Student Nurse Political Action Day 2021: Connect, Grow, Energize—Shape the Future
The 23rd annual Student Nurse Political Action Day (SNPAD) was held on April 13, 2021. Each year, SNPAD brings together nursing students from across the state for a day of learning, networking, and advocacy, and this year was no exception. In the face of the COVID-19 pandemic, this year's SNPAD was re-imagined as a one-ofa-kind, virtual experience that brought nursing educators and students together from across Illinois to discuss, learn, and connect – at no cost to participants. Over 1000 nursing students from 46 schools attended (see list).
The event opened with a Coffee Keynote with Jennifer Grooms, CEO of RekMed. Jennifer's inspirational session focused on her transformation from someone who had a crippling fear of blood into a nurse entrepreneur. Throughout the rest of the morning, nurse leaders presented various topics, including advocacy, health policy, and getting involved with nursing associations, including ANA-Illinois and the Student Nurse Association of Illinois (SNAI). Speakers included Glenda Morris Burnett PhD, MUPP, RN – Rush University College of Nursing, Gloria E. Barrera MSN, RN, PEL-CSN, Sue Clark, President – Capitol Edge Consulting, and Elizabeth Aquino, PhD, RN – President, ANA-Illinois.
After lunch, Buck Davis provided the keynote address. Buck's powerful presentation engaged participants in a meaningful discussion on diversity, how to manage unconscious bias, how to be a positive and inclusive team member, and how to gain skills on how to address inappropriate comments in the workplace. The address segued into the final presentation and discussion of the day, which focused on diversity, equity, and inclusion within the nursing profession.
The event closed with the selection of the SNPAD Scholarship Recipient. For the first time, ANA-Illinois selected one student attendee for a $500 scholarship. This year's recipient was Loyola University Chicago student Chase Wade.
Thank you to all nurses who made the first virtual SNPAD an overwhelming success. Whether the topic was entrepreneurship, public health, or diversity and inclusion, many attendees contributed insightful comments on these topics. They helped to bring awareness to some of the major issues in nursing.
A big "thank you" to all of our sponsors for their financial contributions.
List of colleges participating in SNPAD 2021:
● Aurora University
● Blessing-Rieman College of Nursing and Health Science
● CAAN Academy of Nursing
● Carl Sandburg College
● Chamberlain University College of Nursing
● Chicago State University
● City Colleges of Chicago - Malcolm X College
● College of Lake County
● College of Staten Island
● Danville Area Community College
● DePaul University School of Nursing
● Elmhurst University
● Governors State University
● Graham Hospital School of Nursing
● IECC - Frontier Community College
● Illinois College
● Illinois State University - Mennonite College of Nursing
● Illinois Wesleyan School of Nursing
● Joliet Junior College
● Kennedy-King College
● Lewis & Clark Community College
● Lewis University
● Loyola University - Marcella Neihoff School of Nursing
● McKendree University
● Millikin University
● Molly College
● Northern Illinois University School of Nursing
● Oakton Community College
● Olivet Nazarene University School of Nursing
● Purdue Northwest University College of Nursing
● Rasmussen University
● Resurrection University
● Rush University College of Nursing
● Saint Xavier University School of Nursing
● Sauk Valley Community College
● Southern Illinois University Edwardsville
● Southwestern Illinois College of Nursing
● Spoon River College
● St. John’s College of Nursing
● Trinity Christian College
● University of Illinois Chicago, College of NursingSpringfield, Chicago, and Champaign Campuses
● University of Phoenix
● Walden University
● Western Governors University
● Western Illinois University School of Nursing
Congratulations to Illinois State University –Mennonite College of Nursing who had the most attendees with 155! The program is featured on page 3.
Student Nurse Political Action Day...continued on page 6
INF PRESIDENT'S MES S AGE
A Thank-You to Nurses!
We have made it to Summer 2021, and the pandemic continues. Little did we know a year ago, we would still be living in the pandemic. How long this will last, no one knows for sure. The vaccines have certainly helped slow down the spread of the Covid-19 virus, but we are still here socially distancing and trying to stay safe.
Cheryl Anema PhD, RN
2020 was the year of the Nurse, but it was not just a celebratory year for nursing, but a year that displayed the NEED for nurses. Nurses showed the world how they were our front-line workers of the pandemic. To continue the celebration, the World Health Organization (WHO) and the American Nurses Association (ANA) joined to extend the Year of the Nurse and Midwife into 2021. Nursing is more visible and recognized because of the continued dedication and compassionate care provided to patients and the community during this pandemic.
I am proud to be a nurse, even if not working at the bedside. I graduated from nursing school over 40 years ago and remember the feeling of first passing the NCLEX and legally becoming an RN. I was excited and proud to join the profession. Now, I look back over these many years of nursing and see that nursing is still serving its community and leads healthcare to fight against this virus. I am not saying we are doing it alone; we are not. Nurses are part of a team of professionals and essential workers.
Nurses are a universal gift to all. The dedicated work that they do and the kindness they deliver daily should
serve as a reminder of the fundamental humanity inside us all. Becoming a nurse is one of the most selfless acts a person can undertake.
The sacrifice that nurses, and other healthcare providers, make daily cannot fully be understood. Even before COVID-19, nurses gave up family holidays, social events, and weekends. Now? They are on the front line of the Virus War! Whatever you believe, nurses "have" risked their lives and continue to go to work and care for the needs of their patients. Every nurse out there who is working in the field, preparing others to work in the field, or have retired and support nursing today through their words and support, need to be proud they are a nurse!
The IL Nurses Foundation (INF) continues to celebrate nursing through the 40 Under 40 Emerging Nurse Leader program and the Nurse of the Year Program. Additionally, the INF developed a COVID Publishing Taskforce. Over the past year, calls for nurses and patients' stories to share their pandemic experience with the INF were made. This taskforce compiled and edited the submissions into a book – Stories From Within: Nurses-Patients-FamiliesHealth Care Workers Share Their Pandemic Experience. The book was released a few weeks before Nurses Week 2021. The book is an excellent reflection on nursing care through the pandemic and the sacrifices that nurses and other healthcare workers made to care for the patients and families impacted by the pandemic. This book is available for purchase on Amazon.com, with all profits going to the INF. I hope you decide to buy a book for yourself and a few others for gifts to fellow nurses, nursing students, and anyone impacted by this pandemic.
THANKS to each nurse for all they have, are, and will be doing to bring health and comfort to people throughout the state and worldwide, especially through this pandemic.
To support the IL Nurses Foundation's work, please go to https://www.illinoisnurses.foundation/ and click on "Ways to Give." Every donation promotes INF collaboration with community partners to promote the health of the public, support nurses through charitable research, and enhance educational initiatives.
NOW HIRING
RN Health Center Administrator
Positions available in Chicago Heights, Chicago, and Hazel Crest, IL.
Apply online
https://www.auntmarthas.org/careers/ Please direct any inquiries to Kmoreno@auntmarthas.org
The Nursing Voice
INF Board of Directors
Officers
Cheryl Anema PhD, RN President
Brandon Hauer MSN, RN Vice President
Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN Secretary
Karen Egenes EdD, RN Treasurer
Directors
Maureen Shekleton PhD, RN, DPNAP, FAAN
Alma Labunski PhD, MS, RN
Linda Olson PhD, RN, NEA-BC
Amanda Buechel, BSN, RN, CCRN
Lauren Wojtkowski BSN, RN, CEN
ANA-Illinois Board Rep
Colleen Morley DNP, RN, CCM, CMAC, CMCN, ACM-RN Susana Gonzalez MHA, MSN, RN, CNML
ANA-Illinois Board of Directors
Officers
Elizabeth Aquino, PhD, RN President
Monique Reed, PhD, MS, RN Vice President
Jeannine Haberman DNP MBA, RN, CNE
Treasurer
Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN Secretary
Directors
Holly Farley, EdD, MS, RN
Susana Gonzalez, MHA, MSN, RN, CNML
Nicole Lewis, DNP, APRN, FNP-BC
Dorothy Kane MSN, RN
Zeh Wellington, DNP (c), MSN, RN, NE-BC
Editorial Committee
Editor Emeritus
Alma Labunski, PhD, MS, RN
Chief Editor
Lisa Anderson-Shaw, DrPH, MA, MSN
Members
Cheryl Anema PhD, RN
Deborah S. Adelman, PhD, RN, NE-BC
Linda Anders, MBA, MSN, RN
Kathryn Booth, MSN, RN, CNL
Nancy Brent, RN, MS, JD
Irene McCarron, MSN, RN, NPD-BC
Linda Olson, PhD, RN, NEA-BC
Lanette Stuckey, PhD, MSN, RN, CNE, CMSRN, CNEcl, NEA-BC
Executive Director
Susan Y. Swart, EdD, MS, RN, CAE
ANA-Illinois/Illinois Nurses Foundation
Article Submission
• Electronic submissions only as a word document attachment using current APA guidelines.
• Email: info@ilnursesfoundation.com
• Subject Line: Nursing Voice Submission: Name of the article
• Must include the name of the author and a title.
• INF reserves the right to pull or edit any article / news submission for space and availability and/or deadlines
• If requested, notification will be given to authors once the final draft of the Nursing Voice has been submitted.
• INF does not accept monetary payment for articles.
Article submissions, deadline information and all other inquiries regarding the Nursing Voice please email: info@ilnursesfoundation.com
Article Submission Dates (submissions by end of the business day) January 15th, April 15th, July 15th, October 15th
Advertising: for advertising rates and information please contact Arthur L. Davis Publishing Agency, Inc., P.O. Box 216, Cedar Falls, Iowa 50613 (800-626-4081), sales@aldpub.com. ANA-Illinois and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the ANA-Illinois and Illinois Nurses Foundation of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. ANA-Illinois and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of ANA-Illinois or those of the national or local associations.
ANA- ILLINOIS PRESIDENT' S M E S SAGE
Dear Illinois Nurse Colleagues, I hope you are well and finding effective ways to continue to cope with the ongoing COVID-19 pandemic.
I have seen many of you volunteering your time at COVID-19 vaccine clinics to protect us all against the virus. And many have shared their vaccine photos and experiences that have helped instill confidence in others to get their vaccine when it's their time.
Nurses are the perfect ambassadors to enhance vaccine confidence. Thank you for all of those efforts and the ongoing work to get us through this pandemic.
As we continue to think about ways to integrate selfcare into daily routines, ANA-Illinois received grant funding to launch a program called "RNconnect2 WellBeing." It's a text-messaging program that supports the emotional and mental well-being of nurses and nursing students in Illinois by sending text messages with reminders and resources on building resilience, self-care, gratitude, and much more. You can opt-in to participate by texting RNconnectIL to 60298
On behalf of ANA-Illinois's Board of Directors, I would like to thank all of you who participated in Student Nurse
Political Action Day (1000 registrants from 46 different colleges/schools of nursing) and Nurses Day at the Capitol (75 attendees). Both events were a huge success and an excellent opportunity to listen, learn and support one another as we advance the nursing profession. The Expert Panel on Diversity, Equity, and Inclusion also has a series of quarterly webinars; the next session is on July 28th, "Microaggressions, Unconscious Bias and Structural Racism" please go to the ANA-Illinois website Expert Panel page to register.
Are you looking for more ways to get actively involved? We have new member engagement opportunities, including serving on the expert panel on nursing education and community service task force. There is also an open call for nominations to serve on the Board of Directors or as an ANA Membership Assembly Representative. Please go to www.ana-illinois.org to learn more.
Let's continue to work together to celebrate and elevate one another and the nursing profession.
Sincerely,
Elizabeth Aquino, PhD, RN President, ANA-Illinois @LatinaPhDRN
The world needs nurse leaders. We ask, why not you?
Founded over 100 years ago, Illinois State University’s Mennonite College of Nursing is renowned for providing students with quality educational experiences that leave them better for their investment. Employers across Illinois seek out our graduates, including Memorial Health System, Advocate-Aurora Health, OSF, and Carle. We are an Advocate-Aurora Health Preferred Education Provider, which means you qualify for more in tuition reimbursement if you choose one of our programs. We have Dual Enrollment and Pathways partnerships with 16 community colleges statewide, and our RN to BSN program is ranked #3 in Illinois and #14 in the entire United States by US News & World Report. We believe that nurses have a unique lens and need to be at the decision-making table, helping to guide the future of health care. Currently, only 13% of nurses in the US hold a master’s degree; only 1% have a doctorate. Our programs prepare you to excel—at the bedside and beyond.
Program offerings:
• Traditional & Accelerated BSN
• RN to BSN
• BSN to DNP – Family Nurse Practitioner
• BSN to DNP – Leadership & Management
• Doctor of Nursing Practice
• Ph.D. in Nursing
• Certificate – School Nurse
• Certificate – Psychiatric Mental Health Nurse Practitioner
• Certificate – Family Nurse Practitioner
Interested students can learn more at: https://bit. ly/3ns4Y8Y At MCN, we’re working hard to reshape health in our communities. We invite you to join us.
