Within Reach: Practical Applications of Nursing Inquiry

Volume 9│Issue 1│February 2018 Carilion Medical Center, 1906 Belleview Ave, Roanoke, VA 24014 http://chsweb.carilion.com/nursserv/NursW eb.html nursingresearch@carilionclinic.org (540)266 -6216

Transitions: What’s old is new. Are you ready for a change?

Tameka D. McDaniel, DNP, RN, CCRN - AGCNS student (University of Detroit Mercy) Note: Tameka is a student in the Adult-Gerontology Clinical Nurse Specialist Post-Master’s Certificate Program at the University of Detroit Mercy. Her practicum preceptor is Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC.

Who am I? What is my purpose? What is my mission? Am I ready for change? These are all questions that one asks when there is a transition in career, purpose or position. Such is the case with Carilion Clinic‟s „Within Reach‟ publication. Such is the case with myself. Within Reach and I have much in common. Follow along as I spin the unlikely tale of Carilion Roanoke Memorial Hospital‟s professional publication and the path I never thought I‟d take.

Who am I? Me: I am a registered nurse of 12 years and a Detroit, MI to Richmond, VA transplant. I began my career with an ADN and obtained my education through a stepwise fashion. Critical care has been my specialty for a decade, and I never thought that would change. I have always loved being at the bedside. Nothing and no one could change that……or so I thought.

Within Reach: Within Reach is Carilion Clinic‟s quarterly peer-reviewed publication written by nurses. The publication is focused on the nursing perspective and covers various topics related to patients and families, human touch, research, education, clinical practice, and advocacy.

What is my purpose?

Me: Throughout my career, my purpose was to be a critical care sleuth. I thrived in an environment where I had drips, tubes, waxing/waning blood pressures, labile oxygenation and infections. My job was to figure out how to manage the varying condition of the patient(s) for 12 hours and coerce the patient to near homeostasis or some resemblance of stability until 0700 report. That all changed when I noticed the high rate of readmissions among the patients for whom I cared. All of a sudden, my purpose changed. I became an AGCNS (Adult Gerontology Clinical Nurse Specialist) student at the University of Detroit Mercy. I found myself driving two and a half hours from Richmond to Roanoke every week to gain practicum hours under the tutelage of Drs. Cindy Ward, Phyllis Whitehead, Donna Bond and many others to gather an understanding of my new role and purpose. The uncertainty ahead has been both fearful and exciting.

Within Reach: Since its inception, Within Reach has been the voice of Carilion nurses. The publication contains EBP & research reports, educational material, event ads, opportunities and accolades. It was developed as, and continues to be, a platform for nurses to meet CAP (Clinical Advancement Program) requirements, write about subjects pertinent to nursing practice, and display the accomplishments of Carilion nurses. Since 2010, Within Reach has been the physical manifestation of the literary research of Carilion nurses, a platform for professional opinions and a medium for perfecting editorial skills. Often, this publication affords the system‟s nurses their first opportunity to publish, guidance through the process and the accomplishment of having conducted evidence based scholarly research. Carilion excellence is on full display for all to see within the pages of Within Reach. The transitions ahead for this publication are, like mine, both fearful and exciting. *Continued on page 3

Carilion Clinic Roanoke Campus

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ARTICLES 1 Transitions: What’s old is new. Are you ready for a change?

Tameka D. McDaniel, DNP, RN, CCRN

4

Article Review: Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients.

Brenda Epperly, BSN, RN, CCRN

6

What is best practice for hang time for intravenous fluids and change times for IV fluid sets?

Kim Carter, PhD, RN, NEA-BC

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Slavery and Human Trafficking Prevention Lesia Yates, BSN, AAS, RN, FNE, SANE A/P

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Carilion Children’s Family Camp Weekend: Much More than a Weekend in the Great Outdoors Sarah Kress, CCLS

RECOGNITION/EVENTS 14 Maria Hirsch - John F. Garde Research of the Year Award ; Carolyn Kiefer - 2018 APIC Chapter President Elect

15

Phyllis Whitehead - Policy Council Selection/Opioid & Substance Abuse; Shirley Ballantyne - Oakey‟s Hospice Caregiver Award 2017

16 18 20 21

Conference Corner Citations & Recognitions “See Where Our Nurses Have Traveled” Map 2018 Week of the Nurse, Art & Science of Nursing Showcase

Within REACH Editorial Board: Kimberly Carter, PhD, RN, Editor Margaret Perry, MSN, RN, Associate Editor Donna Goyer BS, RN, CPAN, CAPA Christine Huson, MSN, RN Deirdre O. Rea, MSN, RN Sarah Browning, DNP, RN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Vivian Wilson, BSN, RN, CCRP Candace Asbury, BSN, RN Angelina Surgent, MSN, RN, ONC Monica Coles, MSN, RN-BC, ACNS-BC Michele Kosinski, DNP, MBA, RN James Ingrassia, MSN, RN Beth Assenat, BS

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(*Transitions continued from page 1) What is my mission?

