Among older former cigarette smokers, a strong correlation was shown between smoking duration and health, with longer smoking history associated with greater risk for poor overall health, chronic obstructive pulmonary disease (COPD), and chronic disease, according to CDC research.
In national data, for people ages 65 and older who had once smoked but quit, a linear association was seen between years of active smoking and risk for fair or poor health, reported Ellen A. Kramarow, PhD, of the CDC in Atlanta, in National Health Statistics Reports.
Based on data from the 2018 National Health Interview Survey (NHIS) and adjusted for age, sex, race, and Hispanic origin and education, the analysis linked several negative health outcomes with increasing smoking duration:
Poor or fair health: 17.8% (smoking duration ≤10 years), 20.3% (>10 and <25 years) , 23.4% (25 to <40 years), and 28.5% (≥40 years)
COPD: 9.1%, 12.2%, 20.3%, and 32.7%
At least four chronic conditions: 18.1%, 17.2%, 23.3%, and 26.1%
Limitations on social life: 8.6%, 9.1%, 10.7%, and 14.2%
Kramarow told MedPage Today that while the health benefits of quitting smoking are numerous and well characterized, less is known about the health risks associated with smoking in the past among older former smokers.
Older adults in the U.S. are more likely than younger adults to have a history of smoking, with former smokers making up 21% of the 2018 NHIS population overall, and 40% of survey participants who were ages 65 and older. This 40% represented nearly half of men in the 65-plus age group and a third of women.
Quitting smoking is associated with immediate and long-term health benefits, such as improved lung function and reduced risk of heart attack and stroke.
Among the former smokers, ages 65 and older, who participated in the 2018 NHIS, more than half reported smoking for 25 years or more, with 23.5% smoking for 40 or more years, and 31% smoking for 25 to 40 years.
Some 18% reported smoking for less than a decade, and 27.6% reported smoking for more than 10 years and less than 25 years.
Roughly three-fourths of the older former smokers had started smoking by age 20, and 93% of those who smoked for less than a decade reported quitting 40 years earlier or more.
Conversely, among older former smokers who smoked for 40-plus years, 37.4% reported quitting within the last 5 years, and 57.3% reported quitting more than 5 years and less than 25 years before participating in the 2018 survey.
The analysis divided the older former smokers into four smoking duration categories: 10 years or less, more than 10 years and less than 25 years, 25 to less than 40 years, and 40 years or more.
Kramarow noted that the study had significant limitations, including the inability to control for how long ago a former smoker quit. Smoking length was established based on answers to the questions; “How old were you when you first started to smoke fairly regularly?” and “How long has it been since you quit smoking cigarettes?”
“There may be independent effects of time since quitting on health among older adult former smokers,” she wrote. “Measured at one point in time, it is difficult to separate the impact of number of years smoked from time since quitting because they are so highly correlated.”
Information was also lacking on the intensity of smoking — whether the former smokers had been light or heavy smokers. The survey also did not ask about use of other tobacco products.
Despite the limitations, Kramarow told MedPage Today that the findings bolster evidence of a dose-response relationship between smoking and poor health, and she said clinicians caring for older patients should ask about smoking history.
“When considering the health of older people, it is worth keeping in mind that a significant proportion are former smokers,” she said. “Smoking history is probably still relevant, even if someone stopped smoking decades ago.”
Kramarow disclosed no relevant relationships with industry.
Enterprise High School students refused to allow anti-mask protesters to disrupt the start of the new school year. Senior Dalee Cobb, a cheerleader and javelin thrower, declared, “I feel like the opinion of parents and adults in general right now are just a big part of that problem.” Prior to a football game in late August, Cobb and other student athletes at the Utah school urged their community to take a stand against a growing anti-mask movement that threatened to postpone local school reopenings: “We, of all people, know that wearing a mask is not fun, “Cobb said. “Neither is wearing a seat belt or a life jacket or pads for football, but we do all these things so we have a future.” (As of September 1, there have been over 52,000 COVID-19 cases in the state).