Call for Submissions to The Nursing Voice
The Nursing Voice editorial committee seeks article submissions and Continuing Education (CE) article submissions for our upcoming issues. We are also going to have themes for each issue starting with the September 2021 issue. If you have an article worthy of a CE, the INF staff can assist in applying for the CE.
September 2021 Issue: Supporting the New Nurse: Current Challenges in Nursing Education and the New Nurse Graduate/Orientee (Clinical experiences, E-learning, Simulation, Preceptor & Educator challenges, ‘Code Red')
December 2021 Issue: Inclusion and Diversity in Healthcare (Implicit bias, gender identification and nursing care, racial bias in healthcare, diversity in nursing employment/recruitment/education)
March 2022 Issue: Public Health Issues and the Nursing Profession (2020 Equity, Access to health care, School nurses, Environmental issues and health care, Community Health)
Article submission is not limited to the issue theme.
The Nursing Voice submission guidelines can be reviewed at https://www.illinoisnurses.foundation/ programs/ (scroll down past scholarship and grant information)
Questions about submissions can be sent to syswart@ana-illinois.org
Liz Aquino, PhD, RN
ETHICS IN ACTION
Over the last 15 months, the COVID-19 pandemic affected nurses, other healthcare professionals, patients and families, and all people and countries worldwide. Death, illness, isolation, loss of jobs, depression, and financial problems are just a few of the negative effects associated with this global pandemic.
Lisa Anderson Shaw DrPH, MA, MSN
example, at the beginning of the pandemic, scientists said masks should not be worn by the public, and then later that they should. As knowledge and understanding about COVID-19 advanced, policy and practices related to the pandemic were altered. When looking for guidance from the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015a), all nine provisions can be cited, especially Provision 1 (respect), Provision 2 (primary commitment to the patient), Provision 3 (safety), and provision 5 (nurse's duty to self).
Respect for human dignity is at the heart of nursing care, especially in times of stress that can manifest itself in various ways, including symptoms of anxiety, depression, sadness, and helplessness.
Lina Olson PhD, RN, NEA-BC
The ethical issues faced by nurses affect patient and family safety and the safety of nurses, colleagues, and all those affiliated within health care organizations in unique ways. The nursing profession was hit very hard by the pandemic. In the early days of the pandemic, many first-line health workers did not have enough personal protective equipment (PPE) and were exposed to the virus. Many nurses became ill from this exposure. Over the past year, there have also been reports of anxiety, depression, and sleep problems among nurses and other health care workers associated with caring for patients with COVID-19.
As the pandemic progressed, scientific knowledge and understanding about COVID-19 grew and changed, often creating confusion and frustration about the characteristics of the disease. There were subsequent implications for policy and practice with often confusing messaging from scientists and others about balancing safe practices in caring for patients and each other. For
During these stressful times, healthcare institutions began to mobilize support services for nurses and healthcare staff. Healthcare institutions in the United States began developing resources to care for COVID-19 patients and organize health and wellness resources for their clinical and supportive care staff, especially in cities with large medical centers (Anderson-Shaw, & Zar, 2020). Some examples are system-wide mental health and wellness programs, daily huddles among nurses and other healthcare workers, and moral distress rounds and debriefing sessions.
The ANA Code of Ethics for nurses, Provision 1 states, "The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person" (American Nurses Association [ANA], 2015b). This statement is fundamental to nurses' relationships with their patients as well as co-workers. Stressful situations, especially when the stress is constant and ongoing, can negatively affect nurses' mental and physical health. Provision 1 is a reminder that no matter how stressful nurses' work may be, it is essential to continue showing compassion and respect to patients, co-workers, and ourselves. COVID-19 has had a real impact on nurses and relationships with others and subsequently on mental health. Provision 5 emphasizes duties to self and others as a component of moral respect, which extends both to oneself and others. Promoting the safety of ourselves, colleagues, patients and families, and nurses' own families have created ethical concerns during this time.
Numerous studies have been conducted over the past year, both nationally and internationally, that focused on the impact of the pandemic on nurses. These have highlighted the resulting emotional and mental health issues. Strategies to protect and promote nurses' mental health benefits, the individual nurse, and the profession. The American Nurses Association and other professional nursing associations have identified resources such as the ANA Healthy Nurse Healthy Nation program (healthynursehealthynation.org), the ANA COVID-19 Resource Center (ANA Nursing World.org), which includes ANA's COVID-19 Self-Care Package for Nurses. Self-care strategies include education, building resilience with mindfulness and meditation, and seeking professional help through therapy. During this time, nurses have often reminded themselves that "I am ok" and "I will be ok," and it is also ok to seek resources that improve mental and emotional health.
Further information will be forthcoming in future columns.
Please send clinical ethics questions to The Nursing Voice for discussion in upcoming issues.
References
Anderson-Shaw, L.K., & Zar, F.A. (2020). COVID-19, moral conflict, distress, and dying alone. Journal of Bioethical Inquiry, 17(4), 777–782. https://doi.org/10.1007/s11673-02010040-9
American Nurses Association (2015a). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org Retrieved from https://www.nursingworld. org/practice-policy/nursing-excellence/ethics/code-ofethics-for-nurses/coe-view-only/
American Nurses Association (2015b). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks. org
Providing Competent, Supportive Care for People Who Are Transgender
F. Patrick Robinson, PhD, RN, ACRN, CNE, FAAN
Sherry L Roper, PhD, RN
The idea that gender is binary (male or female) and determined at birth predominates Western cultures. However, research evidence and lived experiences suggest that gender exists on a spectrum with many options. Some people identify as a gender different from their gender determined at birth (Deutsch, 2016). Our traditional understanding of gender, based on chromosomes and primary (genitalia) and secondary sex characteristics, is often called biological sex or gender (or sex) assigned at birth. Gender identity, on the other hand, is the innermost concept of self as male, female, a blend of both, or neither (Lambda Legal, 2016.).
The majority of people are cisgender, which occurs when gender assigned at birth and gender identity are the same. However, the best available data suggest that approximately 1.4 million adults do not self-identify with their gender assignments (e.g., someone assigned female at birth but identifies as male) (Flores et al., 2016). Transgender is an umbrella term for this population. A visibly growing segment of the U.S. population does not identify with the binary notion of gender. Nonbinary is a collective term for this population, but individuals may use terms such as genderqueer, gender fluid, or gender non-conforming.
There is no standard or correct way to be (or be seen as) transgender. Some people who are transgender choose gender-affirming hormone therapy to achieve masculinizing or feminizing effects; others do not. Surgery that revises genitals to conform to gender identity is a critical part of the transition for many people who are transgender (Deutsch et al., 2019). Others do not feel that genital surgery is a necessary part of transition but may opt for non-genital surgeries to produce desired characteristics, including breast augmentation or removal and body contouring procedures. In other words, the importance of therapy related to the quality of life varies by individual. Also, some people who are transgender may want these services but do not have access to them because they are (a) unavailable in the community; (b) not covered by insurance (even if the individual has insurance, and many do not), and (c) too expensive.
Remember: there is no one way to "be" transgender or cisgender. People choose to express their gender identities in personally satisfying ways, which may or may not match social expectations of what it means to look and behave as a male or female. Some transgender women choose not to wear makeup or dresses, and some cisgender men choose to wear their hair long and earrings.
Health Disparities in People Who are Transgender
Negative attitudes and discrimination toward the transgender community create inequalities that prevent the delivery of competent healthcare and elevate the risk for various health problems (Grant et al., 2011). In comparison to their cisgender counterparts, people who are transgender experience higher incidences of cancer, mental health challenges, and other health problems (Department of Health & Human Services, n.d.). For instance, transgender women, compared to all other populations, are at the highest risk of injury from violence and death by homicide. People who are transgender are also more likely to smoke, drink alcohol, use drugs, and engage in risk behaviors (Institute of Medicine, 2011).
Furthermore, discrimination and social stigma increase poverty and homelessness in people who are transgender (Safer et al., 2017). The inability to afford basic living needs may lead to employment in underground economies, such as survival sex work or the illegal drug trade, which place the person who is transgender at an even higher risk for violence, drug use, and sexually transmitted infections (Deutsch, 2016).
People who are transgender are more likely to rely on public health insurance or be uninsured than the general population. Even those insured report coverage gaps caused by low-cost coverage that does not include standard services for preventative, behavioral health, or gender-affirming therapies, including hormones (Deutsch et al., 2019). Lack of access to comprehensive health care leads some people who are transgender to seek hormones from the community and social networks without clinical support and monitoring, putting them at additional risk for adverse reactions and complications.
Researchers suggest that healthcare providers' inability to deliver supportive and competent care serves as a powerful mechanism underlying health disparities (Fenway Institute, 2016). The experiences of people who
are transgender are often not included in healthcare provider diversity and inclusiveness training. While transgender-related content in health professions basic education programs would effectively improve provider knowledge, skills, and attitudes, transgender health has not been prioritized in nursing education. The result is a nursing workforce inadequately prepared to care for people who are transgender (McDowell & Bower, 2016).
Nursing Care of People Who Are Transgender
Competent, supportive transgender care requires nurses to recognize potential biases and understand gender that may differ from their current beliefs and social norms. Honest reflection on these feelings is an essential step in providing competent transgender care. Using a lens of cultural humility, where cisgender nurses acknowledge that they do not adequately know about being transgender while also being open to learning, is helpful. In this spirit, open, transparent inquiry on the part of nurses when they do not know something (When I speak to your children, what name should I use to refer to you?) or how to proceed with care (I need to place a catheter into your bladder, and I know you have had gender-affirming surgery. Do you want to give me any special instructions?) can build trust.
While gender-affirming care such as hormones, androgen-blocking agents, and surgeries require specialist care management, nurses will encounter transgender patients in all healthcare areas. Assessing the history and current status of gender-affirming therapies is critical to inform safe care. For example, hormone-induced changes in muscle and bone mass, along with menstruation or amenorrhea, can alter gender-defined reference ranges for laboratory tests such as hemoglobin/hematocrit, alkaline phosphatase, and creatinine (Deutsch, 2016). Nurses should consider the gender assigned at birth (especially if it is the only gender information to which the lab has access) and genderaffirming therapy-induced physiological changes to make valid inferences about lab values. Nurses should also ensure that a complete history of the use of hormones and androgen blockers (including those obtained from non-licensed providers) is taken. Nurses should work with other providers to ensure that hormone therapy does not stop with hospitalization unless contraindicated by current pathology or prescribed medications. Abrupt cessation of hormone therapy can have a significant and negative impact on emotional and physiological health.
Systems-Level Policies, Processes, and Advocacy
Professional nurses can play a crucial role by advocating for policies and processes that promote safe, effective, and supportive care for people who are transgender. Misgendering a patient (making an incorrect assumption about gender identity) can cause emotional distress and erode patient-provider trust. Unfortunately, electronic health records (EHR) often do not support competent care for people who are transgender. For instance, healthcare providers should use a 2-step gender identification process (Deutsch, 2016). However, many do not, and EHR systems rarely provide prompts for the processor space for easy documentation and access to information derived from the process. Asking about a patient's current gender identity can result in several responses. The EHR should make checkboxes for a reasonable number of those responses, including male, female, transgender male, transgender female, and nonbinary. A fill-in-the-blank is needed for other identifies. The gender assigned at birth also requires options beyond male or female; people born with external genitalia, gonads, or both that do not conform to what is typically male or female (intersex) may have been identified incorrectly at birth. The EHR should provide an intersex option to this question. Some people who are transgender are uncomfortable revealing gender assigned at birth, so decline-to-state should be another option. Note that this process should be the standard for all patients, not just those assumed to be transgender. People who are transgender may use names other than their legal names (Lambda Legal, 2016). Navigating a legal name change is complicated and costly. Some people who are transgender do not have the resources for a legal name change; for others, it may not be safe, given current social or legal circumstances. Using a patient's chosen name and pronouns is critical to patientcentered care. The EHR should prominently document the patient's chosen name and pronouns, which should also be used outside the EHR, including for appointments and prescriptions. Patients should only have to provide the information once, decreasing the need to correct
providers and improving patient-provider relationships. EHRs should also contain an organ inventory, perhaps as part of surgical history, as providers will need to know about the presence or absence of reproductive and gonadal organs to inform clinical decision-making. This information must be clear, unambiguous, and easily accessible in the EHR to inform care and prevent medical and surgical errors.
Nurses should work within governance processes to ensure that all institutional policies support transgender patients, staff, and visitors. Nondiscrimination statements should include gender identity. Policies about restrooms and staff changing rooms (usually labeled in genderbinary terms) should state that a person's gender identity rightly determines the room to be used and that that right should not require any proof (e.g., health provider confirmation) related to gender or gender identity. Finally, clear guidelines concerning non-private room assignments should include assigning roommates based on gender identity rather than gender assigned at birth.
