The last time you walked into a patient’s hospital room, what was touching the floor? A purse or briefcase? A cell phone charger? The call button? The TV remote? A blood pressure cuff? Pulse ox? Water bottle?
I don’t know about you, but whenever I see high-touch items like these casually dropped or placed on the hospital floor, I cringe. Until recently, however, I didn’t have any data to back up my revulsion.
For better or for worse, I do now. Yes, bacteria and viruses really can get transferred from patients, to floors, and back up again to other patients, health care providers, and even visitors.
According to a recent study published in the American Journal of Infection Control, patient room floors in five Cleveland-area hospitals were often contaminated with health care-associated pathogens, and objects on the floor frequently resulted in the transfer of pathogens to hands.
Of particular concern, the study found that C. difficile (Clostridium difficile) was the most frequently recovered pathogen from patient room floors. The frequency of contamination was similar in each of the five hospitals studied and in patient rooms and bathrooms, alike.
How should this impact your day-to-day practice? Here’s what I think:
1. If you aren’t already educating patients and visitors to avoid putting personal items directly on the floor, start doing so.
2. If and when items land on the floor, make sure that patients and visitors have access to sanitizing wipes to clean those items, and remind them to do just that.
3. Educate your coworkers on the importance of using sanitizing wipes on items that have touched the floor.
4. Remind patients and health care workers to wash hands or to use hand sanitizers frequently and as per hospital policy, but also after touching items that may have been in contact with the floor.
5. Advocate for institutions to provide patients and visitors with more hooks for hanging up items that might otherwise end up on the floor.
6. Work with environmental services to improve the efficacy of your institution’s current floor cleaning. Does your hospital use sporicidal agents or ultraviolet-C room decontamination? Find out and voice concerns if you have them.
But the buck doesn’t stop on the floor.
According to a study in the Journal of Hospital Infection last year, patients’ nonslip socks are frequently contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). In fact, 85% of the nonslip socks tested were contaminated with VRE. Ick!
Here again I see a role for nurses in educating patients and caregivers to help prevent pathogen transfer:
- Teach proper doffing techniques for sock removal.
- Advise patients to refrain from touching socks with their hands unless necessary.
- Provide clean socks often.
- Provide hand-sanitizing opportunities throughout the day.
Likewise, similar research in World Journal of Microbiology and Biotechnology has suggested that wheelchairs could be a source of pathogen dissemination in health care facilities. Which, I venture, gives nurses a chance to remind patients and coworkers to clean their hands after taking wheelchairs for a spin. And it certainly couldn’t hurt to disinfect the wheels on a regular basis.
Finally, the ubiquitous smartphone: Recent research finds that mobile phones serve as reservoirs of infection in the health care environment. The study, published in the American Journal of Infection Control, looked at genetically identical strains of Staphylococcus aureus recovered from mobile phones and palms and fingers of users and multiple users. The results reinforce, yet again, the need for frequent hand washing or hand sanitizing throughout the day for patients and health care providers—particularly after touching common items like phones.
Spring is always a time for a fresh start and thanks to the research I’ve covered today, it seems we’ve got even more great reasons to clean up and clean often. Now, if only I could get my family to help by putting away their phones and picking their stuff up off the floors at home!
While Catherine Browning, DNP, RN, PMHNP-BC, now works at the Arthur Center Community Health in Mexico—well, in Mexico, Missouri, that is—there was a time when she worked overseas. In honor of International Nurses Day, we asked her about her experiences. Here’s what she had to say (what follows is an edited version of our Q&A):
Catherine Browning, DNP, RN, PMHNP-BC, graduate of Chamberlain’s Doctor of Nursing Practice (DNP) degree program
When you worked as an International Nurse, where did you work? When? What did your job entail?
I worked at a Psychiatric Nursing Faculty in Kuwait from 2001 – 2009. I worked at Kuwait University and I worked at the Public Authority for Applied Education and Training’s College of Nursing. My job entailed teaching BSN and ASN students, both Kuwaitis and Arab and African students of varying nationalities. I taught in the classroom, and I accompanied my students to their clinical settings in medical hospitals, clinics, and the state psychiatric hospital. I provided counseling to many people over the years, including many war victims.
Why did you choose to go overseas to work as a nurse?
For as long as I can remember, I always wanted to live and work on the other side of the world. As a child, I dreamed of being a nurse in Africa. Later, I had fantasies of being in the Middle East. I wanted to help people, especially those of other cultures. I knew I could learn so much from them and I wanted to offer what help I could. Though I dreamed of going there someday, that dream seemed far away for many years and almost unlikely to be achieved.
Was I in for a huge culture shock. Not only was the flight a grueling 17-plus hours, but once I arrived to the Kuwait airport, security questioned and detained me for hours. There were signs of military and security presence everywhere. After all, Saddam Hussein had only invaded Kuwait during the Gulf War 10 years previously.