Me: As a clinical nurse specialist (CNS) student, education focused on the three spheres of influence1 (McClelland, McCoy, & Burson, 2013).The spheres include the nurse, patient, and system (McClelland et al., 2013). As I transition into the CNS role, my mission evolves beyond the patient to include my fellow nurses and the health system.

Within REACH: As a peer-reviewed publication for nurses written by nurses and nurse-led teams about patient care, nursing education and clinical phenomena, Within Reach communicates and celebrates the scholarship of Carilion nurses. Building upon the Carilion Clinic Professional Nursing Practice Model, REACH, the articles share important information about practice issues and patient care innovations and approaches that influence patient outcomes. Within Reach offers a forum for nurses to experience their first peer-reviewed publication process, become a peer-reviewer, share their scholarship, and find solutions to patient care challenges. As Within REACH moves from a paper to electronic format, the editorial board is revisiting the vision and mission of the publication. Future editions will provide you with updates as Within REACH embarks upon this transition to a greener format.

Am I ready for change?

Me: Change is inevitable whether you welcome it or not. Transitioning from a veteran bedside nurse to an AGCNS is a huge evolution. Addressing the issues that affect health literacy, medication compliance, and readmission rates supersede my questionable readiness for change. There is a need that I have identified and intend to address within healthcare.

Within Reach: Until now, the publication could be found throughout the hospital as a color, bound professional journal free for the taking. Now, Within Reach is going green. The publication will no longer be available as a hard copy. Digital copies will continue to be sent to Carilion Clinic nursing staff. The need to transition to a more cost effective and environmentally responsible format fuels the change and supersedes the committee‟s questionable readiness for change. A need has been identified within Carilion to transition Within REACH from paper to exclusively digital, and the Within Reach Editorial Board intends to take this exciting next step in the publication‟s evolution.

Conclusion

Both Within Reach and I have much in common. We both are in a state of transition. There are new directions and changes that are necessary to meet our mission and focus. With each change, an evaluation of who we are, purpose, vision, mission and a readiness for change is conducted. Like the transition of Within Reach to a digital format, I too face inevitable changes. I am grateful to my instructors, preceptors and Carilion staff for fostering an environment that supports growth and change. What has been an old and constant way of life is new, different, scary and exciting. Like the Within REACH Editorial Board, I embrace change and look forward to the transition. Are you ready for a change?

References 1. McClelland, M., McCoy, M. A., & Burson, R. (2013). Clinical Nurse Specialists. Clinical Nurse Specialist, 27(2), 96–102. https://doi.org/10.1097/NUR.0b013e3182819154.

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Article Review: Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients Brenda Epperly, BSN, RN, CCRN - 10M ICU Article Review: Jones, G. M., Bode, L., Riha, H., & Erdman, M. J. (2016). Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients. American Journal of Critical Care, 26 (1), 37-42. doi:10:4037/ajcc2017439 Background Neurological physicians frequently prescribe 3% sodium chloride to reduce cerebral edema and intracranial pressure from the effects of neurological injuries. Pharmaceutical manufacturers recommend infusion through a central venous access due to high osmolarity and possibly inducing electrolyte imbalances.

Objective Studies regarding peripheral infusion have only been performed on neurocritical pediatric patients.

There have not been any studies for adults regarding safety concerns, contraindications, or infusion -related reactions requiring an intervention. There were two objectives from this study: to evaluate complication/reaction of intravenous (IV) site requiring interventions and to assess for electrolyte changes or abnormalities.

Method A retrospective multicenter cohort study was performed at two large urban teaching hospitals.

The study took place between September 2011 and September 2015 for discharged patients who received 3% sodium chloride via peripheral IV access. Daily documentation of IV site, gauge of IV, infusion rates, duration, and linked IV sites were collected. General demographics were also added with inclusion of age, gender, etc. and exclusions of those less than 18 and over 89 years of age, pregnancy, end-stage renal disease, syndrome of inappropriate anti-diuretic hormone (SIADH) and diabetes insipidus (DI) due to the inability to monitor electrolyte imbalances. Lab values were monitored for potassium, chloride, sodium, and bicarbonate.

Results Information was gathered from 213 patients. The median hospital stay was 11 days with 6 days being spent in critical care units. The median infusion duration was more than 51 hours with infusion through peripheral IVs (majority 18-20 gauge in the antecubital space) at 44 hours 43 minutes. 73.7% (157) of patients received their total infusion peripherally with a median duration over 44 hours. Once central access was obtained, the median infusion time was 19 hours 32 minutes. Infusion rates ranged from 30 ml/hour to 75 ml/hour. Only 3 patients had infusions greater than 50 ml/hour. Fifteen patients suffered phlebitis or extravasation (7%) and there were no incidents of thrombophlebitis reported. Hyperchloremia (49.3%) and hypokalemia (46.9%) were the most common electrolyte abnormalities although this data was very limited. Only 16.9% of those with hyperchloremia received interventions but 43.6% with hypokalemia received treatment.