Power to Make a Difference
The ANA Code of Ethics obligates nurses to practice "compassion and respect for the inherent dignity, worth, and unique attributes of every person" (ANA, 2015, para 1). While some nurses may intentionally discriminate against people who are transgender, it is more likely that a lack of knowledge and experience leads to nursing actions that result in suboptimal care. Nurses play critical roles in transgender care by (a) providing supportive, affirming care, (b) creating an inclusive environment, and (c) leading interprofessional teams toward genderaffirming care. Education and a commitment to understanding the lived experiences of people who are transgender is, therefore, essential for all nurses.
References
American Nurses Association. (2015). What is the nursing code of ethics? https://nurse.org/education/nursing-code-ofethics/ Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Healthy people. Lesbian, gay, bisexual, and transgender health. https://www. healthypeople.gov/2020/topics-objectives/topic/lesbiangay-bisexual-and-transgender-health
Deutsch, M.B. (2016). Guidelines for the primary and genderaffirming care of transgender and gender nonbinary people (2nd ed.). Center of Excellence for Transgender Health, University of California at San Francisco. https://transcare. ucsf.edu/sites/transcare.ucsf.edu/files/TransgenderPGACG-6-17-16.pdf
Deutsch, M.B, Bowers, M.L., Radix, A., & Carmel, T.C. (2019). Transgender medical care in the United States: A historical perspective. In J.S. Schneider, V.M.B. Silenzio, & EriksonSchroth, L. (Eds.). The GLMA Handbook on LGBT Health (1, 83-131). Santa Barbara, CA: Praeger. Fenway Institute, National LGBT Health Education Center. (2016). Providing inclusive services and care for LGBT people. https://www.lgbtqiahealtheducation.org/publication/ learning-guide/
Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How many adults identify as transgender in the United States? UCLA School of Law, William Institute. https:// williamsinstitute.law.ucla.edu/publications/trans-adultsunited-states/ Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. https://www. transequality.org/sites/default/files/docs/resources/NTDS_ Report.pdf
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. http://www.nationalacademies.org/ hmd/Reports/2011/The-Health-of-Lesbian-Gay-BisexualandLambda Legal. (2016). Transgender rights toolkit. https://www. lambdalegal.org/issues/transgender-rights
McDowell, A. & Bower, K. (2016). Transgender health care for nurses: An innovative approach to diversifying nursing curricula to address health inequalities. Journal of Nursing Education, 55(8), 476-479. DOI 10.3928/0148483420160715-11
Safer, J. D., Coleman, E., Feldman, J., Garofal, R., Hembree, W., Radix, A., & Sevelius, S. (2017). Barriers to health care for transgender individuals. Current Opinion in Endocrinology, Diabetes, and Obesity, 23(2), 168-171. DOI: 10.1097/ MED.0000000000000227
Singh, S., & Durso, L. E. (2017). Widespread discrimination continues to shape LGBT people's lives in both subtle and significant ways. Center for American Progress. https://www.americanprogress.org/issues/lgbt/ news/2017/05/02/429529/widespread-discriminationcontinues-shape-lgbt-peoples-lives-subtle-significant-ways/
Submitted by Susan Hurley, RN, BSN, MPH Marketing co-director IANPC
The Illinois Ambulatory Nurse Practice Consortium (IANPC) was established in 2013 and is a local networking group of the American Academy of Ambulatory Nursing (AAACN). The IANPC mission is to promote leadership, collaboration, and innovation in the delivery of ambulatory care nursing through professional clinical practice, education, research, and health policy initiatives.
Why Join IANPC?
• Networking opportunities
• Professional growth and development
• Earn free CEs at events
IANPC membership is FREE to join, provides a connection to a national nursing organization, and offers opportunities to share best practices. Quarterly educational events are held that focus on members’ interests such as current clinical issues, self-care and quality improvement. IANPC welcomes anyone with a professional interest in Illinois ambulatory nursing.
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Want to learn more? The IANPC can be reached via email at ianpcnurses@gmail. com. Click on the link or use the QR code to become a member.
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INF Stories From Within
Illinois Nurses Foundation publishes book “Stories from Within,” detailing the experiences of nurses, healthcare providers, patients, and family members with COVID-19 Editors: Anema, C., Egenes, K., Morley, C., & Swart, S.
The Illinois Nurses Foundation (INF) is proud to present “Stories from Within,” a book detailing the experiences of nurses, healthcare providers, patients, and family members throughout the COVID-19 pandemic.
The book is available to the public and can be accessed at http://bit.ly/ Storiesfromwithin
Over the past year, nurses and nurse educators walked willingly into the COVID-19 pandemic biological storm. Their stories are many, their experiences varied, but what brings them all together is a commitment to ensuring people who face health challenges are cared for and comforted. “Stories from Within” serves as an important memoir of what the nursing profession was faced with and how, together, nurses supported each other, their families, and most importantly, their patients,” said Cheryl Anema, President of the INF. “Time after time, these nurses were terrified and exhausted yet determined and resilient. This book shares those stories."
As a nurse practitioner, graduate nursing student, and mom, Jovonne Owens tells her story about the anxiety levels running high amongst her hospital colleagues. “We watched the news reports of growing COVID-19 numbers and deaths while struggling to obtain proper patient protective equipment to care for our patients. Things became tough when we began to see our hospital staff members lose their own lives as they battled on the front lines against this virus we were still learning about.” She recounts her fears for herself and her family during this time and the sacrifices she made to ensure the health and safety of all who crossed her path.
This past year, nurses shouldered the clinical risk and unspoken acceptance of personal sacrifice necessary to beat back the COVID-19 pandemic. Nurses helped not only individuals who faced complications due to COVID-19 but also their families, who could not be at their family member’s bedside. One story told by a bedside registered nurse in a neonatal intensive care unit described the emotionally challenging heartbreak of a mother seeing her newborn infant being re-intubated and not having the support of her husband by her and their baby’s side due to COVID-19 hospital restrictions. “It was heartbreaking to see that all the father wanted was to be with his wife and hold his child,” the nurse said. Nurse educators rose to the challenge of providing advanced critical care education to nurses who never imagined themselves working during a pandemic—in many cases, making drastic changes to how they teach overnight.
“Stories from Within” is an essential memoir of what the nursing profession faced and how, together, nurses and other healthcare providers supported each other, their families, and most importantly, their patients. 100% of the proceeds from the sale of this book will support the INF’s programs focused on nursing excellence.
The INF’s mission is to collaborate with community partners in promoting the health of the public by supporting nurses through charitable research and educational initiatives. Facebook: https://www.facebook.com/IllinoisNursesFoundation Website: https://www.illinoisnurses.foundation/
PRACTICE CORNER
Illinois Law & Nursing Practice
QUESTION
An RN sent in a concern that he is feeling sadder than usual since caring for patients during the Pandemic. He is also experiencing difficulty concentrating when at work and is concerned he may be depressed. He is apprehensive about seeking treatment if it will affect his license. He asks if his anxiety surrounding treatment and his license is well founded.
ANSWER
A qualified No. Experiencing mental suffering of any kind is not an issue under the Act and its Rules. It is an issue if it affects a nurse licensee’s safe and competent practice.
The Illinois Nurse Practice Act and its Administrative Rules underscore the importance of good mental health for nurse licensees. In fact, in order to obtain a license as a professional registered nurse (RN), an advanced practice nurse (APRN), or a licensed practical nurse (LPN) in Illinois, the applicant must be “fit.”
Although that term is not defined in the Act or rules, synonyms for the word include “healthy” and “well.”
Once licensed, the Act and its Rules address “competent” practice. This term is also not specifically defined but synonyms include “capable,” “able,” and “fit.”
Mental distress and the Act most clearly intersect in its section on Grounds for disciplinary action (225 ILCS 65/70-5).
If a nurse licensee is found to meet one or more of the 40 listed grounds, disciplinary action may be taken against the nurse, including, but not limited to, a refusal to renew the license, placing the nurse on probation, or suspending the license.
All of the possible connections between mental distress and the grounds in this section are beyond the scope of this article. A number of those links can be highlighted, however.
They include:
“(4) A pattern of practice or other behavior which demonstrates incapacity or incompetency to practice under this Act.
(14) Gross negligence in the practice of practical, professional, or advanced practice registered nursing.
(19) Failure to establish and maintain records of patient care and treatment as required by law.
(30) Physical illness, mental illness, or disability that results in the inability to practice the profession with reasonable judgment, skill, or safety.”
The Administrative Rules (68 IL IAC Part 1300) also list possible connections between mental distress and its impact on safe and competent nursing practice.
In Section 1300.90 of the Rules, Unethical or Unprofessional Conduct, examples include: “2) A departure from or failure to conform to the standards of practice as set forth in the Act or this Part. Actual injury to a patient need not be established.
5) Demonstrating actual or potential inability to practice nursing with reasonable skill, safety or judgment by reason of illness, use of alcohol, drugs, chemical or any other material, or as a result of any mental or physical condition.
6) Engaging in activities that constitute a breach of the nurse’s responsibility to a patient.”
And, in the Rules Section 1300.350, Standards of Professional Conduct for Registered Professional Nurses, Section 1300.445, Standards of Conduct for APRNs, and Section 1300.260, Standards of Professional Conduct for LPNs, each is to practice nursing, advanced practice nursing, and licensed practical nursing respectively only when in functional physical and mental health.
The RN is right to be concerned about his feelings of sadness and it is in his best interest, both professionally and personally, to seek treatment as soon as possible.
Seeking treatment is a win-win for the RN and for any nurse licensee. It is especially an advantage under the Act and Rules because voluntary treatment is indirectly encouraged.
In the Section Grounds for Disciplinary Action, if the RN, or you, would be subject to an involuntary admission or a judicial admission to a hospital as provided in the Illinois Mental Health and Disabilities Code, one’s license is automatically suspended.
The suspension terminates only upon a finding by a court that the individual is no longer subject to either of the admissions to a hospital and issues an order to that effect and discharges the person. Then and only then, upon recommendation of the Board of Nursing to the Secretary of the Illinois Department of Financial and Professional Regulation (IDFPR) that the nurse licensee be allowed to return to nursing practice (225 ILCS 65/70-(c)).
Founding Director of the RN to BSN Program Department: Daniel L. Goodwin College
of Education
And, if the RN’s mental distress is such that his continuing to practice constitutes an immediate danger to the public, the Secretary of the IDPFR can immediately suspend his license (a summary suspension) without a hearing. A hearing within 30 days must occur to determine what disciplinary action may be taken against the nurse.
So, whatever mental distress this RN or you are experiencing, seek guidance from a mental health professional as soon as you can, including a PsychiatricMental Health APRN, and follow through with his or her recommendations.
You can read the entire Illinois Nurse Practice Act and its Rules by going to the Illinois Nursing Workforce Center’s website at: nursing.illinois.gov/nursepracticeact. asp
You can also access the Illinois Mental Health and Developmental Disabilities Code at: ilga.gov/legislation/ icls/icls5.asp?ActID=1496&ChapterID=34
Erratum to: March 2021 The Nursing Voice PRACTICE CORNER Illinois Law & Nursing Practice
Nancy J. Brent. MS, JD, RN
Erratum:
After publication of the original article, it came to the author’s attention that there were two editorial errors in the first sentence of the RESPONSE in the article. There should not be a period after the word “No” and the word “state” should not be capitalized.
RESPONSE:
No. State statute or administrative rule requires you to have a second RN witness a parent’s phone consent for his or her minor child who is being treated in your healthcare facility.
The correct text is:
No state statute or administrative rule requires you to have a second RN witness a parent’s phone consent for his or her minor child who is being treated in your healthcare facility.
Northeastern Illinois University invites applications and nominations for the position of Founding Director of the RN to BSN Program
Full Time, Continuing Position
The Founding Director of the RN to BSN Program reports to the Chair of the Department of Health Sciences and Physical Education and is responsible for all curricular, budgetary, and personnel matters of the Program; and provides leadership/vision in fulfilling the Program, Department, Daniel L. Goodwin College of Education, and University missions and goals.
Develop a quality innovative RN to BSN completion program that is accessible to a diverse and multicultural student population. The Director reports to the Chair of the Department of Health Sciences and Physical Education (HSPE) and is responsible for all Departmental curricular, budgetary, and personnel matters; and provides leadership/vision in fulfilling the Department, Daniel L. Goodwin College of Education, and University missions and goals.
Minimum Qualifications
An earned masters or doctorate from an accredited institution in nursing or a health related discipline; holds a current unencumbered nursing license in the State of Illinois or is able to obtain the license within 6 months of appointment; a minimum of 5 years of nursing experience within the last 10 years; 3 to 5 years of experience in an administrative role in an academic nursing program; a record of excellence in program and curriculum development; experience with national, regional, state, and professional accreditation processes.