Kuwait University had a rigorous schedule for me to follow during the week of visiting hospitals, meeting with colleagues and students, giving talks and interviews, and touring the psychiatric hospital. I was totally overwhelmed by the language, the heat, the intimidating men in flowing gowns and headdresses, and the somewhat antiquated hospitals. I almost talked myself out of working there and then the second to last day I toured the psychiatric hospital. I was terrified. I kept thinking, “How can I do this? I don’t understand the language. I am not familiar with the culture. How do I know who to trust and how can patients know it’s safe to trust me?” And then I stepped foot on the women’s psychiatric ward, and after that the men’s psychiatric ward, and suddenly I knew everything would be OK. I recognized the client’s symptoms and immediately knew how to interact with them non-verbally. I learned to ask for help, and I felt a great connection with the patients.
By the time I arrived back to America a few days later, there was an email awaiting me saying I was offered the job.
How was working as a nurse different there? What were the biggest challenges of your job?
Working as a nurse in the Middle East didn’t take all that much adjusting. I learned right away that nursing is nursing and the patients we serve and the professional nursing values we uphold are the same everywhere. As long as I remained true to what I know and believe about nursing, I was confident and comfortable in my nursing and teaching roles. The biggest challenge was learning to maneuver through the complex bureaucracy to finally get my housing and my salary and my health insurance set up. Those things took months and that was a stressful time.
What were the greatest rewards?
My greatest rewards of working in Kuwait were:
- Forming amazing, life-giving bonds with my students, their families, and new friends I grew to know and greatly respect and love. The Arab people were so kind and hospitable to me. They appreciated the wisdom and learning I had to share and so often I felt like I really made a big difference in someone’s life.
- Having whole new cultural and travel opportunities in that part of the world. I studied Arabic, listened to lots of Arab music, wore Arab perfume, burned Arab incense, grew to love Arab food, and shaped my life to be more and more like those living in the culture. I loved the hot, dry climate and my health was better than ever before. I traveled during my vacation time to most of the Arab countries. I was so excited to spend time in Egypt, Turkey, Syria, Jordan, Lebanon, Palestine/Israel, and the Gulf countries. I also got to know really well people from Africa and India, and I even traveled to India, which was another dream come true.
- The job provided more holiday time and greater income than I was accustomed to and that was very beneficial for my mental health. Having lengthy holiday and vacation time, in particular, really taught me the importance of resting, renewing, and enjoying life.
Remember the school nurse? At the time, they were usually women, and especially when you were a little kid, she made everything seem better when you didn’t feel good.
In honor of National School Nurse Day, we spoke with Brenda L. Brooks, the district head nurse, school nurse-teacher, and coordinator of health services in the Hudson Falls Central School District in Hudson Falls, New York to find out more about what being a school nurse is like today.
What follows is an edited version of our Q&A.
As a school nurse, what does your job entail? What do you do on a daily basis?
We do just about everything. In a typical day, I’m coordinating sports physicals; I might instruct a first grader on hygiene, and then help a student with anxiety issues at the high school. School nursing is way more than band-aids and ice packs. We’re first responders to any sort of issue that happens on buses or outside school.
It’s also working with parents to coordinate medical care. For example, rashes. If a student comes in with a rash, it may need clearance from a doctor before we can get that student back to school. So we’re doing everything we can to get that student back in the classroom as quickly as possible. In all, it’s serving the whole student, and making sure students aren’t missing time from the classroom.
Why did you choose this field of nursing?
I’ve worked in several hospitals specializing in every department except OR/ER and mental health. I’ve also worked in a doctor’s office. When my kids came along, I realized that the part of nursing I liked the best was the teaching. So I went back to school and got my teaching degree and taught science for 15 years. But I felt like I wanted to make more of an impact in my district. When the head nurse job opened up, I jumped on it.
What are the biggest challenges of your job?
Resources are always a challenge—whether that’s staff or things for my students like lice kits, transportation to the doctor, clothing, toothbrushes, etc.
A large challenge for us is getting support from a student’s family. For example, if a student is prescribed an EpiPen, will their parents be able to afford it?
Going along with that, we face the challenge of the mental and emotional obstacles outside school. I have kids who want to be in school, but their parents have mental/emotional or physical issues that keep them from supporting their child. For example, I put in a NARCAN program in the school to get all our nurses and PE teachers trained to use the medication. I am working on district-wide strategies to address the impact of stress and traumatic events on the minds of our students.
What are the greatest rewards?
It’s a similar reward as when I was a teacher. It’s that moment when you’ve helped a student succeed. Now as a nurse, I’m helping their entire family succeed.
What would you say to someone considering this type of nursing work?