Median sodium levels were 139 mEq/L and osmolarity levels were 290 mOsm/L.

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Limitations As a retrospective study, details relied heavily on accurate documentation of the peripheral IV site for complications, reactions and linking the medication to a specific IV site. The data for electrolyte values were limited due to inconsistent collection times for lab draws and lab orders for patients.

Discussion At the recommendation from drug information resources to limit peripheral infusion to 900mOsm/L (TPN), central lines are being placed for infusion of 3% sodium chloride. However, it has been acceptable to use peripheral IVs until central access has been obtained. The results from this study showed minimal risks for peripheral infusion. Central lines have many safety and health concerns including infection, thrombosis, and pneumothorax. These complications increase the cost of healthcare and may increase mortality.

Limited data for electrolyte imbalances showed a need for additional research in clinical outcomes.

Minimal complications and reactions were reported with infusion of 3% sodium chloride through peripheral IVs showing that large bore peripheral IV sites should be considered for extended use.

This action would eliminate an insertion of a central catheter, reduce complications associated with central lines, and lower healthcare costs.

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What is best practice for hang time for intravenous fluids and change times for IV fluid sets?

Kim Carter, PhD, RN, NEA-BC, Senior Director, Nursing Research and EBP Note: The literature review provided the supporting evidence for the January 2018 fast track revisions of Venous Access policies related to IV fluid bags.

Background Since 2014, supplies of 0.9% sodium chloride injection, lactated ringers, and 5% dextrose and water injection have been low1, and hurricanes in 2017 impacting the Puerto Rican supply resources compounded an already severe shortage of intravenous (IV) fluids. The fluid shortage has prompted reexamination of practice to determine possibilities for conservation of fluids, such as frequency of fluid and fluid set changes. The purpose of this literature review was to examine the evidence for hang time for intravenous fluids and change times for IV fluid sets.

Search Strategy The HERO Online Search Resource (Figure 1) was used for the literature search using the Keywords included IV Fluid hang time, IV fluid contamination, fluid container contamination and intravenous or IV. Limits included published since 2000, written in English, and published in peer review. Additional information was obtained by searching relevant professional organization websites and using ancestry with retrieved articles.

Summary of the Literature In response to the IV fluid shortage, The Institute for Safe Medication Practices (ISMP) 1 in 2014 recommended extending hang times beyond the standard 24 hour maximum, noting the importance of collaborative agreement between nursing, pharmacy, medical staff, infection control, and others affected. Support for this ISMP recommendation to extend hang times was credited to a single cross-sectional study over 18 months in a 257 bed teaching hospital that evaluated 264 infusate specimens from crystalloid fluids used for 24 hours or more 2. In this study2, Rickard and colleagues determined a colonization rate of 0.4%, with only coagulasenegative Staphylococcus being isolated. They found no difference in median duration of use for colonized and sterile specimens (Mann-Whitney, p=.99). Finding no relationship between duration of use and colonization to length of infusate use, the researchers concluded that “routine replacement may be unnecessary” and recommended further research2, p. 3028.

The Academy of Medical Surgical Nurses notes that the time for changing standard maintenance and intermittent flush bags is set by each organization, ranging from every 24 to 96 hours 3. At the current time, there is insufficient evidence to support a nationally recommended length of hang time for most IV fluids4,5. If available, manufacturer‟s recommendations for specific medications should be followed. Kienle notes that “many organizations have different allowances for hang time, based on different levels of infection risk: emergencies (change as soon as possible), immediate use (within 24 hours), pharmacy-compounded, and manufacturers‟ plain or premixed solutions with no additions.”5 A study conducted in a veterinary emergency room (ER) and intensive care unit (ICU) of 90 IV fluid bags of lactated balanced-electrolytes solution hung at either a bin or sink location were evaluated for contamination after 2, 4, 7, and 10 days6. No fluid bags were contaminated at days 0 or 2, with contaminations rates of the fluid bags of 1.1% on day 4 and 4.4% on day 7. All contaminated fluid bags were in the ER. Port contamination was 3.3%, 11.1%, 17.8%, and 31.1% on days 0, 2, 4, and 7 respectively, with similar port contamination in the ER and ICU. More port

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contamination occurred at the sink than the bins (38.3% versus 16.7%, p=0.032). While not conducted in a human setting, this study provides relevant information and a model for a potential human-related study.

The CDC makes no recommendations related to fluid hang time, but does make the following recommendations for replacement of administration sets4: 1. In patients not receiving blood, blood products or fat emulsions, replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, but at least every 7 days. Category 1A 2. No recommendation can be made regarding the frequency for replacing intermittently used administration sets. Unresolved issue.

The CDC makes specific recommendations for parenteral nutrition with or without fat, fat emulsion, and propofol infusion hang times, but for no other solution4. These are the most current guidelines.