Preferred Qualifications
• Demonstrated ability to develop a quality innovative on-line RN to BSN completion program that is accessible to a diverse and multicultural student population;
• Progressive experience in providing leadership and working collaboratively with faculty in the development of online and hybrid academic nursing programs;
• Commitment to and experience working with diverse populations consistent with the University’s mission documents and description of “Diversity at Northeastern Illinois University” located at http://www.neiu.edu/about/strategic-plan/diversity-northeastern;
• Experience establishing educational and clinical partnerships that promote health and health care to meet the needs of a dynamic, diverse, and multicultural global society;
• Experience with program assessment and evaluation of student outcomes;
• Demonstrated experience working in collaboration with faculty, students, administrators, staff and external constituencies;
• Willingness to work in a collective bargaining environment
Salary and Benefits
Salary is commensurate with qualifications and experience. Comprehensive benefits package including health, dental and vision benefits, sick and vacation days, and participation in the State Universities Retirement System. This position requires a background check.
To Apply:
In order to be considered for employment by Northeastern Illinois University (NEIU) you must submit the following and send all documents within one PDF/Word document to GCOENursingSearch@neiu.edu.
• A letter of interest addressing your qualifications for this position
• Current Curriculum Vitae
• Three (3) current academic and professional references
• Current Illinois RN licensure
• Employment Application
• Statement of Annuitant Status
• Copies of unofficial transcripts are accepted; however, official transcripts for all earned degrees will be required of candidates selected for on-campus interviews
• This position requires a background check
In addition to the links provided above for the Employment Application (fillable), Affirmation Action Form and Statement of Annuitant Status, you can also obtain these forms at the NEIU Office of Human Resources, Bernard Office Building (BOB), 5555 N. Bernard Street, Chicago, IL 60625, Monday through Friday, 8:30a.m.to 4:30p.m.
Review of applications begins September 15, 2021 and continues until the position is filled.
https://www.neiu.edu/founding-director-of-rn-bsn-program-0
Nancy J. Brent, MS, JD, RN
CONTINUING E D U C AT ION OFFERING
The Right to Designate a Caregiver Prior to Discharge
Dhara Mehta
Introduction
The Caregiver Advise, Record, and Enable Act, which became effective on January 27, 2016, gives admitted patients or their legal representatives the right to elect a caregiver before the patient's discharge from the healthcare facility for after-care services (IHA, 2016). Caregivers offer after-care to a patient post-discharge according to the healthcare team's discharge plan (IHA). After-care services refer to clinical assistance provided to a patient after their discharge. They can include activities of daily living, tube feeding, medication administration, ventilator care, and follow-up appointments (IHA). Implementing this policy offers the patient more autonomy over their care once they leave the healthcare facility and can be considered as the facilities' role in supporting patient-centered care even after discharge. By allowing patients or their legal representatives to choose their caregiver, patients are included in the discharge planning process and experience less anxiety in the transition from hospital care to home care. The purpose of this paper is to evaluate the advantages and disadvantages of this policy along with its political, financial, and social impacts so that further revisions can be recommended.
Policy Relevance to Health Care
Hospital discharge planning is very complex and entails several steps leading to the discharge, the discharge, and even after to manage the patient's care. This includes evaluating the patient to determine if they no longer need inpatient services, determining if the caregiver needs training, and even arranging follow-up healthcare (Flink & Ekstedt, 2017). This policy plays a crucial role in this process, as it allows the patient or their legal representative to decide and appoint a trusted caregiver to be a part of this discharge process. In one qualitative study of seventeen patients, thirteen of them stated that most decisions were made for them and wanted to be more involved in making decisions regarding their care (Jerofke-Owen & Dahlman, 2018). Additionally, healthcare is focused on providing patient-centered care. Allowing patients to choose who provides them care once they leave the facility is part of this patient-centered approach. Research shows that when care is patient-centered, patients feel in control, are more satisfied with the care, and have positive outcomes (Kuipers et al., 2019).
Similarly, when health care is taken outside the healthcare facility with the same approach, patients are more willing to participate in their care, accept care from their caregivers, and respond better to care. This policy supports the patient-centered approach and maintains
Director of UnDergraDUate Programs
Illinois State University is recognized by The Chronicle of Higher Education, as the only public university in Illinois to be a “Great College to Work For”!
The Mennonite College of Nursing is seeking a faculty member to direct our Undergraduate Programs.
Responsibilities for this position include:
Planning and developing the implementation of all sequences within the undergraduate program, Completing course and clinical schedules,
• Prepares, teaches and evaluates assigned courses, and Assists in faculty orientation and mentoring.
Qualifications include:
• A Master’s degree in Nursing and prior teaching and administrative experience in a baccalaureate or higher degree program is required.
A Doctorate in Nursing is preferred.
Salary is commensurate with experience and qualifications.
Illinois State University is located in Bloomington-Normal With a population exceeding 125,000, the twin-cities are half way between Chicago and St. Louis and are known for having a high quality of life including a small-town atmosphere, high standard of living, stable economy and high educational attainment.
the patient's sense of autonomy to help yield better overall health outcomes for patients, making it relevant in healthcare. Furthermore, while this policy is relevant in healthcare as it can provide other benefits, this policy also raises a number of issues.
Strengths of the Policy
Giving patients or their legal representatives the right to choose their caregiver provides several benefits aside from giving them a sense of autonomy and supporting a more patient-centered approach. It also reduces patient anxiety and is a financially cost-effective option for patients. This policy helps reduce the anxiety and fear that overwhelms the patient when they need to focus on healing, coming to terms with their health issues, preparing to make lifestyle changes if needed, and planning for discharge. A study looking at the effects of stress and anxiety in patients during their discharge process determined that the discharge process generates significant stress (Sharif et al., 2014). By allowing the choice of a caregiver, patients experience less anxiety when preparing for discharge and after-care.
Another benefit that arises from the ability to choose a caregiver is the financial aspect. In many cases, Medicare, Medicaid, and other private health insurance companies do not entirely cover caregivers leaving individuals to pay out-of-pocket (Lai, 2012). Independent caregivers are paid $10-$20 hourly to provide care which may not be feasible for older adults who live on government support and pension (Lai). It may also involve working with a stranger compared to the flexibility of choosing a trusted caregiver. In most cases, the caregivers chosen are often family members who provide the care for little to no compensation (Lai). As a matter of fact, in 2017, the Public Policy Institute estimated that $470 billion of unpaid assistance was offered by family caregivers (Reinhard et al., 2019). Therefore, having a trusted family member to provide care is both convenient and cost-effective.
Weaknesses of the Policy
Simultaneously, this policy has its disadvantages. While it provides autonomy, supports a patient-centered approach, reduces patient anxiety, and is cost-effective, it raises concerns on the competence of the patient's appointed caregivers, ineffective training systems, and the process of verifying a caregiver before the patient's discharge. This policy covers the right of a person or their legal representative to choose their caregiver. However, it does not include any criteria about how caregivers are evaluated to determine if they can indeed perform the needed tasks for the required length of time as planned by the healthcare team. Patients are not qualified to decide whether those caregivers will be capable and available to perform those tasks.
This policy also states that caregiver training will mainly occur by observing health care professionals and taking initiatives to perform those tasks while under their supervision (IHA, 2016). Additionally, there is an option for a pre-recorded video that can be given to caregivers to watch, allowing for little physical interaction and the opportunity to ask questions. At a minimum, this policy states that caregivers should have the opportunity to see a live or pre-recorded video demonstration, the ability to ask questions before discharge and be provided answers in a culturally competent and appropriate language (IHA). However, there are no other training criteria to ensure that caregivers have received adequate training and will be able to provide adequate continued care after discharge. One study shows that appropriate care as per the discharge plan decreases over time. It becomes challenging to provide care due to other obligations that may lead to caregiver fatigue (Schulz et al., 2020). This unstructured training increases the risk of caregivers overlooking certain vital steps in the discharge plan.
Review of applications will start immediately. To learn more about this exciting opportunity and to apply, please contact by June 13, 2021:
Lissa Bevins at mabevin@ilstu.edu or (309) 438-3143 or visit: jobsearch.illinoisstate.edu/en-us/search/?search-keyword=mennonite
n U rsing . illinoisstate . e DU
Finally, another weakness in the policy states that hospitals should make some effort to contact the patient's appointed caregiver. If they cannot be reached for training and instruction, it should not hinder the patient's discharge process when appropriate (IHA, 2016). With no regulations set in place to verify patients have an acceptable caregiver to perform after-care, the risk of readmission and poor patient health outcomes increases (Hahn-Goldberg et al., 2018). Additionally, suppose caregivers have not made an effort to receive any instruction or training pertaining to their patient. In that case, the chances of failing to provide adequate after-care will increase (Hahn-Goldberg et al.).
By analyzing the policy's strengths and weaknesses, it is evident that there is support for and against this policy. It is equally important to evaluate this policy regarding its effect on political, financial, and social platforms.
Policy Issues: Political Impact
Policies must be evaluated for their political influence as politics play a crucial role in creating and implementing policies. The biggest political influences on this policy come from health insurance organizations, specifically from Medicare and Medicaid, and third-party home care organizations. If patients are allowed to choose their own caregiver, then third-party home care organizations would lose potential revenue to make if patients were to use their services instead (Slayter et al., 2019). If more people started appointing their caregivers, these organizations would lose money, resulting in layoffs and further loss of profit.
Medicare is a federal program for those over 65 and those under 65 with disabilities (Landers et al., 2016). Medicare and most other private health insurances only cover home care short-term if it is medically necessary (Landers et al.). Other non-medical home care and aftercare services that unskilled caregivers can deliver are not covered and require additional costs (Landers et al.). On the other hand, Medicaid is a joint state and federal program that provides coverage to seniors with low income and limited assets (Janus & Ermisch, 2015). They may cover medical and non-medical home care depending on the state policies (Janus & Ermisch).
Additionally, Medicaid offers Home & Community Based Service Waivers (HCBS), which can be used to pay for medical and non-medical home care services (Janus & Ermisch, 2015). Since money and other resources are invested into these programs at federal and state levels, it is in the best interest of Medicaid, Medicare, and even other private healthcare agencies to support this policy. Given that Medicare does not always cover home care, allowing patients to appoint a caregiver that can be trained provides benefits such as improved patient outcomes, reduced readmission rates, and proper aftercare management (Landers et al., 2016). For Medicaid, allowing patients to choose a caregiver is a cost-effective option relieving them from providing coverage (Janus & Ermisch). With the increasing aging population and greater demand for Medicaid coverage due to low income, Medicaid alone covered 70 million people, of which 9 million were over the age of 65, nationwide in 2020 (Medicaid, 2020). Therefore, by supporting this policy and advocating for patients to choose a caregiver, Medicaid can divert additional costs associated with offering home care and ultimately save federal and state resources.
By assessing the political influence on this policy, it can be determined that private health insurances, Medicaid, Medicare, and home health agencies greatly influence this policy and may have played a key role in how it was written. For example, the policy specifically states that the hospital should allow the patient or legal representative to name a caregiver and make some effort to get in touch with that person (IHA, 2016). This benefits the patients and organizations, like Medicaid and Medicare. However, if the caregiver's contact is unsuccessful, then it should not be a reason to interrupt the patient's discharge as long as its deemed appropriate (IHA). This would benefit private home care organizations as those patients who need caregivers will have to bear out-of-pocket costs to hire a caregiver. Based on the evaluation of how politics influence health policy, it can be seen how influential politics is in creating health policies.
Policy Issues Impacting the Nursing Profession: Financial In 2019, Medicare cut payments to 2,583 health facilities nationwide due to increased readmission rates, translating to a cut of about $563 million for the year (Rau, 2019). Annually, hospitals are evaluated to determine how often patients are being readmitted within 30 days of being discharged for conditions including myocardial infarction, chronic lung disease, heart failure, coronary artery bypass, pneumonia, and hip/knee replacements (Rau). Readmission rates are a significant concern because they affect patient outcomes due to increased risk of exposure to hospital-acquired infections, a need for further extensive management, and medical errors (Rau). One study also determined that in some cases, readmission occurred due to other
factors such as poor after-care activities, which included medication management and adhering to follow-up appointments (Felix et al., 2016). In this study, patient surveys determined that although 2/3 of patients rated their discharge positively, they were still readmitted within 30 days, and 1/3 of the total patients readmitted were noted to have missed one or more follow-up appointments (Felix et al.). Simultaneously, this can also be costly for the hospitals. In 2012, hospitals in Arkansas reported that readmission costs resulted in an annual excess of $12 billion (Felix et al.). When considering the negative impacts of readmission rates on hospitals and patient outcomes, it can also affect the nursing profession. Readmission increases nurses' workload in providing patient care since those patients often take longer to be discharged the second time (Felix et al.). If patients were initially discharged with a trained caregiver, readmission rates would be much lower, decreasing the workload for all healthcare professions, including nursing. An additional study showed that when patients can choose their own trusted caregiver, they are likelier to comply with the post-discharge management plan (Skufca, 2019). Without this policy and keeping the politics mentioned before in mind, patients may not obtain an adequate caregiver to assist them, increasing their risk of poor after-care leading to readmission.
