addresses the profound dis- low-up considerations. $55.00 parities in policy, health care law, and Don't let the price of new book releases scare you away. Be re- health outcomes that affect American Indians, and describes sourceful--the Research Librarian at your local or school library how these disparities, woven into the cultural, environmental, can check into interlibrary loans. Used books through Amazon historical, and geopolitical fabric of American Indian society, and similar sources reveal bargains. Nurses’ Work, for example, are responsible for the marked lack of well-being among Amer- can be purchased used for about $3.00 plus shipping. Ameri- ican Indians. American Indian nurse authors, natives of nine can Indian Health and Nursing just started showing up on used unique American Indian cultures, address the four domains of lists but wait a couple months and see the price become very health‚ physical, mental, spiritual, and emotional‚ within each reasonable. region to underscore the many stunning inequalities of opportu- nity for health and well-being within the American Indian culture ACA does not endorse or sponsor any of the products compared with Anglo culture. In an era of cultural competency, included. these expert nurse authors bring awareness of what is perhaps the least understood minority population in the United States. $70.

27 Volume 27, No. 1

ACN 2017 Symposium Highlights Beth Schultz, RN, DNP

This year the theme for our Educational Symposium • “I really liked the roundtable discussions because I really was “Be Extraordinary, Be a Camp Nurse." The Symposium had the chance to ask questions and talk with the other began with a welcome reception for new attendees. The room nurses.” was buzzing with enthusiasm and the contagious excitement kindled the energy as the business meeting began. Day one of the Symposium brought sessions on everything from the highlights of the “hot line” last summer to a “hands on” chance for using an otoscope. During the Symposium the “APP” was a great place to learn what people were thinking. Evelyn DuBois shared this: “ACN you rock! What a wel- coming and wonderful experience. Gained so much knowledge and great ideas, met wonderful peers and leaders in camp nursing. I can’t thank you enough. I feel energized.” “I have so much to do before camp because of the things I learned from the sessions and conversations with my camp nurse colleagues.” Diana Mathis

Comments from the “Super Heroes” Many attendees commented that one of their favorite parts of Symposium were the Round Table discussions. During that time nurses had a chance to really spend time talking to one another about common concerns and interests. They were able to share thoughts and ideas and learn what works for others and share what works for them. • The presentation on “picky eaters” gave me some ideas of how to best approach challenging campers. • “I have so much to do before camp because of the things I learned from the sessions and conversations with my camp nurse colleagues.” Diana Mathis • “I didn’t think I needed to attend a presentation on lice, I mean how much more can there be to learn? But I actually did come away with information that will be really helpful at camp this summer.” • “I loved the pins that were given out this year! What a great first day of symposium.” • “The session on medication administration was great, bringing things back to the basics helped me to think about it in a different way.” • “I enjoyed Dr. Garst’s session on over parenting. I think we have to address the issue rather than try to ignore the behavior. He provided a lot of practical information for making the camp experience better for both campers and parents.”

28 March 2017

Association News

Symposium 2017 Success Jane was described as an individual who “transformed What a great time we had at the Symposium with camp the way we approach health and wellness and is a beacon nurse friends and leaders from across the US. When we of positive energy and inspiration to children and adults.” come together as a camp nurse family, great experiences Congratulations Jane – such a well-deserved award as you set and education are created and much support is gained for a high mark for future camp nurses. We are fortunate to have our specialty practice. Thanks to all of you who gave of your Jane as part of our ACN camp nurse family! time, energy, and talent to make this a great event! Thanks to our Sponsors for their support in making symposium a great Erceg Receives Susan Baird CompassPoint Writing Award learning opportunity.