It’s demanding; it’s frustrating, and you’ll pull your hair out. But it’s so worth it. You make a HUGE impact. I tell my staff they’re the little stone thrown into the pond. You may not be able to see the waves far off, but you know you made an impact.
Is there anything else about being a school nurse that is important for people to know?
The most influential person in a student’s school life is their classroom teacher. But if kids are ill, worried about their parents’ health, are hungry, or don’t have clean clothes, they won’t be in that classroom. And many of those responsibilities fall on the school nurse. So we are serving many of the needs outside of class that are just as influential.
The American Nurses Association urges health care to eliminate all forms of bullying and incivility from our workplaces. Nursing and health care leaders, including the ANA, often leap immediately to declare that facilities follow a “zero tolerance” policy when dealing with bullying thinking that it will eliminate the behavior. The literature, however, reveals that this implementation rarely succeeds when used in isolation. One reason is that those enforcing the zero tolerance policies are bully’s themselves. In other words…zero tolerance may have zero effectiveness.
When nurse leaders are silent in the face of bullying and uncivil behavior, they unknowingly (or knowingly) condone the behavior. If staff observes leadership tolerating bullying and uncivil behavior, then they feel they have no recourse and no one to turn to for help; staff does not feel that they can safely report being bullied. The bully sees this silence as acceptance and continues the behavior. Those that bully have a supportive atmosphere to continue terrorizing their colleagues. They are supported as they move ahead in their career and to various job postings within the facility, thus reinforcing the fact that a bully is very often in a leadership position. This is compounded if the bully-leader is also productive and meets the goals of the facility. Very often leaders may not approve of the behavior or even be aware that it is occurring, but the staff understands that silence is acceptance.
It is a well-known fact among staff nurses that many of those in nursing leadership do not belong in their positions and that many in hospital or facility administration don’t belong there ether. Whether it is a lack of education in organizational leadership or a lack of experience, many nurse managers and administrators have difficulty dealing with day-to-day issues let alone bullying on a unit or within the facility. It is also well-known that managers often ignore policies on bullying because they feel that they are ineffective or that bullying itself is not an issue.
Many nurse managers unfortunately see their staff only as employees there to get a job done. Staff presence or absence affects patient care and the bottom line. The victim is not seen as a person with rights.
Nurse leaders should:
- Receive evidence-based education regarding bullying, incivility, and workplace violence.
- Be aware of their own actions and words…are they a bully?
- Name the action of a perpetrator as “bullying” or “horizontal violence” – get it out in the open and freely expressed.
- Take the opportunity of staff meetings to speak on the issue. Use this as a teaching moment and to express that bullying will not be tolerated.
- Ensure that there exists facility policies in place to deal with bullying, and if not, be a part of team that creates them.
- Be fully committed to eradicating bullying from a unit/facility.
- Avoid moving a bully from unit to unit in order to avoid removing a productive employee. This sends a signal that bullying is condoned.
- Create and enforce a culture of respect.
- Immediately acknowledge staff concerns and complaints, but act on sincere, accurate information.
- Actively listen to concerns of staff.
- Be on the lookout for the formation and existence of cliques.
- Ensure that self-governed staff decisions are fair, accountable and responsible.
- Be supportive of all staff.
- Ensure that those staff that precept students or new staff are educated as to how to do so.
- Be fair and consistent in dealing with all staff.
- Be aware, at all times, of unit culture – has anything altered the emotional atmosphere of the unit? Be aware of morale.
- Be sympathetic and empathetic.
- Be a champion of open communication.
- Be supportive of those continuing their education.
- Don’t blame the target of a bully.
- Ensure that staff are accountable for their actions.
- Encourage assertiveness, discourage aggression.
- Ensure adequate, safe staffing levels.
- Make bullying victims aware of employee assistance programs.
The CDC states Lyme disease is the most common vector-borne illness in the United States, and each year, an average of 329,000 new cases are reported. As we approach the month of May and Lyme Disease Awareness Month, it’s hard not to take notice of the articles by scientists and ecologists across the country warning that 2017 is poised to be the worst year for Lyme disease yet.
As incidences of Lyme disease grow, nurses play a critical role in helping patients obtain an accurate diagnosis and proper treatment. “Lyme patients are sick, they are complicated, and they have lots of ongoing complaints,” says 30-year, veteran nurse practitioner and Lyme specialist, Ruth Kriz. “They don’t fit in a nice, neat medical textbook where you have symptoms ABC. Therefore, you have a diagnosis of illness X. There are too many things that it mimics,” she says. In fact, Lyme disease is known as the “The Great Imitator” because it mimics conditions like multiple sclerosis, fibromyalgia, lupus, and chronic fatigue syndrome (to name a few).