On the other hand, this policy allows the discharge process to continue even if the caregiver is not present as long as the healthcare team feels it is appropriate (IHA, 2016). This aims to reduce hospital costs from keeping patients longer than needed once the healthcare team has provided the care that was needed. These hospital costs include hospital room, bed, food, and medical and non-medical supplies. The nursing profession is impacted here because while this policy aims to reduce unnecessary workload for nurses and optimize their skills and time for patients that require immediate care if patients are readmitted due to poor after-care compliance, it increases the nurses' workload. Through this evaluation, it can be seen that this health policy has both positive and negative impacts on the nursing profession.
Policy Issues Impacting the Nursing Profession: Social
Aside from the political and financial influence on this health policy, there are also social issues that impact this policy and affect the nursing practice. The major social concerns in the nursing profession include short staffing, long work hours, and increase workload (Matthews, 2012). To represent the nursing force and address these social influences, organizations such as the American Nurses Association (ANA), which aim to advance and protect the nursing profession, have released position statements and have their own Code of Ethics (ANA, 2015). One statement is known as "Addressing Nurse Fatigue to Promote Safety and Health," which is geared towards reducing the risk of nurse burnout associated with increased shift work and long working hours (ANA, 2014). By doing so, they aim to protect the health and safety of those in the nursing profession and their patients (ANA, 2014). This position affects the Caregiver Advise, Record, and Enable Act in several ways. The policy states that caregivers can obtain training and instruction as the "opportunity arises," which means that the caregiver has the right to stop and ask the health professionals to train and instruct them in performing those tasks that are expected to be part of the discharge orders (IHA, 2016). While the ANA Code of Ethics Provision 4.1 states that the nurse's responsibility includes direct nursing care activities and teaching, social issues such as insufficient staffing and long work hours affect this ability (ANA, 2015). Being asked to train, instruct, and assess caregivers on care practices in handling multiple patients when short-staffed can lead to nurse fatigue, poor patient outcomes, and inadequate caregiver training (Matthews). Nurses need to be able to balance patient care during the shift, and having to take the time in the middle of the task to provide efficient training can decrease the quality of care they provide to other patients, the time they spend with other patients, and risk rushed and inadequate training for the caregiver who can lead to longer shift hours in an already shortstaffed environment. Being expected to train caregivers without a structure during busy times will make the caregivers' training ineffective and will neither occur in the culturally competent manner nor allow enough time for the caregiver to ask questions as this policy requires (IHA). Therefore, the current issues of short staffing and long shift hours that ANA and the Nursing Code of Ethics are trying to address can impact the expectations in this policy.
Another position statement from ANA is "Care Coordination and Registered Nurses' Essential Role," which states that an essential role of the nursing profession is to promote patient-centered care and
advocate for patients during care coordination (ANA, 2012). This position statement directly impacts the health policy because this policy allows for a more patientcentered approach to the patient's care, in conjunction with ANA's Code of Ethics which includes advocating for patient autonomy through self-determination (Provision 1.4) and a patient-centered approach (Provision 2.1), giving the patient the right to choose a caregiver for their after-care promotes this patient-centered approach and sense of autonomy (ANA, 2015). However, social issues such as short staffing and long work hours influence the effectiveness of a patient-centered approach. One study showed how social issues such as staffing, work hours, and workload are key barriers to effective patientcentered care (Lloyd et al., 2018). Based on the ANA's position statement and the Code of Ethics, it can be seen how social issues can impact this health policy. While this health policy promotes the idea of a patientcentered approach and patient autonomy, it also requires nursing professionals to train and instruct, provide care, coordinate care, and make reasonable efforts to contact the caregiver for the patient. However, the social issues that currently exist in the nursing profession can interfere with patient care and, ultimately, the discharge process in which the caregiver needs to be trained appropriately.
Policy Revision: Proposal
After evaluating the Caregiver Advise, Record, and Enable Act through its strengths and weakness and political, financial, and social influence, a proposal for policy revision can be made. Three changes that are being proposed include structured training and instruction for caregivers, implementing a minimal criterion for chosen caregivers to meet the patient's after-care needs, and initiating a top 2-choice in caregiver for patients. Applying a structured training and instruction process will alleviate many issues that have been presented in this assessment. A structured training program will allow caregivers to learn and ask questions about the patient's after-care needs without the stress of feeling rushed. It will also improve the caregiver's understanding of their after-care to lower readmission rates, financially benefiting both health insurance organizations and the hospital. At the same time, it will help lower the risk of nurse fatigue and assist in addressing the social issues (increase workload, long shifts, and short staffing) hindering the nursing profession from providing quality patient care while being expected to train caregivers in suboptimal settings.
Implementing a minimal criterion for chosen caregivers to be eligible for the patient's after-care needs is another crucial aspect. To make sure that the discharging patient will be receiving the appropriate after-care as determined by the healthcare team, caregivers must be competent and willing to provide care for that patient in the first place. The health policy states explicitly that the assigned caregivers are under no obligation to continue providing after-care to the patient, raising concerns (IHA, 2016). If the caregiver chooses to discontinue care, the patient will be at higher risk of missing their medications and follow-up appointments, increasing their risk of being readmitted. To counter this, having a minimal criterion that includes whether or not the caregiver is willing to provide after-care for the patient for the given timeframe if they are physically and mentally competent to provide the necessary care, and if they are willing to receive structured training, will improve the patient's outcomes.
Initiating a top 2-choice in caregiver for patients will significantly impact the healthcare team's effort to secure a caregiver that is both the patient's and is available for the patient after discharge. Since the current policy does not obligate assigned caregivers to partake in after-care and allows for a patient's discharge if appropriate even if the caregiver has not been successfully contacted, having a second choice would increase the likelihood of having a trained caregiver before discharge (IHA, 2016). This would address readmission rates and poor aftercare compliance and prove to be financially beneficial for healthcare facilities and health insurance organizations. It will also assist in decreasing the nurse workload and nurse fatigue.
These three proposed points can have numerous benefits if included in this health policy. They address the weaknesses of this policy and aim to satisfy political, financial, and social issues surrounding the nursing profession.
Conclusion
The Caregiver Advise, Record, and Enable Act gives patients the right to appoint a caregiver of their choice (IHA, 2016). This opportunity allows patients to receive after-care from someone they trust and supports nursing goals of providing patient-centered care and autonomy. This policy also helps reduce patient anxiety and is financially cost-effective. At the same time, this policy
has specific weaknesses: concerns of patient-appointed caregivers' competence, the training process, and the method of verifying a caregiver before discharge. When evaluating this policy further in terms of politics, it is undeniable how influential health insurance organizations such as Medicaid, Medicare, and private health insurance companies are regarding this policy. Financial influences on the nursing profession caused by readmission rates due to poor after-care compliance, and social issues such as increased workload, extended shift hours, and short staffing impact how this policy is carried out. The social issues impacting this policy can lead to further nurse fatigue and decrease overall patient care quality. The financial issues can lead to a surge in hospital costs, patient out-of-pocket costs, and increased use of medical resources. However, with the revised proposal, these issues can be addressed through three points: structured training for caregivers, implementing a minimal criterion for chosen caregivers, and initiating a top 2-choice in caregiver. These revisions can lead to better patient outcomes and reduce readmission rates directly addressing the appointed caregivers. Evaluating this health policy to see its impact on patients and nursing professionals through different platforms provides an overall picture to propose further recommendations for its improvement.
REFERENCES AVAILABLE UPON REQUEST
CE Offering: #2021-06-015- The Right to Designate a Caregiver Prior to Discharge
1.0 Contact Hour
This offering expires in 2 years: June 10, 2023
Learner Outcome: Learners will demonstrate knowledge on the advantages and disadvantages, as well as the political, financial, and social influences of The Caregiver Advise, Record and Enable Act and its proposed policy revisions by passing a post-test with 80% or better.
HOW TO EARN
CONTINUING EDUCATION CREDIT
This course is 1.0 Contact Hour
1. Read the Continuing Education Article
2. Go to https://www.surveymonkey.com/r/202106-2021Self_Study to complete the test and evaluation. This link is also available on the INF website www.illinoisnurses.foundation under programs.
3. Submit payment online.
4. After the test is graded, the CE certificate will be emailed to you.
HARD COPY TEST MAY BE DOWNLOADED via the INF website www.illinoisnurses.foundation under programs
DEADLINE
TEST AND EVALUATION MUST BE COMPLETED BY June 1, 2023
Complete online payment of processing fee as follows: ANA-Illinois members & Affiliates - $8.00 Nonmembers- $15.00
ACHIEVEMENT
To earn 1.0 contact hour of continuing education, you must achieve a score of 80%
If you do not pass the test, you may take it again at no additional charge
Certificates indicating successful completion of this offering will be emailed to you.
DISCLOSURE
There is no conflict of interest for anyone with the ability to control content of this activity.
ACCREDITATION
This continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)
CE quiz, evaluation, and payment are available online at https://www.surveymonkey.com/r/202106-2021Self_Study or via the INF website www. illinoisnurses.foundation under programs.
Detection and Treatment of Delirium Experienced by Patients in the Long-Term Care Setting
Michelle E. Jordan MSN, AGPCNP-BC
The American Psychiatric Association (APA) defines delirium as an acute disturbance in attention and awareness accompanied by cognitive disturbances that cannot be explained by a disorder in neurocognition that precedes the delirium and cannot be explained by another medical condition (for instance, a brain tumor). Delirium is not a disease but a multi-causal clinical syndrome causing a serious disturbance of a patient's mental abilities, affecting patient functioning, safety, and quality of life. A thorough assessment of factors contributing to delirium should be followed by prompt treatment.
Delirium Is Prevalent in Long-Term Care Settings
Estimates of the elderly diagnosed with delirium in long-term care settings have been estimated to be around 40%. However, the prevalence of delirium in a long-term care setting is estimated to range between 13-88%. The problem is that delirium is often undiagnosed or misdiagnosed. Delirium appears 5988% in patients near death. These variations can be attributed to the following: the multi-causal nature of the condition; the number of tools clinicians use to make the diagnosis; clinicians' knowledge of the condition; and the diversity of the population who experience delirium.
Many patients who transition to long-term care settings suffered delirium during or resulting from a recent hospitalization. Delirium is often a surgical complication of older adults with an incidence of 25% after elective surgery and 50% after high-risk surgery, such as hip fracture repair and cardiac surgery. The elderly who presents at the emergency room are diagnosed with delirium in the range of 8-17%; some will eventually be admitted to long-term care settings.
Problems Associated with Delirium Recognition and Treatment
Delirium often goes unrecognized and, therefore, untreated. Failure to recognize delirium is a longstanding problem. Clinicians may be insufficiently trained to recognize delirium. Caretakers in longterm care settings often lack sufficient knowledge of a patient's normal cognitive function, a necessary benchmark as a point of comparison. Caretakers need to take sufficient time to establish this with patients or with the help of family members. Engaging with patients is critical because continual brain stimulation is essential for normal cognitive functioning. When family members are not available, one case being the restrictions placed on family visits during the recent Covid epidemic, lack of family support and engagement may contribute to the development of patient delirium. Poor communication among caretakers, especially nurses, and the patient's family members can lead to failure to recognize when patients begin to veer from their normal cognitive function into delirium. Caretakers may not have or may not utilize proper assessment tools such as the Confusion Assessment Method (CAM).
The relationship between delirium, dementia, and depression can be misunderstood. Delirium and dementia, the two most common causes of mental impairment in older populations, are frequently confused and lead to failure to treat delirium. Dementia is a neurodegenerative condition that develops slowly and progressively leads to diminished cognitive functioning that interferes with a patient's independence and ability to engage in daily life activities. In contrast, delirium is a syndrome characterized by a rapid onset that leads to inattention, impaired cognition, and fluctuating symptoms. The problem is further complicated when delirium is superimposed on dementia or depression.
Psychoactive medications for delirium can exacerbate delirium, cause additional problems, or mask the condition. Polypharmacy can have negative consequences for older adults. Patients in long-term care settings are frequently treated with psychoactive medications for agitation, depression, or insomnia, but these medications can exacerbate delirium, cause additional problems, or mask the condition. Antipsychotic medications (APMs) make agitated patients more comfortable, but they can mask hyperactive delirium and convert it to hypoactive delirium. Hypoactive delirium is characterized by apathy, withdrawal, and lethargy. APMs generally put patients at risk of falls due to hypotension, disorientation, oversedation, and extrapyramidal symptoms. Due to their overuse, the Center for Medicare and Medicaid Services in 2017 limited prescriptions for APMs to 14 days and required a written reassessment rationale for new prescriptions.
Nursing homes often fail to treat delirium properly— patients who have dementia and delirium challenge long-term care facilities. Since facilities must report the use of physical restraints to control symptoms like agitation, restlessness, wandering, and aggressiveness, they treat patients with psychotropic medications. Various federal regulations regarding these medications have contributed to inconsistent compliance. Financial concerns have led to increased APMs, the decrease of costly registered nurses (RNs), and the increase of less expensive licensed practical nurses (LPNs). A higher percentage of RNs in nursing homes are associated with lower rates of APMs, while higher numbers of LPNs are associated with higher rates of APMs. The point has already been made that caregiver engagement with patients increases the brain stimulation necessary for normal cognitive function. When caregiver engagement decreases, patient brain stimulation is lessened, preparing the way for delirium.
