When treating a patient with Chronic Obstructive Pulmonary Disease (COPD), the physical symptoms are usually easy to see. The psychological impacts, like depression and anxiety, are there too, but they can be more difficult to identify. That’s why it is critical for the nurses and other health care providers caring for these patients to have a better understanding of what they are experiencing – both physically and mentally – in order to guide the best possible care.
Because little research exists on the emotions and feelings a patient faces while living with this chronic disease, I set out to learn more. My findings from a series of interviews with severe (stage IV) COPD patients published in The Journal for Nurse Practitioners uncovered some of these “hidden symptoms” of COPD, shedding light on the mental struggles COPD patients must face every day. Additionally, I found that some health care providers can do more to lessen this burden for the patient.
I believe there are steps that nurses can take to ensure that they’re addressing all of the symptoms of COPD:
- Help Patients Make Sense of the Diagnosis: Many of the patients in the study spoke about being confused when they first experienced symptoms of COPD. They knew something was wrong when they started to experience breathlessness, one of the most common symptoms of COPD, but they didn’t fully understand what caused it. As you can imagine, it’s easy to feel afraid when you don’t know what is happening to your body. It’s our job to help educate our patients about their condition, communicating with their physician and offering recommendations beyond just telling them to quit smoking or to use an inhaler.
- Take the Time to Ask Thoughtful Questions: Once diagnosed, many patients are overwhelmed with feelings of guilt, fear and hopelessness. Specifically, severe COPD is often met with increased anxiety about the end of life, and many patients in the study admitted having a difficult time accepting that this is how they were spending their last years. They also often had a hard time being optimistic about the future. It is important to let patients know that they are not alone and encourage them to share anything they may be feeling. This will ultimately help us provide the best possible care and treatment.
- Connect Patients to a Support System: The patients in my research were brave enough to share their stories, and I know there are many more patients out there struggling with similar emotions and feelings. There are many resources that we can offer these patients in order to improve their quality of life, including social support groups, end of life planning, and counseling.
Changing perceptions of risk could improve compliance with infection-control measures
It’s often said that knowledge is power. But a new study finds that when it comes to nurses’ compliance with infection-control measures, it’s more appropriate to say attitude is everything.
The study, published in the American Journal of Infection Control, examines the relationship between infection-control compliance, knowledge, and attitude among home healthcare nurses. Researchers surveyed 359 home healthcare nurses in the U.S., and evaluated their knowledge of best practices in relation to their compliance with infection-control measures.
Over 90% of nurses self-reported compliance for most of the measured behaviors. The researchers also found there was not a direct correlation between knowledge of infection-control practices and compliance with those practices. However, there was a relationship between the level of compliance and the participants’ favorable attitude toward infection control.
“This study tells us that knowledge is not enough,” said one of the lead authors, Jingjing Shang, PhD, of Columbia University School of Nursing in New York City. “Our efforts to improve compliance need to focus on ways to alter nurses’ attitudes and perceptions about infection risk.”
The authors suggest that efforts to improve compliance with infection-control practices should focus on strategies to alter perceptions about infection risk. Changes should start on an organizational level, and seek to create a culture of positivity in relation to infection-control compliance.
Among other takeaways from the study:
- Protective equipment lapses: While most of the participants reported compliance on most issues, many reported lapses when it came to wearing protective equipment; only 9% said they wear disposable face masks when there is a possibility of a splash or splatter, and 6% said they wear goggles or eye shields when there is a possibility of exposure to bloody discharge or fluid
- A culture of “presenteeism:” Presenteeism, coming into work despite being sick, has become a patient safety issue over the last few years, especially as it relates to infection control; only 4% of participants felt it was easy for them to stay at home when they were sick, which could be a major contributor to rates of infection
- Hand hygiene is still an issue: 30% of respondents failed to identify that hand hygiene should be performed after touching a nursing bag, which could transport infectious pathogens as nurses travel between patients
“Infection is a leading cause of hospitalization among home healthcare patients, and nurses have a key role in reducing infection by compliance with infection-control procedures in the home care setting,” Shang said.
This story was originally posted on MedPage Today.
Indeed recently released a report of the 15 most difficult healthcare roles to fill in the United States, after reviewing which jobs remained unfilled after 60 days. Nurse practitioner roles and agency nurse roles neared the top of the list, ranked at third and fourth respectively.
Preparing for the Nursing Shortage
There is a strong need for more healthcare workers of all specialties, but especially nurses. As the nursing shortage continues, it remains likely that the US will be in need of at least 95,000 nurse assistants and 30,000 nurse practitioners by 2025.
59.7% of nurse practitioner roles remained open after 60 days of being posted. These roles in particular remain crucial as NPs have more responsibilities than registered nurses, and are able to write prescriptions. Agency nurse roles were similarly difficult to fill, with 57.8% of these roles still available after 60 days.
“To identify the hardest-to-fill healthcare roles, we compiled a list based on the percentage of jobs unfilled after two months,” Indeed wrote in its report. “Job postings can be open for longer than 60 days for different reasons; in this case Indeed uses this measure as a proxy for hiring difficulty.”
Indeed also noted that nurse practitioner roles, as well as pulmonologist and rheumatologist roles, had over two thirds of their job listings still open after 60 days.
