Vanderbilt University recently announced the launch of a new interprofessional pilot project involving the School of Nursing, Law School, and Vanderbilt University Medical Center which will help older adults in need of advance care plans and power of attorney documents get them faster and free of charge.
The Medical-Legal Partnership Clinic project uses a team of Vanderbilt nursing and law students to introduce the challenging topic of advance care directives to patients at the Vanderbilt Senior Care Clinic. Student teams meet with seniors at the clinic before or after patients’ medical appointments to provide information and assistance in creating the medical and legal documents needed to assure patients’ wishes are known and carried out in the future.
Carrie Plummer, School of Nursing Assistant Professor and creator of the program, tells News.Vanderbilt.edu, “A 2017 study found that less than a third of adult Tennesseans surveyed reported having an advance directive or power of attorney paperwork completed. At the same time, the majority of health care providers are not comfortable initiating discussions with their patients about end-of-life decisions and/or feel that they don’t have sufficient time to include these discussions in the primary care setting.”
Nursing students are participating in the pilot program as part of their yearlong Enhancing Community and Population Health course. Fourteen students designed and developed the program by reviewing best practices, researching evidence-based literature, conducting site visits, and creating a HIPAA-compliant database for patient data. They also underwent five weeks of training on clinical skills for patients and caregiver discussions on advance directives, power of attorney, health literacy and patient education, end-of-life care and difficult discussions, adult protective services and elder abuse, and Medicare 101.
The School of Nursing feels that this program is an aspect of nursing’s holistic model of care, to recognize and address patient’s other social and environmental needs outside of diagnosing and treating. To learn more about the pilot program between the Vanderbilt School of Nursing and Law School, visit here.
The rate of suicide in the United States has climbed dramatically over the last few decades, including in the healthcare workforce. Suicide accounted for nearly 45,000 deaths in 2016 and the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased in nearly every state over the past two decades with half of states seeing suicide rates go up more than 30 percent.
According to TheHill.com, an estimated 400 physicians took their lives in 2016. Physicians and nurses commit suicide more often than average Americans, with rates higher for women in both professions. The reasons why healthcare workers are more likely to commit suicide is unknown, but could be related to burnout which has become an epidemic in this population.
The CDC decided to take a comprehensive look at this major public health issue, examining data on suicides from 1999 to 2016. CDC researchers collected data on suicides from every state to better understand the circumstances surrounding suicide and the findings were later published in the CDC’s Morbidity and Mortality Weekly Report.
Principal deputy director of the CDC, Dr. Anne Schuchat, tells NYTimes.com, “Suicide is the tenth leading cause of death in the United States, and one of three that is increasing. The other two are Alzheimer’s disease and drug overdose, in part because of the spike in opioid deaths.”
Dr. Schuchat and Deborah Stone, the lead author of the CDC analysis, have identified effective strategies critical to preventing suicide, which include teaching coping and problem-solving skills to those at risk, establishing more social “connectedness,” and safe storage of pills and guns.
Stone and Schuchat are calling for a comprehensive approach to suicide prevention following the conclusion of their study. The nation currently has no federally funded suicide prevention program for adults even though increasing rates of suicide shows a need for more research and evidence-based prevention protocol.
Schuchat tells NYTimes.com, “Our data show that suicide is more than a mental health issue. We want improved access to care and better diagnostics, but we think that a comprehensive approach to suicide is what is needed.”
More proactive reporting of suicide in the healthcare workforce may help us begin to understand the drivers for suicide among healthcare workers. The healthcare community is in need of access to evidence-based treatment that addresses the warning signs of suicide and how to help prevent it.
To reach the National Suicide Prevention Lifeline, call 1-800-273-TALK (8255).
Concordia University Ann Arbor’s School of Nursing recently conducted a poverty simulation that presented 65 students with tough questions related to the topic: What if you only had a $10 bill for the month to meet your family’s basic needs? How does living in poverty look when you are a senior citizen, disabled, or receive federal assistance?