Non-Pharmacological Treatment of Delirium
The pharmacological treatments for delirium (APMs, anti-depressants, anti-anxiety medications) are still being used and are often necessary; prevention and treatment of delirium with non-pharmacologic approaches are now widely considered the most effective strategy. Delirium screening, such as the Confusion Assessment Method (CAM), is both a method
to detect delirium (evaluative) and a frequent, timely interaction with the patient that serves to promote cognitive functioning (therapeutic). The CAM, consisting of a series of questions asked of the patient, takes less than five minutes; a frequency of every eight hours is sufficient. Staff scores the patient on a change in mental status, including fluctuations, inattention, levels of wakefulness, and disordered thinking. Patients will anticipate holding the hand of their nurses, and after learning the drill, will strive to become better at it. Both the physical and verbal exchange serve as a human connection for the patient and an opportunity for the caretaker to assess changes signaling delirium. Once delirium is detected, the patient should be reassessed for physical contributors—infection, organ dysfunction, polypharmacy, drug withdrawal--and treated accordingly.
Providing a calm environment and encouraging the use of medical supplies and personal objects can alleviate delirium. Hyperactive delirium patients, characterized by agitation, can benefit from reduced stimulation. Earplugs at night, delirium rooms, an orderly, quiet environment, and pain management protocols help contribute to a calm environment. Coordination of nursing interventions, elimination of alarms, well-lit rooms, and the inclusion of personal objects provide benefits. Hypoactive delirium patients, who often appear sedated or depressed, benefit from the stimulation provided by dentures, canes, walkers, wheelchairs, books, radios, personal clothes, and belongings. Physical therapists and occupational therapists can assist with mobilization. Caregivers can remind the patient of the time; a clock, watch, or calendar kept close can help patients keep track of time and dates. Patient families should be involved and supported. The use of volunteers, aids, and other nonlicensed professionals can assist and cut the cost of implementation.
Staff training, educational programs, and interdisciplinary consultation should be established. Interdisciplinary teams should round daily together to discuss all aspects of patient care; pharmacists should be included to help with polypharmacy. Family, physicians, nurses, pharmacists, physical and occupational therapists, social workers, nursing assistants, and chaplains are all part of a patient's team. A new and increasingly available approach is the Hospital Elder Life Program (HELP), designed to prevent and treat delirium. HELP, already used in over 200 hospitals worldwide, is a multidimensional intervention proven to be effective and cost-saving. It promotes a review for reduction and possible elimination of psychoactive medications, early and frequent mobilization, sleep hygiene, along with encouraging hydration and nutrition, providing vision and hearing aids. More information can be accessed online.
Conclusions
The elderly admitted into an extended care facility are moving into a high-risk environment. These patients, many of whom have recently been hospitalized, frequently enter with physiological decline, including brain vulnerability. A high percentage also enter with chronic illness, polypharmacy, and psychological morbidities. They now find themselves in a foreign setting that generates fear, isolation, restriction and are without family and friends to give the usual support. These conditions are immutable and dispose the patient to delirium. Additionally, many facilities are inadequately staffed due to financial pressures, and clinicians are under tremendous time pressure to manage their patient load. Clinicians are often not trained well enough to recognize delirium and may not consistently assess for it.
Clinical staff may need additional delirium training. A complete mental status exam that establishes a patient's baseline cognitive function is necessary. Knowing that over 50% of patients will develop delirium, caregivers need training and should consistently utilize a delirium assessment tool like the CAM. Non-pharmacological approaches (for instance, active communication, addressing eyesight and hearing deficits, and improving mobility) are highly effective in preventing delirium and should be the first approach in treatment. Pharmacological approaches are appropriate when the patient is at risk due to agitation, restlessness, and combativeness, but utilizing them should be carefully and conservatively considered and continually reevaluated as they put patients at risk. Pharmacological treatments are appropriate with delirious patients at the end of life.
IACN Looks Forward: The Future of Nursing Leadership
What is leadership in nursing, and how will it change? It is a difficult question to answer because to everyone, it is different.
According to Tina Decker, Chair of the Department of Nursing at Trinity Christian College, "Leadership looks like applying the nursing process (through assessment, diagnosis, planning, implementing, and evaluating) at a macro level with patient-centered care being at the center."
According to Holly Farley, Chair of the School of Nursing and Assistant Professor at Eastern Illinois University, "Leadership can be described as 'facilitating.'
Leaders determine goals with input from followers and facilitate the path to meeting those goals."
The Illinois Association of Colleges of Nursing (IACN) knows that leadership -- and the ways that it is changing – is an important topic for all nurses, both those currently practicing and incoming student nurses. Read on for an examination of leadership in nursing!
Nursing Leadership in 50 Years
Like everything in the healthcare field, nursing leadership is rapidly changing. Tina Decker shared, "Nurses need to become the voice of the future of
healthcare. Nurses are so used to advocating for patients on an individual level. The future of healthcare requires nurses to become more versed at advocating for the vocation of nursing and nurses themselves. This will directly impact patient outcomes as the nursing workforce is the largest healthcare profession in our country. Nurses need to be a significant voice at the table where healthcare decisions are being made. This includes all levels from acute care settings, to community planning to national legislation."
While some ways in which nursing leadership will evolve seem clear, others are not so obvious. Holly Farley said "I know it will be different, but I do not know that the changes will be. Thirty years ago, I could not have imagined the technological changes that we would be experiencing and the fast-paced advances. I think nurses will continue to take on more responsibility in patient care and coordination."
Becoming a Nurse Leader
Although nursing leadership will look different in 50 years, IACN's members believe the path to leadership will remain similar.
"New nurses need to get involved with professional organizations and research," said Lea Monahan, Director, and Professor of the School of Nursing at Western Illinois University.
Holly Farley instructs students hoping to become nursing leaders to "Embrace change at every level and take every opportunity to be a part of it." Tina Decker similarly advises students to "Opt-in. Participate. Assess what changes are needed, and not be afraid to look for solutions!"
Qualities of a Nursing Leader
Students and nurses alike can become future nursing leaders, but some qualities are absolute necessities. "As cliche as it may sound, leaders need to know themselves pretty well before they lead others. They need to know their strengths and weaknesses, their triggers, the things that inspire them. They need to be self-aware before attempting to help others be their best selves in the workplace," said Tiffany Greer, Associate Dean of the School of Nursing at Olivet Nazarene University. "I think it can be as easy as taking a few personality tests, talking with some honest colleagues, and maybe doing some reflective journaling. Then find a great mentor who can cheer you on in the tough moments and stretch you in the good times. The bottom line is that we need good leaders who are willing to serve others, encourage them to be their best, and humbly lead change."
IACN Encourages Leadership
At the IACN, we encourage all nurses who desire to work towards leadership positions, whether at the bedside, organizational, state, or national level. While the process can be long and difficult, it begins with the first step! For nurses wishing to work towards leadership positions, IACN recommends taking the advice of many of our members and getting involved in the nursing community. For advice on how to become involved in the community and general advice about nursing leadership, feel free to contact us here (https:// illinoiscollegesofnursing.org/contact-us/ ).
Philippine Nurses Association of Illinois in Action
Philippine Nurses Association of Illinois (PNAI) has been volunteering at Kendall County Health Department Covid -19 Vaccination program since February 2021. The organization continues to promote use of mask, social distancing, and hand washing to prevent the spread of Covid-19 despite having received the COVID -19 Vaccine. ***Get vaccinated It will save not only your life, but others as well. ***
Left to right: PNAI Vice President Dean Baron BSN, RN, Tessie Dagger MSN, BSN, RN,Secretay; and Bryan Ranchero, RN, Board Member, volunteered at Yorkville High School, Yorkville, IL during their COVID-19 Community Vaccination last February 27, 2021
PNAI Officers; Left to right: Tessie Dagger MSN, BSN, RN ,Secretary; Marilou Dangalan, RN, President Elect,and Bryan Ranchero, RN, Board Member; volunteered at Oswego East High School, Oswego, IL Covid-19 Community Vaccination on March 21, 2021.
PNAI Nurses administering COVID-19 Vaccine at Kendall County, IL
The Student Nurses’ Association of Illinois
The Student Nurses' Association of Illinois (SNAI) has an update on what has been happening since October 2020 and what is currently being planned for this fall! Stay tuned to our website and social media for further information!
Here is a list of our current members and where they attend nursing school. Each of them was elected in October 2020, and their term will end in October 2021.
Madison Morgan, President, Blessing-Rieman College of Nursing and Health Science
Sara Engel, 1st Vice President, Elmhurst University
Kerixtzy Ballines, 2nd Vice President, Aurora University
Sana Bhalli, Secretary,
Phillip Adeleye, Treasurer, Chamberlain University at Tinley Park
Nandini Patel, Breakthrough to Nursing, Northern Illinois University
Kelechi Asonye, Legislative Director, Northern Illinois University
Marisa Morice, Marketing Director, Chamberlain University
Hiral Patel, Membership Director, Chamberlain University
Hunter Varnes, Image of Nursing Director, University of Illinois at Chicago
Joophil Kim, Nominations and Elections Chair, Resurrection University
Alexis Hodges, Executive Elective Consultant, Aurora University
Check out our website for more information on how to run and attend our Annual Conference in October for a chance to pre-slate for running for office on SNAI.
Talk about Pets for the Elderly
This year for our spring event, we wanted to ask people to get involved remotely due to the current pandemic. We felt that giving back to our community was the most important thing since resources and everyday life were in disarray. We thought about the loneliness and sadness that residents in nursing homes must have felt when their families could not visit them. We came across Pets for the Elderly on social media and fell in love with their posts of adoption day. We reached out to them and agreed to raise money for their Foundation, explicitly in Illinois. Pets for the Elderly is located in many states. We felt that it was essential to focus on Illinois. They also ensured that 100% of our proceeds would be given back to the shelters with no overhang fee. This fundraiser was held over six weeks. We were able to raise $309, which was essentially able to help six animals find their forever home with an older person to provide compassion. The costs that were covered included the adoption charges, immunizations, and spay/neuter surgeries. If you missed out on our fundraiser, you could still make donations to Pets for the Elderly at this link: https://petsfortheelderly. org/donate/index.php
Student Nurse Political Action Day
This year at ANA-IL's first virtual Student Nurse Political Action Day (SNPAD), a panel of SNAI board members were able to speak on their roles, spring fundraiser, upcoming annual conference, and new graduate obstacles amidst the COVID-19 pandemic. This year students who were in attendance learned about the policies that are in the Senate, such as the Nurse Licensure Compact Bill. Illinois has been trying for many years to get the bill through the Senate, and for the first time in many years, the Senate finally passed it. Illinois is now waiting on the House of Representatives to pass the compact licensure before it goes to the governor for final approval. The compact licensure would be a huge success with Illinois and the shortage of nursing. It would allow nurses to utilize their licenses in multiple states that agree with the Nursing Licensure Compact. Having the ability to practice in other states, who accept the Nursing Compact License, would benefit the economy. Travel nursing is on the rise, and this allows nurses to practice in a multitude of areas. Overall, the appeal of working and living in Illinois would only increase for those who are nurses and seeking a new nursing opportunity.
72nd Student Nurse Association of Illinois Annual Convention
Out of the abundance of caution, we are planning to host our annual convention this Fall on October 16th, 2021. Our theme this year is 'Empowering Ourselves to Empower Others.' We realized that we must take care of ourselves through this past year to provide the best care for our patients. Learning how to take time for yourself, tend to your needs, and learn the word 'no', is vital to establish ourselves before going into our careers. This will help eliminate nursing burnout, errors made by the nurse, and overall better patient care. We hope to see you there as we have very exciting things planned for our guests! We plan to have a keynote speaker, many guest speakers, an NCLEX review session, and a new graduate nurse panel to answer any questions you may have about the process of applying for jobs, interviewing, studying for NCLEX, and tips and tricks to pass NCLEX. Also, be sure to look forward to many giveaways and awards handed out during the event by SNAI and our guests. We cannot wait to see everyone there!
Misericordia Home is a campus based community in Chicago, providing care and support to over 600 children and adults with Intellectual and Developmental Disabilities through a full continuum of care.
We are hiring Full-Time and Part-Time RNs and LPNs
Highly Competitive Wages & Benefits!
Inquiries and Resumes should be sent to careers@misericordia.com
Join the American Lung Association’s Online Community: Health Professionals for Clean Air and Climate Action
Are you involved, or would you like to get involved in efforts to protect the health of the patients and communities you serve from air pollution and climate change?
Climate change is already harming our health in many different ways – from worsened ozone pollution due to warmer temperatures, to more frequent and intense wildfires producing dangerous particle pollution.