Symposium 2018!!! Dates: 19-21 February 2018 Location: Coronado Springs, Orlando Florida

Camp Nursing – Scope and Standards The 3rd Edition of ACN Scope and Standards of Practice is available. Purchase online at www.acn.org Revisions to the Scope and Standards were led by the committee including Linda Erceg (chair), Anne Laske, Beth Schultz, and Tracey Gaslin. Leadership team members helped to review the content and provided thoughtful feedback. Our thanks to everyone who helped with the updates to this foundational document. The 3rd Edition of Scope and Standards can be purchased online at www.acn.org. Linda Ebner Erceg, RN, MS, PHN, was selected by Com- passPoint’s Editorial Board to receive the 2017 Susan Baird Congratulations to our Award Winners CompassPoint Writing Award. This award was renamed this year in honor of our faithful and long-standing editor Susan Camp Nurse of Year Baird. Susan has dedicated her career to helping new writers, Award – Jane McEldowney experienced camp nurses, and many others publish their work The Camp Nurse for to share with others. We want Susan to know she will continue 2017 is Jane McEldowney. to be remembered and cherished each year as we give out the Jane was nominated for award in her name. this award by her camp Linda Erceg is a frequent contributor to CompassPoint, director and was described she was recognized primarily for two papers this year: as having insightful skills to Write Right: Creating Useable and Defensible Forms for help improve the health and the Health Center (March, 2016) and The Camp Nurse on wellness of her campers. This award is given to an individual Stage: Presentation Tips and Strategies (September, 2016). who goes beyond the regular job description in service to Her regular feature, Practice Updates, is also widely appreciat- campers and staff. A few activities initiated by Jane include: ed by readers for its timely and pertinent content each issue. 1. Education regarding ultraviolet radiation from sun Editorial Board members vote for the winning paper based exposure infusing morning weather forecasts with UV on criteria that include: originality and timeliness of the subject, predictions and made the concept “real” for campers. relevancy to camp nursing practice, value to increasing the 2. Built a library of educational and entertaining materials. understanding or refinement of camp nursing. The CompassPoint 3. Created braille name tags for children’s bunks. Writing Award was established several years ago to recognize 4. Campaigned for funding across her state to secure achievement in writing, acknowledge a contribution to the funding for every student to attend a week of Outdoor camp nursing literature, and stimulate authorship. The winner School. is a well-kept secret until the Symposium!

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29 Volume 27, No. 1

Hill Recognized for Super Sleuth Creativity Super Sleuth is a regular Barbara’s last case. We thank her for all the good cases she feature of CompassPoint with has shared with us. Now we need to find a new Super Sleuth. many readers saying it is a Contact the Editor at [email protected] for more information favorite! The creative force about this creative role. behind the feature since June 2013 has been Barbara Hill. She took over the feature from Janice Springer who had Connect with Us! initiated the Super Sleuth. Association of CampNurses Barbara spirited a local contest Camp Nurses among children to come up with our Super Sleuth caricature and was never ever late in meeting the CP deadlines, a feat always appreciated by the Editor! This issue of CompassPoint includes

Super Sleuth Answer Answer: Menstrual Cramps There are a couple of issues to be considered in this ments may help reduce cramps. These would need scenario. Number one concern is the bleeding which is re- the guidance of a health care provider. The camper lated to a side effect of naproxen. Naproxen needs to be should eventually discuss the situation and options discontinued at this time due to the bleeding and the camper with her provider. can revisit this in a conversation with her physician at a later 11. A TENS (transcutaneous electrical nerve stimulation) date. It may lighten the menstrual bleeding in some patients, unit is a device connecting to the skin using adhesive but for now it is a risk factor that can cause bleeding. patches with electrodes delivering varying amounts of What suggestions do you have for this camper with all current to stimulate nerves. It may work by raising the the classic signs of menstrual cramps caused by menstrual threshold for pain signals and stimulate the release uterine contractions? These alternative suggestions are tak- of endorphins (natural painkillers) in the body. Some en from those who suffered with cramps. studies report TENS was more effective than a pla- 1. Heating pad cebo in relieving menstrual cramps. 2. Ginger in some form to combat nausea. (gingersnaps What factors contribute to menstrual cramps? is a good one) • A narrow cervical canal 3. Herbal tea (green tea, rose hips, hibiscus in a cup of • A retroverted uterus water) Steep for three minutes and add honey, and • Lack of exercise because exercise releases en- juice from a lemon, lime or orange. dorphins that relieve pain. 4. Sit with a pillow propping up their upper body while • Emotional stress drinking the tea. This position relaxes the abdominal • Adenomyosis, endometriosis, or uterine fibroids. muscles. (need health provider intervention) 5. Try not to use tampons during this time. 6. Avoid sugars and caffeine all month. Also, avoid References smoking and salty foods. Menstrual Cramps: How to Handle PMS Symptoms and More. 7. In the same breath, sometimes a cup of “hot mocha” http://www.medicinenet.com/script/main/art. works to take away the cramps. asp?articlekey=9814&pf=2 8. Slow massage may help and can be done by the Menstrual cramps. camper. http://www.mayoclinic.org/diseases-conditions/ menstrual*-cramps/basic 9. Regular exercise can often lessen menstrual cramps. Menstrual Cramps (Dysmenorrhea): Causes and Pain Relief 10. A number of studies indicate that Vitamin E, B-1, B-6, Options omega 3, primrose tablets and magnesium supple- http://www.webmd.com/women/mentrual- cramps?page=2print=true