As the public becomes accustomed to the ebb and flow of COVID outbreaks, a resurgence of protests against the state mask-wearing mandate came into conflict with the reopening of Utah’s public schools. Students became alarmed when hundreds of parents demonstrated outside the school district administration office and circulated threats to engage in a #NoMaskMonday. Enterprise students decided to use the football game as a platform to take action to protect their own health—and persude parents to send their kids to school in masks so they would be able to resume classes. “We ask that you put your mask on so we can get our game on,” Cobb said, as she urged local football fans to look out for the best interests of their community.
That weekend, Enterprise students also made use of social media to counter parents attempting to organize a #NoMaskMonday protest. Cobb told the Deseret News, “It’s sad to say, but the parents that are doing this, they aren’t us.” School Principal Calvin Holt supported students’ efforts and remarked, “[Students] were concerned about what a rebellion against masks was going to do to their opportunities for school and other activities.”
When schools did open, according to Deseret News, “Most students complied with the mask order, though the school district received some phone calls from concerned parents who got calls or messages from their children that not all students were wearing their masks all the time inside school buildings.” By the end of the first day, the local school district reported that no more than six students had been sent home for refusing to wear masks.
Anti-mask protesters cite a variety of reasons for their refusal to wear a mask. Some refer to the mixed messages that prevailed in the early stages of the pandemic; some are vehemently opposed to statewide mask mandates (at present 34 states require that masks be worn in many public settings); others say that they are still dubious about the severity of COVID-19 and have adopted various conspiracy theories promulgated on social media; a large contingent of anti-mask protesters, of course, use all of these arguments.
In the age of EHR, storing info on a cloud, and working on smart phones, it’s also a prime time for hacking. Nurses need to protect the security and privacy of their patients’ personal and health care-related info so it’s important to educate yourself about cybersecurity best practices. So, how do you go about it?
What are the best ways for nurses to protect their patients’ information?
One of the best ways that nurses can protect their patients’ personal and health care-related information is to inform themselves about cybersecurity best practices. If your organization doesn’t offer cyber awareness training, request that they do so. This type of training can help you understand cyber threats like malicious websites, phishing emails, and other tactics that cybercriminals use to carry out attacks.
Here are a few other good cybersecurity best practices that you can use right away:
Always use unique passwords for your accounts.
One of the biggest mistakes that people across all industries make is using the same password for multiple accounts. A poll from Google and Harris shows that 52% of users reuse passwords across multiple accounts, and another 13% indicate that they use the same passwords across all accounts.
This means that all of your accounts should have unique passwords. This prevents hackers from using the same password to access multiple accounts in the event that one of your accounts becomes compromised.
Never plug personal devices (or unauthorized devices) into workstations or work devices.
Don’t click on attachments or links in emails without first inspecting the messages.
Check to see if the sender’s name and email match, and if any links are legitimate. If the name and email don’t match, or if the link is from some unknown web address, that should send up a red flag. For example:
If you normally get emails from your boss (email@example.com) but suddenly receive an email from an email address like firstname.lastname@example.org or email@example.com, that would be suspicious.
If there’s a link embedded in the email, hover your mouse over the link (without clicking on it!) and it should display the true web address where the link would take you.
If you receive an email from a suspicious address that contains a PDF, Excel file, or Word doc, don’t click on it. It’s possible that the file may contain malware.
If you receive an unusual or urgent request, call to confirm.
A common tactic that cybercriminals use to get you to do something or to provide information is to create an urgent situation. If you get an email or phone call from someone asking (or demanding) that you send them sensitive information, tell them you’re going to call them back to confirm. Use the contact information that’s provided through your organization’s official contact directory—never respond using an email address or phone number provided by the person who reached out to you!
Be aware of what’s going on around you.
Not all data breaches occur because of cyber attacks—sometimes, they come in the form of physical security breaches. Is there someone hanging around the nurses’ station that you don’t recognize or who doesn’t belong there? Ask them if they need help. This proactive approach can help to prevent cybercriminals from gaining physical access to records and other data by accessing computers at those stations or stealing portable devices from the area.
Much like how you sanitize your hands and wear protective gear to keep yourself and your patients healthy, having strong “cyber hygiene” is what keeps your organization (and your patients’ data) safe and secure.