When it comes to rising to the challenge of addressing climate change, leadership from the health and medical community is essential. Nurses treating patients on the front lines are critical to raising awareness of the severe health burdens caused by air pollution and climate change – and to help build public will for solutions.
The American Lung Association’s “Health Professionals for Clean Air and Climate Action” is a campaign designed for nurses, doctors, public health workers, and other health professionals to learn more about health impacts of air pollution and climate change, share their story why fighting air pollution and climate change is important, and take action on critical policy issues. The website also highlights physicians and health professionals who are speaking out for strong climate action.
One key action nurses can take is to add their name to the American Lung Association’s Health Professionals Declaration on Climate Change. More than 1,500 doctors, nurses, academic and health professionals from across the country have signed this declaration urging elected officials to take stronger action against climate change to protect public health. Health professionals can add their name here.
Learn more and sign up to receive the free monthly Health Professionals for Clean Air and Climate Action newsletter on the American Lung Association’s website lung.org/ ClimateChangesHealth
For more information, please contact Diana Van Vleet, National Director of Outreach and Engagement, Healthy Air Campaign, American Lung Association, Diana.VanVleet@ lung.org
There is still time to earn up to 65.5 contact hours*! That breaks down to just $8 per contact hour of quality education!
The Association for Nursing Professional Development (ANPD) will hold its annual convention on August 3-6, 2021, which will be presented in-person and online. Access cutting-edge nursing professional development (NPD) education with peers by attending Aspire to Inclusivity, the 2021 ANPD Annual Convention and earn up to 65.5 contact hours! This year, choose to attend in-person in Chicago, Illinois or online. For registration and more information, please contact the ANPD National Office at 312.321.5135 or info@anpd.org Hotel and Travel, and Health and Safety Information can be found at anpd.org
See you there!!!
*Contact hours are awarded for each individual session. Successful completion of a session requires attendance or viewing of the recorded session and completion of an online evaluation.
Nurses want to provide quality care for their patients.
The Nurses Political Action Committee (Nurses- PAC) makes sure Springfield gives them the resources to do that.
Help the Nurses-PAC, help YOU!
So. . . . . . . if you think nurses need more visibility if you think nurses united can speak more effectively in the political arena if you think involvement in the political process is every citizen’s responsibility.
Become a Nurses-PAC contributor TODAY!
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HEALTH CARE MANAGEMENT
The 33rd Annual National Black Nurse's Day CelebrationHonoring the Legacy of Provident Hospital Nurses Alumni
By Carolyn Rimmer-Owens, BSN-RN¬-C Public Relations Chair of the NBNDC
"They Dared to Dream"
"If I can help somebody, as I pass along If I can cheer somebody, with a word or song. If I can show somebody that he's traveling wrong Then my living shall not be in vain " (Alma Bazel Androzzo 1945, recorded by Grace Field in 1948, and also recorded by Mahalia Jackson years later.)
The 33rd Annual Black Nurses' Day Celebration took place February 26, 2021, as a Virtual Zoom Program. There were more than 200 people in attendance. The National Black Nurses' day committee is a coalition of professional nursing organizations whose work has centered around highlighting the contributions of African American nurses' role in healthcare and society. The organizations include Alpha Eta Chapter of Chi Eta Sorority, Inc; Beta Mu Chapter of Lambda Pi Alpha Sorority, and The Chicago Chapter of the National Black Nurses' Association. Each President shared the history of their organization and welcomed all of the evening's guests.
Dr. Sandra Webb-Booker, Chair of the Black Nurses Day Celebration and the Mistress of the ceremony, gave the welcoming address and a historical overview regarding the Provident Nurses' Alumni. Dr. Webb told the audience that it started with a dream that Emma Reynolds, a young woman, had of becoming a professional nurse. "She had written letters and made applications to numerous schools, only to be denied admission because of restrictions on admitting Blacks into nursing schools." In 1889, Emma Reynolds and her brother, the Reverend Louis H. Reynolds, contacted Dr. Williams about incorporating a nursing school at Provident Hospital, where blacks could train to become nurses. She thanked Reverend Reynolds, Dr. Daniel Hale Williams, and God for transforming the dream into a reality.
Dr. Williams opened Provident Hospital on May 4, 1891, the only school in America where blacks could train to become nurses. Emma Reynolds enrolled in the first nursing class along with seven other young women, and graduated in 1893. Ms. Reynolds went on to receive her M.D. from the Women's Medical College of Chicago at Northwestern University in 1895.
This celebration acknowledges and salutes Emma Reynolds because her dream was one of racial equality and racial inclusion, said Dr. Sandra Webb-Booker. She acknowledged the memorialized and the current Provident nurses that are still living legends. Dr. Webb told the audience that "we can proudly say we had a hospital that gave African American Nurses the opportunity and training to become professional nurses. "
The keynote Speaker was Nailah S. Muttalib, President of Provident Women's Auxiliary of Provident Hospital. She acknowledged Dr. Annie Lawrence Brown's professional contributions, the former Dean of Provident Hospital School of Nursing. "Annie is lauded by many for her outstanding contributions, which led to the
National League for Nursing accreditation of Provident Hospital School of Nursing. Her hard work was a gift to the nursing profession- past, present, and future ".
Ms. Mattalib shared the rich history that the Auxiliary and Provident Hospital Nurses shared in their volunteer efforts working on behalf of the hospital and the community. In the year 2020, she proudly stated that the auxiliary celebrated its 60th anniversary.
"Mark Twain is credited with saying, " the two most important days in your life are the day you are born, and the day you find out why."
Her question was this; "What is your purpose in life"? She spoke passionately about how part of life's purpose should not be limited to financial remuneration but that we should also contribute to humanity." How can we help our fellow men and women"? What contributions can you give to make your community, your workplace a better place"?
Ms. Mattalib told the audience that the nursing profession provides many opportunities to address those needs. She encouraged the nursing students to put a plan in place regarding their chosen specialty. According to her, the decisions they make will lend toward defining their purpose in the nursing profession.
Her message to those new to nursing was not to forget their volunteer contributions to the larger community. She wanted them to know that even though they may feel it does not matter, it matters to someone.
She cited a couple of lines from a poem written by Mayo Angelou. "I have learned that you should not go through life with a catcher's mitt on both hands; you need to be able to throw something back."
She spoke about how Provident Hospital nurses established a history of professionalism that included giving back to the community. "They were expected to be prepared for their regular job.” assignments, and they were prepared; they did not wait until the last moment to prepare- they prepared well in advance and left time to volunteer outside working hours."
There were numerous volunteer activities done collectively between the Nurses and Provident Hospital Women's Auxiliary to raise funds and collect linen for the hospital in what was known as "the Cotton Ball."
Provident Hospital Nurses were a part of the Red Cross Provident Hospital Nurses Alumni Scholarship Awardees each received $ 1,000.00: Presented by Jacki Smith, RN.
1. Jennifer Reed; pursuing a Master of Science from Purdue University with a GPA of 4.0
2. Briana Daniel; pursuing a Bachelor of Science in nursing from Chamberlin College with a GPA of 3.0
National Black Nurse's Day Committee
Louise Broadnax, President of Provident Nurses Alumni; Valerie Hubbard President of Lambda Pi; Ethel L Walton President of Chicago Chapter National Black Nurses Associations; Dr. Sandra Webb-Booker, Chair of National Black Nurses Day Committee; Mr. Ronald Campbell, Co-Chair of National Black Nurses Day
Committee, Adrian Priester-Coary, President of Alpha Eta Chapter of Chi Eta Phi Sorority, Inc; Rev. Dr. Evelyn CollierDixon, Jacki Smith, Carolyn Rimmer-Owens, and Marilynn Parker.
Rev. Dr. Evelyn Collier-Dixon performed libation, which paid tribute to all those who have gone on before us.
Mr. Ronald Campbell gave the closing remarks reminding the audience of the Provident Nurses Alumni's sacrifices and their great Legacy. He challenged us all to dream of a better life for our people.
Louise Hoskins-Broadnax, President of the Provident Hospital Alumni and long-time member of The National Black Nurses Day Committee, passed away on February 27, 2021, the day after the celebration.
It is also noteworthy to mention that Marilyn Render Danzy, a Provident Nursing Alumni and a Nurse Cadet member, got her heavenly wings on March 26, 2021.
Color Guard Presentation: The audience sang "Lift Every Voice and Sing". MAJ Wilson organized the ROTC Salute.
Illinois Nursing Workforce Center Registered Nurse (RN) Survey 2020
RNs completing license renewal were invited to participate in this survey between 3/10/20 and 9/30/2020. The data was collected during the renewal process post payment of the license renewal fee. The 2020 license renewal period was extended from May 30 to September 30, 2020 by Executive Order during the initial period of the COVID-19 pandemic. A total of 41,983 RNs completed the survey for a survey response rate of 22%. Report available on website http://nursing.illinois.gov/ResearchData.asp
Key Findings:
• Employment: 92% of nurses work full-time at one job and are actively employed in nursing.
• Employment setting: the majority of Illinois RNs, 52%, work in an acute care setting such as a hospital; 11% are employed in an ambulatory care setting. RNs positions vary in each setting,
• Diversity: consistent with the increase in ethnic and racial diversity in Illinois, there is a slight increase in the diversity of the Illinois nurse workforce. There is more racial, ethnic and gender diversity of RNs under the age of 45 years in the Illinois workforce.
• Age: approximately 52% are over 55 years of age; age cohorts for Illinois RNs in 2020 are similar to those reported in 2018.
• Education: 58% of RNs have either a bachelors, masters or doctorate as the highest nursing degree.
Diversity
• 58% of Hispanic/Latinx nurses are less than 45 years of age.
• 45% of nurses that are male are less than 45 years of age.
• 42% of Asian nurses are less than 45 years of age.
• 56% of nurses that identify as Multiracial are less than 45 years of age.
Age of the RN Workforce
• 52% of the RN workforce is 55 years of age and older.
• 31% are between the ages of 55-64 years.
• 70% of nursing faculty are 55 years of age and older.
RN Employment Settings
• 52% of RNs practice in a hospital/acute care setting – especially nurses in the younger age cohorts.
The hospital is the most common acute-care employment setting where nurses have different roles.
• 11% of RNs practice in ambulatory care settings, including outpatient clinics, private practice, doctor offices.
• 9% of RNs practice in a nursing home/extended care/assisted living setting.
• 4% of RNs are school nurses.
RN Position Role
• 66% of RNs provide direct patient care as staff nurses working in acute and nonacute care settings.
• 15% Identify as a nurse manager, administrator or patient care coordinator.
• 3% Identify as nursing faculty.
• In Illinois the average staff nurse salary ranges from $55,000-$85,000; the average administrator/manager’s salary ranges from $75,000-$185,000; the average nursing faculty salary ranges from $65,000-105,000.
*APRNs and APRN-FPA’s who are also licensed as RNs were not included in the survey data.
One stop – Illinois Department of Financial and Professional Regulation (IDFPR) home page for your online resources
The IDFPR home page (https://idfpr.com/ ) has a direct link to the following:
• To print your license or download an electronic copy to your phone: use the icon under the blue middle section of the IDFPR homepage. www.idfpr.com
• Address update: Please note that all IDFPR correspondence are now delivered electronically, including renewal reminders (in lieu of the paper postcard sent by U. S. Mail). Licensees are strongly encouraged to visit IDFPR’s online address change webpage (https://www.idfpr.com/applications/LicenseReprint/ ) to provide a current email address and ensure contact information is up-to-date and accurate.
• Name change: Change of name CANNOT be completed via this online process. If your name has changed, you must submit a written notice to the Department and include documentation of the name change (marriage license, court order, or divorce decree) For a copy of the written notice, please use this link https://www. idfpr.com/Forms/DPR/DPRCOAnamechange.pdf
The State of Illinois Coronavirus Response Site: The COVID-19 Vaccine Plan, up-todate information on what Illinois is doing protecting the health, safety, and well-being of Illinoisans. It can be found at https://coronavirus.illinois.gov/s/
The Illinois Nurse Practice Act Rules were finalized on January 4, 2021. A copy is available at this link: https://www.ilga.gov/commission/jcar/ admincode/068/06801300sections.html
The Illinois Nursing Workforce Center (http://nursing.illinois.gov/ )
Education: Post-licensure Illinois nursing education programs are separated between baccalaureate degree completion and graduate education opportunities. The graduate education page includes a grid of which practice specialty each graduate program includes. http://nursing.illinois.gov/Gradeducation.asp
Reports: the 2020 RN survey results highlighting data collected during online license renewal are now available at http://nursing.illinois.gov/ResearchData.asp There are also supply and demand reports of Illinois nurses dating back to 2007.