“One of the biggest challenges facing the field of nursing right now is that many will soon retire,” Indeed reported. “This represents not only a shortage of people to do the job but also a large loss of institutional knowledge.”
Expanding the Recruitment Reach
Rethinking nursing recruitment efforts is key for hospitals looking to fill nursing roles of all specialties. Some hospitals offer bonuses, tuition coverage, and housing options in hopes of attracting top nursing talent. But expanding nurse recruitment to other states can help fill crucial roles sooner.
In its report, Indeed highlighted that the nursing shortage was not found in every region of the United State. Recent research by the US Department of Health and Human Services shows that in 2030, though some states are predicted to have serious shortages of nurses (California, Texas, New Jersey and South Carolina), others may have a significant excess supply of nurses (Florida, Ohio, Virginia and New York).
A new healthcare nonprofit organization in Maryland recently launched to better address rural patients’ needs. IMBUEfoundation will provide care and transportation services to Maryland’s Eastern Shore communities, to improve residents’ options for care and lifestyle choices.
“IMBUEfoundation was established to eliminate the barriers that prevent people from accessing healthcare and living healthy lives,” founder Dr. Seun Ross said. “We are working to address obstacles like health literacy, transportation, and care coordination.”
Recent research by Harvard’s T.H. Chan School of Public Health, the Robert Wood Johnson Foundation and NPR shows that receiving good healthcare is the second-biggest problem for rural American families. Major health concerns for rural Maryland residents include chronic disease, health literacy, care coordination, outreach and education, according to a 2017 assessment by the Maryland Rural Health Association. IMBUEfoundation notes on its site that the lack of services and coordinated care has led many Maryland residents to struggle in finding proper care.
“Healthcare is more than just going to the doctor,” Ross said. “For example, someone who lives in a place like Caroline County, which is both a food swamp and a food desert, is going to have a harder time making healthy food choices, which can lead to obesity— a major factor of chronic disease. It’s a domino effect.”
The new non-profit is helping those in need with nurse practitioners, acting as “clinical concierges” who provide counseling, monitoring, and stewardship activities. The nurse practitioners assist with coordinate care delivery for patients, explain healthcare plans and treatment options, and provide education on alternative care, in addition to other necessary tasks.
Modes of services provided by IMBUEfoundation include the Rural Health Collaborative, Care Coordination, and Transportation Service, in partnership with Lyft.
“From providing transportation to helping patients coordinate between doctors, IMBUEfoundation is working to make sure Maryland’s mid-shore residents have the resources they need to be healthy and happy,” Ross said. “But there’s still so much work to be done.”
For more information about IMBUEfoundation, visit imbuefoundation.org.
VA strives to deliver high-quality, compassionate health care to Veterans across America. We’ve taken great strides to ensure patients living in rural areas have access to a range of care options to best meet their health care needs. Due to VA’s recent “scope of practice” laws—which grant advanced practice registered nurses (APRNs) full practice authority—certified nurse practitioners are stepping in to provide primary care to patients in rural areas.
Currently, nurse practitioners account for 1 in 4 medical providers in rural practices—a 43.2% increase from 2008 to 2016. Their advanced training and ability to diagnose and prescribe medicine enables more efficient, cost-effective health care delivery. Joyce Knestrick, president of the American Association of Nurse Practitioners (AANP), says “NPs are one of the most significant factors in expanding patient access to primary, acute and specialty care, especially at a time when demand is high and physicians remain concentrated in more urban and affluent areas.”
More and more, nurse practitioners are taking on a significant role in the health care of Veterans in rural areas. Their growing presence demonstrates the wealth of experience, growth and impact available to nurses interested in advancing their careers. Bring your nursing expertise to VA and discover a career in which your capabilities are utilized to the fullest extent—and consider a future serving our honorable Veterans living in rural areas. You’ll enjoy a satisfying quality of life unmatched by metropolitan areas, with all the same comprehensive benefits offered across the VA system. To get started, explore open positions near you and apply.
This story was originally posted on VAntage Point.
Stricken with kidney failure brought on by ALS – a progressive neurodegenerative disease that affects voluntary muscle movements – Navy Veteran Richard Cole was told that his only option was relocating to a nursing home, where professionals could oversee his 24/7 health care needs. But he and his wife Yvette, who had no previous medical training, were determined to stop that from happening. So Yvette turned to the one person she thought might give them a fighting chance: her husband’s nurse, Pamela Wade.
Caring for Mr. Cole’s advanced ALS required hemodialysis, ventilators, and round-the-clock care, not typically-available options for in-home treatment. But after realizing how important it was to Richard that he go home, Nurse Wade began training his wife Yvette to care for her own husband on her own terms.
“There are certain criteria you have to pass to go home,” Wade said. “He didn’t fit any of them, but… I couldn’t say no.”
Two-and-a-half-years later, Yvette is still successfully managing her own husband’s treatment and the couple is doing great.
“Pam has been a godsend,” Yvette said. “I can’t say enough good things about her. I am just grateful she stepped in when she did.”
In working with the nation’s bravest patients, VA understands the great strength and toll that their service sometimes takes. That’s why we do everything we can to empower our nurses, doctors, technicians and administrators to adapt protocols and go ‘above and beyond,’ to care for our patients as much on their own terms as possible.
To explore open opportunities and your own empowered career with VA, visit www.vacareers.va.gov.
This story was originally posted on VAntage Point.