Why do nurses need to protect their own email accounts, social media accounts, or their phones? Why do hackers start there?
Your personal email and social media accounts are a goldmine of data for cybercriminals. They can use information that they learn about you through those channels to guess your work account passwords. It also serves as fodder for social engineering tactics.
Nowadays, people tend to use their mobile devices and apps for banking, sending emails, and for handling other sensitive data. If a cybercriminal gets a hold of your cell phone or another mobile device that you use to access those accounts, then they have control of those accounts.
What are the most common tricks that hackers use?
Cybercriminals use the tactics that demonstrate the best outcomes with the least amount of effort. Needless to say, it’s a lot easier to trick someone into handing over their credentials than it is to hack through their organization’s network security defenses.
That’s why phishing is among the most common tactics used by cybercriminals. Phishing relies on the use of social engineering tactics, which often involves them pretending to be a colleague, manager, or another authority figure. Cybercriminals use strong social skills and charm to disarm you while also evoking a sense of urgency, fear, or curiosity that compels you to act. Their ultimate goal is to trick you into doing something you’d normally never do.
For example, you’d never just give a stranger your employee credentials or a patient’s health records or personal information. But if you receive a fraudulent email from someone pretending to be your organization’s IT team saying that your password has been compromised and that you need to reset it via a link they provide, you may be doing precisely that without even knowing it.
Cybercriminals use phishing emails to get users to download malicious software or to click on malicious links. Continuing with the previous example, if you enter your username and password in a password reset form on a fraudulent website that looks like your organization’s site, then you’re giving them the ability to log in to your accounts and access any systems your account touches.
What kind of information are hackers trying to get? What do they do with it?
Hackers love all types of data. They can choose to use it themselves to carry out crimes or sell it to other cybercriminals through a market known as the dark web for profit. Some of the types of data they look for include:
Personally identifiable information (PII) such as names, phone numbers, addresses, social security numbers, etc.
Financial information such as credit or debit card information, bank account numbers, etc.
Protected health information (PHI) such as health records and insurance-related information
Proprietary data and intellectual property
Usernames, passwords, and other account credentials
User credentials and passwords are particularly valuable to cybercriminals. If they have your username and password, then they have the virtual keys to the kingdom. Hackers can use this information to access your organization’s network, databases, patient files, or any other systems that your account touches.
What would readers be most surprised about regarding cybersecurity?
Unless an organization chooses to eliminate everything digital within their environments, there’s no way to prevent every cyber attack. Hackers are always going to find vulnerabilities and weaknesses to exploit. But what you can do is follow cybersecurity best practices to make yourself and your organization tougher targets.
Firewalls, antivirus software, and other technologies can protect your organization from some threats but not all. You and your fellow health care providers are what constitute the “human firewall” of your organization.
Is there anything else that is important for our readers to know?
Data from Black Book Market Research shows that “Over 93% of healthcare organizations have experienced a data breach since Q3 2016 and 57% have had more than five data breaches during the same timeframe.”
Researchers at Vanderbilt University believe that there may be a link between ransomware attacks and data breaches and an increase in heart-related deaths among patients at hospitals hit by those attacks. According to Brian Krebs, a cybersecurity expert and author: “Hospitals that have been hit by a data breach or ransomware attack can expect to see an increase in the death rate among heart patients in the following months or years because of cybersecurity remediation efforts.”
You can complete cyber awareness training on your own. The U.S. Department of Defense offers free cyber awareness training online in the form of its DoD Cyber Awareness Challenge.
Every nine minutes, a life is lost to blood cancer, so Nurse of the Week Heidi Gould didn’t take it lightly when she received a request for another special blood donation. Gould was busy treating COVID patients in the ICU at Memorial Medical Center in Springfield, Illinois, but she readily made time to help.
In 2018, Heidi had donated peripheral blood stem cells after being matched with a 72-year-old patient with Acute Myeloid Leukemia. “If that was your family member,” she says, “you would want someone out there to be a match for them.” This April, his cancer returned, and doctors needed more blood from their patient’s matching donor. Gould had nearly reached her maximum limit for donations, but happily, she still had enough blood to spare. This time, she said, “I went and donated just my white blood cells”.