Additionally, the CDC recommends replacement of intravenous tubing, including add-on devices, no more frequently than at 72-hour intervals unless clinically indicated. Tubing for blood, blood products, or lipid emulsions should be replaced within 24 hours of initiating the infusion, but no recommendation is made for replacement of tubing for intermittent infusions 7. Although the table in the aforementioned Erratum is not included in the 2011 CDC document, it does provide some useful information5.

According to the AMSN3, the 2011 Infusion Nursing Society (INS) recommended changing tubing sets for maintenance IV fluids every 96 hours or “when the integrity of the product or system has been compromised” and infers that this means “changing of the IV fluids every 96 hours also” 3.

The site goes on to note that the INS Practice Criteria II suggests that “there is strong evidence that changing the administration sets more frequently does not decrease the risk of infection.” No updates to this recommendation were located. The INS released a reminder to “slow down and practice the steps of verification for each infusion” in response to the unpredictable changes in infusion brands, containers, connector designs, and methods of administration during this fluid and medication shortage8.

A Cochrane review of 16 studies with 5001 participants revealed no evidence “for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison”8(p.2). Infrequent administration set replacement reduced the rate of bloodstream infection. Mortality increases with the neonatal population with infrequent administration set replacement was demonstrated. Based on the low to moderate quality studies, there is “some evidence that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection.”8(p.2) A systematic review of randomized controlled trials and cohort studies to determine the optimum duration of administration sets for peripheral arterial catheters published between 1966 and 2011 9 revealed only six studies of sufficient quality for inclusion. Two of the randomized controlled trials found no difference in bloodstream infections between 2 and 4-8 days and no infections when sets were replaced every 24 or 48 hours. However, the authors call for more well designed studies for better evidence for decision making for the replacement time for administration sets 9.

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Implications The evidence for infusate hang times (other than lipids, blood, and medications) is limited and in need of further study. Most recommendations from reputable organizations are more than 5 years old. Leading organizations, such as the ISMP, have made recommendations based on limited research, but simultaneously refer back to the organization to make the final decision considering the input of key stakeholders (nursing, pharmacy, medicine, etc). In an email correspondence with Dr. Rickard, the author of the study upon which ISMP based their 2014 recommendation to extend hang times, a study is in press with more findings related to IV hang times. Obtaining the Infusion Nursing Society (INS) Standards of Practice and INS Practice Criteria II from an INS member would be useful. The Nursing Practice Council considered this evidence and the implications for nursing policy.

As a result of the worsening fluid shortage and the evidence supporting lengthened hang time, two policies were fast tracked through approval and revised to change IV fluids without medication every 96 hours instead of 24 hours.

Regardless of hang time, it is important to remember:  

slow down and practice the steps of verification for each infusion 10. infection control practices are essential. However, as hang time lengthens, the attention to strict infection control is paramount10.

References 

Institute for Safe Medication Practices. 2014, January 30. Regarding the current IV solution shortage affecting US hospitals. Accessed online on 12/13/17 at: https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=69  Rickard, C., Vannapraseuth, B., McGrail, M., Keene, L., Rambaldo, S. Smith, C., & Ray-Barruel, G. 2009. The relationship between intravenous infusate colonization and fluid container hang time. Journal of Clinical Nursing, 18(21), 3022-3028.  Academy of Medical-Surgical Nurses. 2012. Question:…regarding infection control and IV solutions…we have IV tubings changed q96hrs and plain IV solutions q96hr but questioning if it should be q24hr?. Connect Network accessed online on 12/13/17 at: https://www.amsn.org/practice-resources/care-term-reference/assessmentsintervention/question-regarding-infection-control  O‟Grady, N., Alexander, M., Burns, L., Dellinger, P., Garland, J., Heard, S., … the Healthcare Infection Control Practices Advisory Committee. 2011. Guidelines for the prevention of intravascular catheter-related infections, 2011. Accessible version available: https://www.cdc.gov/infectioncontrol/guidelines/bsi/index.html  Kienle, P. 2012. Let‟s get clinical! Best practices for determining appropriate hang time for IV fluids. Cardinal Health Essential Insights. Accessed online on 12/13/17 at: http://www.cardinalhealth.com/en/essential-insights/ivfluid-hang-time.html  Guillaumin, J., Olp, N., Magnusson, K., Butler, A., Daniels, J. 2017. Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting. Journal of Veterinary Emergency & Critical Care, 27(5), 548-554.  Erratum. 2002, August 9. Appendix B: Summary of recommended frequency of replacements for catheters, dressings, administration sets, and fluids. 51(RR10); 29. Accessed online on 12/13/17 at: https://www.cdc.gov/mmwr/ preview/mmwrhtml/rr5110a3.htm  Ullman, A., Cooke, M., Gillies, D., Marsh, N., Daud, A., McGrail, MR., O‟Riordan, E., & Rickard, CM. 2013. Optimal timing for intravascular administration set replacement. Cochrane Database of Systematic Reviews, 9, Art. No.: CD003588. DOI: 10.1002/14651858.CD003588.pub3. Link to Cochrane Library. [PubMed: 24037784].  Daud, A., Rickard, C., Cooke, M., & Reynolds, H. 2013. Replacement of administration sets (including transducers) for peripheral arterial catheters: A systematic review. Journal of Clinical Nursing, 22, 3-4, 303-317.  Infusion Nurses Society. 2017, December 08. Fluid & Medication Shortage: Implications for Nursing. Accessed online on 12/13/17 at: https://www.ins1.org/Membership/NewsandEvents.aspx