Called the Community Action Poverty Simulation, the simulation was designed to help students understand the realities of poverty by putting them in the shoes of a person who lives in poverty. According to University of Michigan Poverty Solutions, during 2017, 12.7 percent of people living in the US had incomes below the poverty line. The experience was intended to help nursing students learn to more empathetically and effectively provide care to future patients in these scenarios.
Nursing students interacted with “participants” who played the roles of bill collectors, job interviewers, grocers, police officers, teachers, and more. During the three-hour simulation, nursing students were given scenarios and had to find a way to provide shelter and basic necessities on a limited budget over the course of four weeks.
Anita Simmons, the School of Nursing’s director of simulation, said in a press release, “We are thrilled by the way this program helped our nursing students understand the complexities and frustrations of living in poverty day to day. With a greater awareness of its impact, our students will be able to more effectively address poverty issues when working with patients.”
The Concordia University Ann Arbor School of Nursing requires students to spend 90 minutes per week in simulation labs like the poverty simulation one. To learn more about the university’s simulation program, visit here.
On February 15, 2018, the newest safe nurse staffing bill was introduced to the U.S. Congress. The bill (H.R.5052 and S.2446) has bipartisan support, and is championed by Reps. David Joyce (R-OH), Suzan DelBene (D-WA), Suzanne Bonamici (D-OR), and Tulsi Gabbard (D-HI), as well as Sen. Jeff Merkley (D-OR).
In the past, several safe staffing bills have been presented in previous Congresses but have failed to pass committee. This bill, the Safe Staffing for Nurse and Patient Safety Act of 2018, is slightly different than previous iterations. Under this staffing legislation, Medicare-participating hospitals would be required to form committees that would create and implement unit specific, nurse-to-patient ratio staffing plans. At least half of each committee must comprise direct care nurses.
“It is so important for nurses on the front lines to be able to have a say in what they believe is safe staffing,” says Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, the president of the American Nurses Association (ANA). “This bill benefits bedside nurses by giving them decision-making power, control, and the ability to influence the delivery of safe care,” Cipriano continues.
A committee made of staff nurses—who would make staffing decisions that directly affect their own units—is so important because it is nurses who can best assess patient needs and the resources required to provide safe patient care. Staffing committees would be able to address the unique needs of specific units and patient populations by involving specialty nurses in the decisions, and would have the ability to modify the hospital safety plans as needed.
Overwhelmingly, research supports adequate nurse staffing. Over the last several decades, literature has demonstrated a decrease in patient morbidity and mortality and an increase in patient safety when units are well staffed. “With adequate amounts of staffing we see mortality go down and patient complications can be prevented or diminished,” Cipriano says. “It is important for nurses to have sufficient resources to care for patients, because nurses experience moral distress when they cannot provide the care they know a patient needs.”
Short-changing patients also contributes to nurse burnout, and low nursing retention is expensive. Additionally, adequate nurse staffing leads to reduced health care costs, as a result of fewer hospital readmissions, hospital-acquired infections, medical errors, and other significant measurable patient outcomes. “Patients deserve to have the right care,” Cipriano says. “They need to be kept safe, and the best way to prevent problems and complications is to have the right nurse staffing.”
Is there hope that this bill will pass, when so many previous iterations have not? “It may be difficult to pass the legislation, even this time around,” Cipriano admits. “But the most important impact is that every time we have an opportunity to have this legislation discussed, it’s another opportunity to educate another decision maker. Whether it is congresspeople, their staff, or other leaders in their communities, it gives us the opportunity to continue to reinforce why it is so important to have the right nursing care.”
It is ethically challenging when a nurse is asked to take staffing assignments that do not feel safe. On many units, nurses are expected to care for several acute and critically ill patients at a time, and are given patient loads that stretch them far beyond their reasonable care delivery capabilities. What should a nurse do when faced with an unsafe assignment? Nurses should raise immediate concerns by following the chain of command, and talking with immediate supervisors to express that they believe the situation is unsafe. “The first obligation is to make sure that no patient is left uncared for,” Cipriano says. “Short term, use the chain of command and do everything you can within in your power to make sure that you’re providing at least the minimum care the patient needs.” Longer-term, if nurses truly believe that their organization is not supporting the right staffing ratios, the ANA encourages an active dialogue with leadership, such as a conversation with responsible nursing leaders, quality directors, or patient care committees or councils to focus attention to the issue.