When she donated peripheral blood stem cells two years ago, Heidi first had to receive a daily injection (shot) of Filgrastim, a drug that causes the bone marrow to make and release additional stem cells into the blood. After finishing the series of shots, her blood was removed through a catheter, then cycled through a machine that separates the stem cells from the other blood cells. The process, which is called apheresis, is an outpatient procedure that takes 2 to 4 hours. As Gould describes it, “You have one IV in one arm and it takes the blood out and filters it, and you have an IV in the other arm and it just puts it back in what they don’t need.” Often the process needs to be repeated daily for a few days, until enough stem cells have been collected.
Gould was just happy that she could help preserve a life. “There’s nothing like saving a life. You being the only person that is able to help this person—you can’t put a price on that.”
To see the full story on Heidi Gould, see the video segment on Illinois’ Fox 55 news broadcast.
In March, when New York City staggered under the weight of the COVID-19 outbreak, the images of refrigerator trucks, overwhelmed hospitals, and outdoor triage centers set Amy Kinder’s caregiving instincts afire. On April 5, 2020, the ER nurse left her home in Kokomo, Indiana and joined the thousands of dedicated nurses who came to work on the city’s frontlines. During her 21 days at Coney Island Hospital in Brooklyn, Kinder formed a tight bond with eight colleagues. Now, the nine nurses have described their experience in a new book, COVID-19 Frontliners.
“I remember my first night in the emergency department I was stopped abruptly in my tracks as I was racing down the hallway. My eyes caught movement in one of my rooms. I stopped to ensure what I was seeing. I had a patient actively dying and the patient next to her reached through the rails of the cot and held her hand trying to comfort her. I felt anguish for these patients. They did not know each other, but they were all alone. They had no one but the stranger beside them.” –Amy Kinder, COVID-19 Frontliners
In an interview with the Kokomo Perspective, Kinder said, “We felt like it was important to get the truth out there because you see on the news so many conflicting stories of what’s really happening or what was going on. So we just felt like it was important to get our frontline experience out there so other people really could see and understand what it really was like—because when I was out in New York, [it seemed] like the news sugarcoated what was really going on.”
As they attempted to communicate with non-English speaking patients, Kinder and the other nurses tried to find their footing amid scenes of chaos: “There were patients everywhere, double and triple stacked in rooms, lining the hallways, right up to the nurses’ station.” She added, “I could not believe what I was seeing. How could this be possible? Where did all of these patients come from? I thought to myself, ‘Damn, this is way worse than what I saw on the news.’”
In addition to dealing with the overcrowding and insufficient PPE supplies, Kinder and her colleagues struggled with a shocking volume of mortalities that sometimes included co-workers: “During the hardest time, we learned how to cope in ways we never had before. Not only were we seeing death in our patients but within our own healthcare family. We lost an agency nurse one night at shift change. She was found down in the bathroom. My heart still hurts for this individual’s family.”
When Kinder returned to Kokomo, she found that the experience had left marks on her psyche. Back on duty at the Ascension St. Vincent ER, “Alarms go off, and I flash back to the horror in NYC. I begin to hyperventilate worrying that we are running out of oxygen again or that a patient is in crisis. I have to talk myself down and remind myself of where I am and that I’m no longer in NYC.”
Her 21 days in New York also left Kinder with a sobering awareness of the realities of COVID. “I knew that it was a big deal, but at the same time I wasn’t really sure how big of a deal it was. There’s so much unknown about this dang virus, so I even was on the fence. But then I come home and people are mouthing, and until you’ve been out there and lived it, it hurts to hear people talk like that…”
Having to wear PPE creates a communication barrier that imposes a heavy burden on nurses. Patients look to nurses for information, help, and comfort, but now—at a time when they depend on nurses more than ever—you have to interact while swathed in protective gear. It is nice to be acknowledged as a “hero,” but being a masked hero makes the job a bit harder, doesn’t it?
What can you do to communicate more effectively and connect with patients while wearing PPE? DailyNurse sought guidance from patient-provider communication specialist Dr. Mary Beth Happ, PhD, RN, FAAN, FGSA.