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The HERO Online Search Resource

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Slavery and Human Trafficking Prevention Lesia Yates, BSN, AAS, RN, FNE, SANE Adult/Pediatrics Trained Forensic Nurse Examiner January is National Slavery and Human Trafficking Prevention Month. Healthcare providers are all responsible for watching and recognizing the signs of Human Trafficking. The purpose of this paper is to provide information about the incidence and prevalence of slavery and human trafficking in the United States and explore ways it can be prevented.

Human trafficking, a modern form of slavery, is the illegal “smuggling” of and trading people, for forced labor and sexual exploitation. Estimated in 2014 to be a $150.2 billion per year global industry1, drugs, robbery, and other violent crimes are often also involved2. Traffickers are individual pimps, loose-knit decentralized criminal networks, small families or businesses, or international organized crime syndicates 3.

Human trafficking is a major public health issue domestically and internationally. 80% are women and girls, 50% are minors, and 95% of victims experience physical or sexual violence while controlled by their trafficker4. The most common trafficked individual is a 12-14 year old female.

Virginia ranks 15th in reported cases of human trafficking5, with 152 cases, including 59 minors, reported in 20163. Of those, 70% were sex trafficking (n=56) or sex and labor (n<3)3. This reflects a 168% increase in child trafficking over a four year span5. The close proximity to Interstate 81 makes Roanoke a selected location for human trafficking. In Roanoke, there have been four to five human trafficking cases in the last two years, and each case can have multiple victims6.

In response to this rapidly growing problem, Virginia launched House Bill 2282 effective July 1, 20177 which requires training for educators on the prevention of trafficking of children8. Health care professionals have many responsibilities when caring for patients, including the responsibility for the safe discharge from care. One report in 2005 estimated that 28% of trafficked women saw a health care provider while in captivity (Family Violence Prevention Fund as cited in Dovydaitis9), and healthcare providers are often the only professionals to interact with trafficking victims who are still in captivity 9.

Red flags of human trafficking and slavery include: 

Burn marks or other signs of abuse,



Sexualized behavior,



New tattoo (pimps often brand their victims, a symbol of money, or a barcode on the back of the neck or lower back),



Older boyfriend or new friends with different lifestyles,



Poor physical/dental health,



Untreated sexually transmitted diseases10.

Traffickers often select certain targets, including young women and girls who are homeless, with a history of child abuse or neglect, and those with low self-esteem, attachment or bonding issues, and social isolation11,12. Runaways, people from the gay or lesbian community, those involved with gangs and survival sex (prostitution traded for basic needs or drugs) are often targeted13. Traffickers usually will not leave the patient alone, speaks for them, and will not allow them a cell phone2,10.

There are many resources for victims of human trafficking. Nurses, physicians, and other health care professionals are legally responsible to report offenders. Carilion Roanoke Memorial Hospital employs six full-time Forensic Nurse Examiners available 24 hours a day, seven days a week at the Emergency

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Department. Forensic Nurse Examiners are available for referrals and questions and would be happy to provide education for employees and units. The hospital operator will inform you how to get in touch with the on-call Forensic Nurse Examiner. Additional information is available from: 

Virginia National Human Trafficking Hotline at 1-888-373-7888, TYY 711: Text 233733



www.dhs.gov/blue-campaign



#bluecampaign#toendtrafficking

This misunderstood and relatively ignored issue requires action by individuals, communities and societies.

The consequences of continuing to overlook slavery and human trafficking are serious.14 Healthcare providers cannot remain silent about this growing issue.

References 

International Labour Office. (2014). Profits and poverty: The economics of forced labour. Geneva: ILO. ISBN: 9789221287810; 9789221287827. Accessed on February 7, 2018 at: http://www.ilo.org/wcmsp5/groups/public/---ed_norm/---declaration/ documents/publication/wcms_243391.pdf



Tuoti, G. (2017, August 10). Inhuman Trade: Sex trafficking victims manipulated, controlled for profit. The Patriot Ledger.