Knowing some key pieces of information about the complexities of the illness can increase a patient’s chance of early detection. Moreover, a nurse’s knowledge of the disease could assist a previously misdiagnosed patient with accessing the appropriate medical intervention to improve their symptoms and quality of life. When left untreated, Lyme disease can have permanent, irreversible consequences for patients. Here are four things you need to know to help your patients achieve the best possible outcomes.
1. The two-tiered testing process for Lyme disease may be inaccurate.
Most nurses are probably familiar with the ELISA screening test and Western blot test–the two-tiered testing process that is often used to diagnose Lyme disease. The International Lyme and Associated Diseases Society (ILADS), a nonprofit organization dedicated to understanding Lyme disease through research and education, states, “The ELISA screening test is unreliable. The test misses 35% of culture proven Lyme disease (only 65% sensitivity) and is unacceptable as the first step of a two-step screening protocol. By definition, a screening test should have at least 95% sensitivity.” Furthermore, “Of patients with acute culture-proven Lyme disease, 20–30% remain seronegative on serial western blot sampling. Antibody titers also appear to decline over time; thus while the western blot may remain positive for months, it may not always be sensitive enough to detect chronic infection with the Lyme spirochete.”
Although test results may be negative, patients can still be infected with Lyme disease or other tick-borne illness. As Kriz points out, it’s important to understand the symptoms of Lyme disease because, “We want to treat people, not just the lab work.”
2. As the illness sets in, a patient may complain of a broad set of symptoms.
In the initial stages of the disease, a patient may report nothing more than flu-like symptoms. But as the infection disseminates throughout the body, a host of issues could arise that may seem unrelated to one another. Some of the more common complaints a Lyme patient may have include (but aren’t limited to): unrelenting fatigue, joint pain, widespread muscle pain, disordered sleep, depression, brain fog, fevers, chills, sweating, and Bell’s palsy.
3. Not all patients will remember a tick bite or rash.
ILADS reports less than 50 percent of patients with Lyme disease remember seeing a tick bite or a bull’s-eye rash (erythema migrans). If a patient presents with a bull’s-eye rash, the rash is indicative of Lyme disease.
4. There is more than one school of thought when it comes to the diagnosis and treatment of Lyme disease.
The diagnosis and treatment of this illness are contentious points that divides many healthcare professionals. As a result, two philosophies have emerged on how to diagnose and treat this disease–the IDSA and ILADS. The IDSA maintains a strict adherence to their guidelines that those who test positive for the illness should undergo antibiotic therapy. On the other hand, ILADS believes that due to inadequate testing, a clinician’s clinical judgment can assess who needs to be treated and with what means. While the IDSA has expressed concern regarding the overuse of antibiotics, ILADS believes the decision on how to treat patients should be based on factors such as the risks to patients, their quality of life, and financial costs. It should be noted that the ILADS treatment guidelines are the only guidelines currently listed on the National Guideline Clearinghouse (NGC), a public database of evidence-based treatment guidelines for healthcare professionals and insurance companies.
In conclusion, the more information you have regarding signs, symptoms, and treatment options for Lyme disease and associated tick-borne infections, the more you can advocate in the best interest of your patients on this controversial issue.
Established in April 2006, Transplant Nurses Day was created by the International Transplant Nurses Society (ITNS) in order to raise awareness about the tremendous contributions that transplant nurses make in the lives of their patients and the people with home they work. It’s held every third Wednesday in April—this year on April 19.
“The celebration recognizes the skill and commitment of transplant nurses around the world,” says Allison Begezda, senior marketing manager, ITNS. “Transplant Nurses Day is an opportunity to celebrate the contributions our nurses make to patient care, patient and public education, nursing research, and the profession of nursing.”
As part of the Transplant Nurses Celebration, ITNS holds an annual Transplant Nurses Day essay contest. They ask transplant patients to nominate their ITNS Transplant Nurse. This year’s theme was “My Transplant Nurse: Champion of Care,” and six patients submitted essays for consideration.
There are many types of transplant nurses, including transplant coordinators, surgical nurses, post-operative care nurses, research nurses, and more.
ITNS honors its nurses in other ways besides just on Transplant Nurses Day. The society also honors its members each year with two awards that are presented at the Transplant Nursing Symposium.
As Begezda says, with the Transplant Nursing Excellence Award, ITNS “recognizes that the role of the transplant nurse is unique and dealing with patients through the transplant continuum is often complex and challenging. ITNS recognizes a special nurse whose career has exemplified ITNS’s mission: ‘…promotion of excellence in transplant clinical nursing through the provision of educational and professional growth opportunities, interdisciplinary networking, collaborative activities, and transplant nursing research.’ The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
With the Friend of Transplant Nursing Award, ITNS “wants to recognize a friend of the organization who has made an impact in the field of transplant nursing. ITNS recognizes that you do not need to be a nurse to make a difference. The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
This year’s symposium will be held June 24-26. For more information, go to www.itns.com.