Dr. Happ outlined the problems: “[PPE can cause] muffled voice and conceals facial features, particularly the lips and mouth. We give each other important communication cues through facial expressions (such as smiling) as well as mouth and lip movement when talking. This is particularly important for patients who have any hearing impairment, delirium, or dementia. The patient may not realize that the nurse is speaking or may be confused by the sound of the nurse’s voice without seeing mouth movements. Another way that we communicate is through human touch. Unfortunately, reduced contact time and wearing protective gloves limits touch communication.” Here are Dr. Happ’s tips for nurses seeking ways to connect across the PPE barrier:
1. Use your eyes, your hands, and a notepad to communicate
“Getting and maintaining eye contact with the patient as much as possible is so important. ICU patient survivors have told us how frightening it is when the eyes are their only way to connect with the humans caring for them (due to intubation, physical restraints or weakness) and the nurse or therapist does not make eye contact.
Nurses can allay patient anxiety by using special communication tools and techniques to augment or assist a patient’s understanding of the nurse’s messages. For example, we recommend always keeping a notepad and felt tip pen or marker at the bedside. Write key words or phrases as you are speaking to reinforce and help the patient understand your message. Use picture communication boards to emphasize your meaning if patients have low literacy or English proficiency. Also, gently touch the patient’s shoulder or arm when you speak to get their attention and connect.”
2. Make it easier to identify the person behind the mask
“Over-enunciate, deliberately slow the pace of your speech, and keep each message short. Breathe in and out through your nose. Allow pause time for the patient to process what he/she thinks you said. Validate that they understand – ex: what did you hear me say? What do you understand will happen now? Try not to appear rushed. This is a good quick resource: https://torontoadultspeechclinic.com/blog/2020/3/30/speaking-with-a-mask-on.”
4. Communicate with hand and arm gestures, or use a form of sign language to help convey your meaning
“We recommend simple but consistent (repeated) gestures and the use of referential pointing – that means pointing to objects or parts of the body that you are talking about. By consistent gestures, I mean that you should use the same gesture for particular words (such as, yes/no, okay, pain medicine, hot/cold, tired, turning/repositioning in bed) repeatedly to avoid confusion. We recommend posting a sign at the bedside with frequently used gestures and their meanings (sometimes patients have idiosyncratic gestures) so that others will use the same lexicon or “gesture dictionary.” Family members may be able to help identify meanings for individual gestures or expressions.”
5. Use audio and video technology to help patients stay connected with loved ones
6. Follow some basic communication “dos and don’ts”
Dr. Happ’s list:
Do get the patient’s attention, make and maintain eye contact for as much of the interaction as possible.
Do establish a clear Yes-No signal with the patient (ex: head nods – shake; thumbs up – fist closed; eye blinks – eyes shut tight).
Do post the patient’s Yes-No signal and communication plan (tools, favorite topics, common gestures) at the bedside and pass this info on in shift handoffs and interdisciplinary rounds.
Do have communication supplies (paper, marker, clipboard, communication boards) ready at the bedside anticipating the need.
Do always confirm or validate your understanding of the patient’s message.
Don’t assume that patients who are quiet or have eyes closed have nothing to communicate. The eyes closed behavior may be their way of coping.
Don’t encourage patients who are orally intubated with an endotracheal tube to mouth words. This action is can cause bronchospasm and airway irritation.
Don’t assume that you can lip read a patient’s silently mouthed words with high accuracy. Lip reading is a difficult skill and prone to misinterpretation. For example, a request for “pants” was interpreted as “pain” and the patient received unnecessary sedating narcotics. A patient tried to tell his nurse about a problem with the “urinary bag” but the nurse walked away thinking he said, “you are bad.” The YouTube videos that replace nonsense words in politician’s speeches are evidence of the dangers of lip reading. If you must lip read, always confirm your understanding with the patient.
Dr. Mary Beth Happ, PhD, RN, FAAN, FGSA, is the Nursing Distinguished Professor of Critical Care Research and Associate Dean for Research and Innovation at The Ohio State University College of Nursing. Dr. Happ’s research focuses on improving care and communication with communication-impaired patients.