Accessed on February 2, 2018 at: http://www.patriotledger.com/news/20170810/inhuman-trade-sex-trafficking-victimsmanipulated-controlled-for-profit



Deshpande, N.A. & Nawal M Nour, N. M. (2013). Sex Trafficking of Women and Girls. Rev Obstet Gynecol. 6(1): e22-e2MCID: PMC3651545. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651545/



National Human Trafficking Hotline. n.d. Virginia. Accessed on February 1, 2018 at https://humantraffickinghotline.org/state/ virginia



Wilson, C. (2017). Virginia ranks 15th in US Human Trafficking, Nexstar Broadcasting, Inc. Accessed online on February 1, 2018 at http://wric.com/2017/06/02/schools-to-help-curb-human-trafficking/



United States Department of Justice. (2016, June 17). Roanoke man pleads guilty to sex trafficking, methamphetamine, and gun charges. Press Release Accessed on February 2, 2018 at: https://www.justice.gov/usao-wdva/pr/roanoke-man-pleadsguilty-sex-trafficking-methamphetamine-and-gun-charges



Virginia Launches Statewide Human Trafficking Awareness Campaign, January 6, 2015, www.TheRoanokeStar.com



The Roanoke Star. (2015, January 6). Virginia Launches Statewide Human Trafficking Awareness Campaign. Accessed on February 2, 2018 at: http://theroanokestar.com/2015/01/06/virginia-launches-statewide-human-trafficking-awarenesscampaign/



Capital News Service. (2017). Virginia introduces new law for schools to help curb human trafficking. Accessed on February 2, 2018 at: http://wtkr.com/2017/06/02/virginia-introduces-new-law-for-schools-to-help-curb-human-trafficking/

 Dovydaitis, T. (2011). Human trafficking: The role of the health care provider. Journal of Midwifery & Women‟s Health, 55(5), 462-467. Doi: 10.1016/j.jmwh.2009.12.017.

 Shared Hope International. (2018). Report Trafficking. Accessed online on February 2, 2018 at: https://sharedhope.org/join-the -cause/report-trafficking/

 Blow, M. (2017, April 2). How Children End Up The Targets of Sex Traffickers. The Huffington Post. Accessed online on February 2, 2018 at: https://www.huffingtonpost.com/entry/human-trafficking-pedophile-rings-and-what-youneed_us_58e18869e4b0d804fbbb7456

 McBane, D. (2011). How to Identify the Victims and Perpetrators of Sex Trafficking. Focus on the Family. Accessed on February 2, 2018 at: https://www.focusonthefamily.com/socialissues/family/sex-trafficking/how-to-identify-sex-trafficking-victims

 Institute of Medicine and National Research Council. (2014). Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States: A Guide for Providers of Victim and Support Services. Washington, DC: The National Academies Press. https://doi.org/10.17226/18798.

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Carilion Children’s Family Camp Weekend: Much More Than a Weekend in the Great Outdoors Sarah Kress, CCLS - Department of Pediatrics/Child Life Services For the past 17 years, magic has been made during the first weekend in August at Smith Mountain Lake‟s Skelton 4H camp. To the unsuspecting observer, it may look like any other summer camp where kids are canoeing, climbing rock walls, riding horses, swimming, doing arts and crafts, and more. What that viewer does not realize is that these participants are extraordinary children battling chronic or critical illnesses and their families.

This is Carilion Children‟s Family Camp Weekend.

This weekend exists to provide children and families, who may not otherwise have the opportunity to go to camp, a chance to experience what camp is all about. The main goal is for everyone to have fun; however, beyond all the great outdoor activities, family camp also serves as an incredible place for families to connect with others going through similar challenges and share about community resources.

This year 20 families, for a total of 90 people, were in attendance.

Invitations to camp are sent out based on referrals from Carilion Children‟s specialty clinics and inpatient units of children and families whom are felt would benefit from this experience. Children arrive at camp with ports, g-tubes, wheelchairs, tracheostomies, ventilators, TPN and more. They may have cancer, sickle cell disease, diabetes, a heart condition, a genetic or autoimmune disorder, autism, or Down syndrome.

While caregivers are present and able to deal with the majority of their child‟s medical needs, it is incredibly important to have Carilion Children‟s staff present at camp throughout the weekend to troubleshoot issues and deal with any emergencies. Some of the Carilion team members who help with camp include Physicians, Pediatric Nurse Practitioners, Registered Nurses, Respiratory Therapists, Certified Nursing Assistants, and Child Life Specialists. Also of note is the dedicated interpreter who spends the weekend ensuring the Spanish-speaking families feel at home as well.

Camp would not be possible without all of the devoted team members who put their hearts into the weekend.

This camp is a labor of love for the Carilion Children‟s child life team and other core staff members who plan and run the events of the weekend. The planning committee determines the special activities for the children and adults throughout the weekend and works with community partners to get the food, supplies, and services to make it all come together. During the weekend, the 4H staff runs the traditional camp activities, and the Carilion staff and volunteers facilitate the special activities and meals, all while making sure families are having a good time. This year‟s weekend was carnival themed, so at various points throughout the weekend there were balloon animals, magic tricks, fire-twirling, juggling, tie-dying, and an actual carnival complete with games, prizes, face painting, sno-cones, popcorn, superheroes, and Star Wars characters.