“Nursing care is like a medication,” Cipriano says. “You wouldn’t withhold a life-saving medication, so why would you withhold the right amount or right dose of nursing care?”
If you are passionate about safe staffing laws, consider calling or writing your congressperson and encourage them to support the Safe Staffing for Nurse and Patient Safety Act of 2018.
Our Nurse of the Week is Saman Perera, a Tennessee-native nurse fighting healthcare inequality through Doctors Without Borders. Born in Sri Lanka and raised in Hendersonville, TN, Perera decided to join Doctors Without Borders after graduating from nursing school and is now setting an example for his community on how to get involved in global humanitarian efforts.
After attending the University of Illinois for his bachelor’s degree in nursing and Vanderbilt University for his master’s degree, Perera embarked on his first mission to Haiti following the 2010 earthquake to help with the cholera outbreak there. His missions have also taken him to work in primary care in the Democratic Republic of Congo and to the frontlines of Chad treating war-wounded victims.
However, Perera was most recently stationed on a two-month medical mission in Bentiu, South Sudan, working in a refugee camp hospital made up of 130,000 residents. The camp was created as a result of a civil war breakout in the area. Although his missions often take him to volatile, war-torn environments lacking housing and running water, Perera says the toughest aspect of his job is managing the emotions involved. Perera has found that the best way to cope with the emotions of treating victims of war is to focus on task-oriented jobs like training local nurses.
For Perera, his work with Doctors Without Borders goes beyond just nursing and medicine. He tells UTDailyBeacon.com, “I realized that medicine, for me, is a Band-Aid to something a lot bigger; we’re talking wars, huge injustices, malnutrition in countries like Congo. For me, my presence there and the presence of Doctors Without Borders is more than medicine, it’s a way of saying injustice is not okay.”
Perera recently moved to Knoxville, TN after returning from his two-month mission in South Sudan. He plans to work as a hospital nurse practitioner while he prepares for another Doctors Without Borders mission trip. In his spare time, Perera encourages other current and future healthcare workers to get involved in global aid and serve those in need.
To learn more about Perera’s time as a medical mission nurse for Doctors Without Borders, visit here.
Barbara and Donald Jonas, founders of The Jonas Center for Nursing and Veterans Healthcare, recently unveiled a new vision to support the country’s most vulnerable citizens through Jonas Philanthropies. Building on more than a decade of high-impact investments in nursing scholarship, leadership, and innovation, Jonas Philanthropies will begin expanding the organization’s scope to fund other scalable solutions aimed at the most vulnerable and neglected.
According to a press release from JonasPhilanthropies.com, “The organization’s new model will invest where it matters most – meeting needs of the country’s most vulnerable citizens with high-impact solutions to transform healthcare.”
The Jonases have always had a deep passion for the nursing industry and its integral role as the backbone of the American healthcare system. Their venture began over a decade ago when they decided to sell their impressive art collection to fund the basic human needs of healthcare through their first philanthropic organization, the Jonas Center for Nursing and Veterans Healthcare.
Their impact spans the country, funding more than 1,000 doctoral nursing scholars to help care for the most vulnerable populations and improve care for veterans. They have since expanded to help support low vision and blindness and children’s environmental health.
Donald Jonas, Co-founder and President of Jonas Philanthropies, says, “Jonas Philanthropies is an evolution of our work and personal passion, but it also reflects the broader needs of the healthcare industry, which will help ensure its impact and scalability for generations to come. We are incredibly excited to celebrate this next chapter.”
Their new name, Jonas Philanthropies, represents their expansion beyond nursing and veterans care. To learn more about Jonas Philanthropies and their impact on the field of nursing, visit here.