30 March 2017

Certificate in Camp Nursing: Change is in the Air! Linda Ebner Erceg, RN, MS, PHN

I have to face reality. I need to hear from you, other camp So I’m asking if the Certificate is worthwhile? Does it pro- nurses. Here’s my challenge: vide something valued not only by nurses but also by the Camp • Camp nurses with Associate or Diploma nursing back- Community? And might there be a way to reposition the Certifi- grounds are interested in the Certificate but current eligi- cate so it’s obtainable by more nurses? bility criteria are a barrier to their participation. I discussed these questions with various stakeholders: • Our Certificate in Camp Nursing (CCN) has launched its camp nurses, the University’s Deans, the Certificate’s faculty, third year yet there aren’t any nurses who have completed currently enrolled students as well as those who’d like to enroll the program. but haven’t for some reason, and a variety of camp profession- • Financially, the program’s holding its own because of un- als. The resounding outcome is that people would like to see dergraduate enrollment, especially in the “Introduction the program not only succeed but also thrive. But change is to Camp Nursing” course. Graduate courses – the Cer- needed for that to happen. tificate’s last three – have 0-2 people enrolled. That’s not We’ve gone back to the proverbial drawing board and dis- enough to sustain those courses. cussed options with, I think, good success. Here’s a summary • Courses carry college credit and, as a result, cost some- of the changes that are currently under consideration: thing. That cost is tough to absorb for some camp nurses. Criteria Current Certificate Proposed Change • RN with a baccalaureate degree OR • RN OR Eligibility • Jr/Sr Nursing student in a baccalaureate degree • Jr/Sr Nursing student in a baccalaureate degree program. program. • First two courses are co-numbered for undergrad and graduate students. Co-number all courses for both undergrad and Courses • Last three courses are post-baccalaureate (gradu- graduate-level candidates. ate) only. • The nurse is prepared to impact the health out- Certificate Develop camp nurses who not only impact their comes of his/her camp. Outcome camp’s health profile but also camp nursing practice. • Graduate-level work also requires contribution to camp nursing practice. Undergraduate: $286 per credit Future change dependent upon what University Program Cost Graduate: $417 per credit determines. Grants, Continue grant-eligible status. Program is currently grant-eligible. Scholarships Develop scholarships. Courses allow both grad and undergrad enrollment, Courses are sequenced: and are sequenced as follows: • Nrsg 4400/5400 is required for Nrsg 4407/5407. • Fall Semester: Nrsg 3400/5400 and Nrsg • Both 4400/5400 and 4407/5407 as well as graduate 3407/5407. These must be completed to progress Course status are required to progress to Nrsg 6400 and to next courses. Sequencing 6407. • Spring Semester: Nrsg 4404/5404 and Nrsg • All courses must be completed for entry to the Cap- 4405/5405. These must be completed to progress stone (Nrsg 6850). to last course. • Summer: Nrsg 5408. What do you think? Those that have started the program will certainly be able to continue but I think the program’s long-term sustainability needs these changes. Let me know of your ideas and/or reactions by emailing me at [email protected]. I look forward to hearing from you – soon!

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

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