Camp is about helping all kids, no matter their abilities, just be kids. The experiences they gain at camp go beyond joyful adventures and are in truth, life-changing. At camp with others who experience health challenges, these children can find a sense of belonging and value in who they

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are. The experiences often teach kids and their families that they can do much more than they may have previously thought. Every day together is seen as a gift for many of these families, and camp gives them the opportunity to make priceless new memories together.

Some of these memories come in the form of “firsts”. What follows are just a few that took place at Family Camp. This year was the first time one teenager who uses a wheelchair for mobility had ever been to summer camp. It was the first time one child with a port and g-tube had ever climbed a rock wall. It was the first time one teenager with cancer was able to ride a horse. And, for the first time, one family of a child with autism was able to take a vacation together.

The rewarding experience of camp is not just for the children and families. The staff members and volunteers also benefit from the weekend. All of the hard work that goes into planning and running the camp is made more than worthwhile when the participants arrive on Friday. There is nothing that can compare to seeing the elation on a child‟s face when he catches a fish, or the relief that two parents feel when they are able to entrust their child, who they have never left before, with a qualified medical professional for a few hours so that they may take advantage of some respite together as a couple. In truth, just watching the children play happily and seeing the caregivers connect and make new friends is more of a gift than anyone could imagine. That‟s another year of Family Camp magic.

Carilion Children’s Family Camp Weekend 2017

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Curiosity!

Maria Hirsch, C.R.N.A. Director of Certified Registered Nurse Anesthetists John F. Garde Researcher of the Year Award Maria was part of a national team recognized for its research during the American Association of Nurse Anesthetists annual meeting in Seattle. The AANA Foundation Closed Claim Research Team, of which Hirsch is a member, was awarded the John F. Garde Researcher of the Year for its rigorous qualitative analysis into insurance claims where CRNAs were involved. The team has made more than 100 presentations and published 10 articles addressing anesthesia adverse outcomes.

Commitment!

Carolyn Kiefer, BSN, RN, CIC Carilion Infection Preventionist 2018 Chapter President Elect Association for Professionals in Infection Control and Epidemiology (APIC) Carolyn was selected as Chapter President-Elect for APIC Virginia. The APIC Virginia Chapter serves the Commonwealth of Virginia. APIC-VA is a multi-disciplinary voluntary organization committed to mentorship of our members, support of best practices, and ultimately, improvement of the quality of health care throughout the continuum of the varied practices.

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Compassion!

Phyllis Whitehead, PhD, APRN, ACHPN, RN-BC Clinical Nurse Specialist - Carilion Palliative Care & Pain Management Selected to the Policy Council/Opioid & Substance Abuse The Transition Team for Governor Ralph Northam invited Phyllis to participate in a policy workgroup regarding issues related to opioid and substance abuse. The Policy Council is comprised of stakeholders from across the Commonwealth to provide thoughtful insights and perspectives. Dialogue will address significant issues and potential recommendations for how to address challenges. A report will be delivered to the Governor and his cabinet.

Compassion!

Shirley Ballantyne, BSN, RN, HNB-BC Carilion Hospice - Roanoke Oakey’s Hospice Caregiver Award 2017 Oakey’s awards a caregiver each year to honor the dedicated staff who work in hospice and that are wonderful caregivers throughout our area. The program is open to all Roanoke Valley hospices. Their goal is to honor great caregivers for the exceptional care they provide. Caregivers are nominated by families and loved ones of the patients and must describe in detail why they believe the caregiver should receive an award. Oakey’s holds a special Hospice Caregiver Awards Ceremony and the winner is awarded a $1,000 scholarship to be used for continuing education.

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CONFERENCE CORNER

2017 VNA Nurse Staffing Summit, Hot Springs, VA Pediatrics presented at the 2017 Virginia Nurses Association Fall Conference in Hot Springs, VA. Their abstract titled Implementation of a Pediatric Acuity Scale in an Inpatient Setting detailed the development and use of a pediatric acuity scale in the inpatient setting.

l-r: Kate Lilley, BSN, RN, CPN; Joanna Murray, BSN, RN, CPN; Nicole Dudley, BSN, RN, CPN

29th Annual IHI National Forum, Orlando ,FL Carilion New River Valley, Forensic Nurse Examiner and DNP student April Marshall, MSN, RN, CNM, SANE -A/P was accepted for a national podium presentation at the 29th Annual IHI National Forum in Orlando, FL. Aprilâ&#x20AC;&#x2122;s project titled Standardize, Sustain and Spread TIC (Trauma Informed Care) used a SBIRT model of screening, brief intervention, and referral to treatment with follow up phone calls.

April Marshall, MSN, RN, CNM, SANE-A, SANE-P

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2018 Eastern Associated for the Surgery of Trauma Congratulations to Jennifer Bath, MSN, RN, AGCNSBC, CEN, TCRN! Jen is a Clinical Nurse Specialist in Trauma Services and was accepted for an oral presentation during the 31st EAST Annual Scientific Assembly in January 2018 in Lake Buena Vista, FL. The presentation was titled Implementing a Call Back Program in the Trauma Population.

Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN

VACNS Spring Conference 2017, Fredericksburg, VA Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC; Amy Lucas, MSN, RN, CCNS, CCRN-K; Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN attended the VA Clinical Nurse Specialist Spring Conference 2017 to present their poster Reflections on New Clinical Nurse Specialist Transition into Practice. This project described the challenges of role development for new clinical nurse specialists.

l-r: Cindy Ward, DNP, RN-BC; Amy Lucas, MSN, RN; Jennifer Bath, MSN, RN

VA Association of CNS’s Annual Pharmacology Update for APN’s, Richmond, VA Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN presented on the Pharmacology of Traumatic Brain Injury at the 2017 Virginia Association of CNS’s Annual Pharmacology Update for Advanced Practice Nurses .

l-r: Donna Bond, DNP, RN; Nancy Altice, DNP, RN; Sheila Delp, MSN, RN(ret.); Jennifer Bath, MSN, RN

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CITATIONS & RECOGNITIONS October 2017 - February 2018

POSTERS Murray, J., Lilley, K., Alley, N. 2017, November 3-4. Implementation of a Pediatric Acuity Scale in an Inpatient Setting. VNA Nurse Staffing Summit, Hot Springs, VA Berry, M. 2017, November 3-4. A Presurgical Testing Program that Decreased PostOperative Mortality. VNA Nurse Staffing Summit, Hot Springs, VA Marshall, A. 2017, December 10-13.

Implementation of Patient-Centered, TraumaInformed Care in a Rural Hospital Emergency Department. Institute of Healthcare Improvement/29th Annual IHI National Forum, Orlando, FL

PRESENTATIONS Bath, J. 2017, September 29. Pharmacology of Traumatic Brain Injury. Virginia Association of CNSâ&#x20AC;&#x;s Annual Pharmacology Update for Advanced Practice Nurses, Richmond, VA Carter, K., Bogue, R., Conway, R. 2017, October 9. Nurse Socio-Relational Wellbeing and Depersonalization of Patients: Extracting Statistical and Qualitative Evidence to Shape Recommendations for Nurse Communication Training. International Conference on Communication in Healthcare & Health Literacy Annual Research Conference, Baltimore, MD Bath, J. 2018, January 9-13. Implementing a Call Back Program in the Trauma Population.

31st EAST Annual Scientific Assembly, Lake Buena Vista, FL

PUBLICATIONS CCU Team, Carilion Roanoke Memorial Hospital (2017). Case study in teamwork: Reducing suffering for coronary care patients.

Institute for Innovation. Published online at: http://www.theinstituteforinnovation.org/docs/ default-source/innovation-stories/case-study2017-carilion-roanoke-memorialhospital_final.pdf?sfvrsn=2 Peters, K., Harvey, E., Wright, A., Bath, J., Freeman, D., Collier, B. (2018). Impact of a TeamSTEPPSÂŽ trauma nurse academy at a level 1 trauma center. Journal of Emergency Nursing, 44(1), 19-25. http:// dx.doi.org/10/1016/j.jen.2017.05.007 Davenport P, Carter K, Echternach J, Tuck, C. (2018). Integrating high reliability principles to transform access and throughput by creating a centralized operations center. Journal of Nursing Administration, 48(2), 93-99.

Baker, D. & Quinn, B. (2018). Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control, 46, 2-7. (*Donna Bond, DNP, RN, CCNS, AE-C, CTTS partnered with 23 other US hospitals to provide data for the Hospital Acquired Pneumonia Prevention Initiative, a national, multi-center study)

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RECOGNITION: Hirsch, M. 2017. A member of a national research team that was recognized by the American Association of Nurse Anesthetists with the John F. Garde Research of the Year Award Kiefer, C. 2017. Awarded the title of 2018 President-elect for the Virginia Chapter of Association of Professionals in Infection Control and Epidemiology Whitehead, P. 2017. Selected to serve on the Governor-elect Policy Council on Opioid and Substance Abuse.

Seidel, L. 2018. Completed the curriculum to be certified as a Koru Mindfulness Teacher. The curriculum was reviewed by the leaders of The Center for Koru Mindfulness.

Bath J. 2018. Selected as an item writer for the Adult-Gerontology Clinical Nurse Specialist certification exam.

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See Where Our Nurses Have Travelled!

(Since October 2014)

“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom

Palm Springs

Lake Buena Vista

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Need editorial or financial support to present your work at a national nursing conference?

Contact Nursing Research & EBP for:  Assistance with writing your abstract  Poster development  Financial support through Nightingale grants. nursingresearch@carilionclinic.

REGISTER IN CORNERSTONE FOR ONE OF OUR MARCH RESEARCH CLASSES! Basic Nursing Research for the Frontline Nurse (CE333L) March 8, 2018 3:00-7:00pm - CRMH 1 South Computer Room D **************************** Advanced Research I: Appraising and Synthesizing the Literature (CE372L) March 21, 2018 1:00-4:00pm - CRMH 1 South Computer Room D

Carilion Clinic Roanoke Campus