Increasing Patient Engagement through Electronic Health Record Portal Adoption: A Nurse Care Coordination and Education Opportunity
Susan Watkins Ph.D., RN & Lauren Wiseman MSN, RN-BC
The American healthcare system is disjointed, difficult to navigate, and illnessfocused. The fragmentation between patient care services, healthcare organizations, and electronic health record systems has resulted in duplicative, costly, and poor-quality care outcomes (Frandsen et al., 2015). Patient adoption of Electronic Health Record (EHR) portals has been postulated as a key strategy to improve patient engagement levels (Centers for Medicare and Medicaid Services [CMS], 2016). Increased patient engagement in health management is a prerequisite of healthcare transformation initiatives to reduce fragmentation, improve care outcomes, and increase cost-efficient care delivery (Powell & Meyers, 2018). EHR portals are designed to provide patients access to their laboratory values, encounter documentation, medication, and appointment information. The portal can also allow patients to securely communicate with their healthcare team (ONCHIT, 2021). Healthcare providers have been incentivized and subsequently required to demonstrate compliance to the CMS Promoting Interoperability objectives of certified electronic health record technology (CEHRT), previously known as Meaningful Use (CMS, 2016). Healthcare providers who have low patient EHR portal registration and utilization will not demonstrate this compliance, potentially reducing CMS payment reimbursement totals (ONCHIT, 2021).
Patient adoption of EHR portals remains suboptimal and slow to expand nationwide (National Institutes of Health [NIH] Health Information National Trends Survey [HINTS], 2021; Hong et al., 2020; Powell & Myers, 2018). The HINTs 2020 patient respondents indicated that 79.3% of their Health Care Providers (HCP) maintain their information in a computerized system; however, only 50% have been offered online access to their medical record, and only 42.3% have been encouraged by their HCP, nurse, or office staff to use the patient portal. Only 30.5% of the respondents had accessed their electronic healthcare information within the last 12 months before participation in the survey. Of those who did access the patient portal, the survey cites that the most frequent reasons are scheduling appointments, requesting medication refills, access laboratory results, sending secure messages to their HCP, and completing needed healthcare forms. Of those that accessed their electronic health information, 27.3% perceived the information as easy or very easy to understand (NIH, 2021). This data yields beneficial information for HCPs to consider for promoting EHR portal adoption to increase patient's engagement in their healthcare.
EHR Portal Barriers
Evidence supports patient's concerns with confidentiality, lack of experience with digital health tools, insufficient internet access, and social determinants of health as
associated factors with patient adoption of EHR portals (Hong et al., 2020). Patients with complex health needs are frequently overwhelmed when they present to their HCP. Registering for the EHR portal may seem like another complicated task without education or explaining the value to their healthcare (ONCHIT, 2021).
Powell and Myers (2018) conducted a qualitative analysis of patient and HCP perceptions about how the usability of EHR portals may contribute to chronic disease self-management support. Their results support the importance of user interface and education as contributing factors to sub-optimal portal adoption (Powell & Myers, 2018). Patients indicated that if the portal's navigation to log in and access information is too complicated, it deterred them from engaging beyond the log-in page. The data supports that the portal user interface must be efficient and visually appealing. The patient can quickly obtain information, send messages, request refills, schedule or cancel appointments, and share their electronic healthcare information as needed. Patients indicated the portal should include a mobile interface that is easily accessible, intuitive, and simple to navigate for information access and input. The portal interface should accommodate different health literacy levels. Patients revealed they received insufficient education from their HCP or other care team members on portal usability and the benefit to their health self-management. The authors concluded that clinicians need to actively engage patients in portal enrollment, utilization, and the benefits of maximizing disease self-management support efficiency (Powell & Myers, 2018).
EHR Portal Facilitators
Powell and Myers (2018) reinforce that improving adoption of the patient portal can be achieved by mimicking other user adoption methods, such as education and personal assistance using the applications. Their data and conclusions are consistent with the ONCHIT (2021) standards that reinforce the need for clinicians to invest more time in educating patients and their support systems about portals. The ONCHIT (2021) standards recommend clinician support to include assisting patients in creating their user-profiles and teaching them to navigate the portal to experience the personal benefits it offers. These standards also encourage clinicians to engage in their personal EHR portals to become more familiar and proactive in providing portal education and its value to their patient populations for increased efficiency and care coordination. Patient messaging communication through the portal can improve efficiency barriers caused by telephonic and mail communication documentation burdens related to the additional time needed to transcribe phone messages, print and mail information, postage costs, and miscommunication issues. As healthcare clinicians, it is essential to invest more time proactively when patients are engaged in our services to promote portal adoption and increased utilization for patient-centered care (Powell & Myers, 2018). Nurses have the opportunity to educate and promote this valuable service. Strategies to improve patient engagement in EHR portals may include adding patient portal engagement strategies into the standard office visit workflow, including access assistance, navigation education, and practice locating each feature (ONCHIT, 2021). One example is introducing the patient to the portal during an RN care coordination visit when care planning communication preference is discussed. If the patient prefers electronic communication, it would be ideal for introducing the portal and benefits to the patient for efficient communication, information retrieval, and accessibility to the practice clinicians. The patient can create their account alongside the nurse, who can demonstrate the functionality. The nurse can also send an introductory letter with the web access link information home with the patient. It is imperative to involve the patient's key social supporters in the EHR portal introduction and accessibility information, including additional proxy account availability. This will allow the patient to have support in using the EHR portal and empower the patient's family also to be engaged. It is a standard of care for nurses to educate the patient and their social support systems to improve self-care disease management; therefore, the same principles should apply when educating patients about EHR portal use and benefits for healthcare accessibility. It is not helpful to introduce the portal without explaining its value and how valuable it is to their healthcare. If it is discussed quickly and without meaning, it sounds like any other nonessential grocery store "rewards card" seems beneficial but proves to be too complicated to receive any benefit (ONCHIT, 2021). Consumers are flooded with marketing tactics to 'sign up" for incentives accounts, provide online feedback, provide email for customer promotions, and have become untrusting and fatigued to this type of advertising. If healthcare aims to become patient-centered, more time needs to be invested in introducing, educating, and assisting patients in navigating within their EHR portals (ONCHIT, 2021). Nurses can use the fundamental Knowles Adult Learning principle, first provide a logical explanation about the topic being discussed when teaching new information to adult learners. Keeping the instruction task-focused instead of memory-based and delivered in a format conducive to individual learning styles will guide the learner to become self-directed (Knowles, 1984). Using these principles with more patient-centered engagement techniques can help the patient become more empowered and improve their healthcare experience and outcomes.
References
Centers for Medicare and Medicaid Services. (2016). Electronic Health Record (EHR) Incentive Programs. https://www.cms.gov/regulations-and-guidance/legislation/ ehrincentiveprograms?redirect=/ehrincentiveprograms
Frandsen, B. R., Joynt, K. E., Rebitzer, J. B., & Jha, A. K. (2015). Care fragmentation, quality, and costs among chronically ill patients. American Journal of Managed Care, 21(5), 355. https:// www.ajmc.com/journals/issue/2015/2015-vol21-n5/care-fragmentation-quality-costsamong-chronically-ill-patients?p=2
Hong, Y. A., Jiang, S., & Liu, P. L. (2020). Use of patient portals of electronic health records remains low from 2014 to 2018: Results from a national survey and policy implications. American Journal of Health Promotion [Online], 34 (6), 677–680. https://journals.sagepub. com/doi/10.1177/0890117119900591
Knowles, M. (1984). The adult learner: A neglected species (3rd Ed.). Houston, TX: Gulf Publishing. National Institutes of Health. (2021). Health Information National Trends Survey. https://hints. cancer.gov/data/download-data.aspx
Office of the National Coordinator for Health Information Technology (2021). Health IT Playbook. https://www.healthit.gov/playbook/certified-health-it/ Powell, K., & Myers, C. (2018). Electronic patient portals: Patient and provider perceptions. Online Journal of Nursing Informatics (OJNI), 22(1). https://www.himss.org/resources/ electronic-patient-portals-patient-and-provider-perceptions
Hispanic Nurses Embrace Precision Medicine Through the All of Us Research Program to Ensure the Hispanic/Latinx Community is Represented in Biomedical Research
Susana Gonzalez RN, MSN, MHA, CNML
Past President, National Association of Hispanic Nurses – ILLINOIS Chapter
All of Us (NAHN-Illinois) grant Co-P.I.
Monica J. Rodriguez
Director of Communications and Engagement
All of Us Research Program, Precision Medicine Initiative, Northwestern University
Since 2016, nurses from the National Association of Hispanic Nurses – ILLINOIS Chapter (NAHN) began educating their Hispanic/Latinx communities in the Chicagoland area with the All of Us Program grant. The nurses collaborated and built partnerships and provided a strong, trusted presence to help educate and encourage hundreds of diverse community members and health care professionals to learn and participate in this research initiative.
The All of Us Research Program is a part of the Precision Medicine Initiative from the National Institutes of Health (NIH). The program provided NAHN with an opportunity to launch an educational campaign to spread awareness about this necessary research. The "one size fits all" model of health care does not adequately address the health care needs of our diverse population. Through
the work of the All of Us Research Program, Hispanic nurses in the Illinois chapter, along with their Health Care Provider Organizations (HPO) partners, including the Illinois Precision Medicine Consortium and other Community-based organizations (CBO) partners, are working hard to impact change.
Precision medicine is based on you as an individual. It considers your environment, lifestyle, and your family health history, and genetic makeup. This may help healthcare providers tailor healthcare to individual needs. Until now, little research of this kind has invited minority and under-served populations to participate.
NIH's goal of reaching one million or more people from diverse backgrounds is impressive. With the help from nurses who work with patients every day and are the most trusted healthcare workforce, we can make this goal achievable. Join this historic effort and become ONE in a MILLION.
NAHN-Illinois continues to be part of the All of Us is a historic effort to gather data from one million or more people living in the United States to ensure medical researchers have a data source representing the diversity of the United States. We ask that you join All of Us Research.
To learn more about the All of Us Research Program, please go to https://allofus.nih.gov/ or contact NAHNILLINOIS Chapter nurses at https://www.nahnillinois.org/
Hektoen Nurses and Humanities Arts Exhibition
Sandy Gaynor RN PhD
Nurses’ Relaxation and Renewal Through the Arts
COVID-19 delayed us a year, but it could not stop the enthusiasm for the very first Nurses' Relaxation and Renewal through the Arts exhibit! More than 100 nurses and nursing students from throughout the Midwest submitted visual art, print, prose, photography, poetry, musical performance, and crafts. A COVID-19 restricted "soft opening" was held April 9, 2021, at the International Museum of Surgical Science (IMSS) 1524 N. Lake Shore Drive, Chicago, to celebrate with a small group of masked artists, Hektoen Advisory nurses, and donors in attendance. Opening remarks by Mary Ann McDermott RN, EdD recognized the efforts of the many volunteers who made this art show happen, from raising sponsorship money, encouraging and contributing art, to physically arranging and hanging the exhibit. Guests toured the three galleries that house our exhibit, including artists' statements about what art-making means to them. Of the 150 pieces submitted to the project, 60 are on display at the IMSS. The entirety of the exhibit is shown continuously on a film loop at the museum, and the digital catalog can be seen on the Museum website: www.imss.org , as well as the Hektoen Nurses and Humanities website: hektoen.org/nurses-the-humanities/
The museum has a classroom available for those who may want to bring a clinical group or a management team to discuss the role of art in health care and their own clinical practice. The foundation statement of the Hektoen Nurses and Humanities group is "our mission is to expose a broad array of art forms for nurses to use for healing in both their patients and themselves." This exhibit displays representational art and art as a craft, art as team building, and art as creativity for personal rejuvenation. Special event opportunities are available for nursing groups with prior arrangements. Saturday, May 22, 2021, we will host Karen Egenes RN, EdD: "Nightingale on the Nile" presentation cosponsored by Hektoen Nurses' and Humanities and the University of Illinois Nurses History Project. If you would like to reserve a room or plan a special event, please contact Mary Ann McDermott at maryannmdermott@msn.com or Sandy Gaynor at dsgaynor@sbcglobal.net
Come Celebrate the extended World Health Organization (WHO) designated 2020/21 Year of the Nurse! Donations from generous sponsors have provided FREE ADMISSION for all nurses and nursing students. The exhibit will be on display every day from 10 am until 4:30 pm until July 11, 2021 (closed Memorial Day and the 4th of July).
Identifying Self-Care Practices in Heart Failure Patients
Jeana Koster BSN, RN
Despite advances in pharmacologic and technological management, heart failure's chronic disabling condition continues to have profound effects on approximately 6.2 million adults in the United States (Centers for Disease Control and Prevention [CDC], 2020). In 2018, over 350,000 death certificates had heart failure as the cause of death (CDC, 2020). Heart failure in 2012 cost the United States over 30 billion dollars in medical care (CDC, 2020). Heart failure carries a risk of mortality compared to common cancers and has one of the highest rehospitalization rates of all chronic diseases (Biddle, Moser, Pelter, & Robinson, 2019).
Heart failure is defined as a syndrome that results from structural or functional disorders of the heart preventing the ventricles from filling or ejecting blood (Knecht & Neafsey, 2017). Although there have been advancements in understanding pathophysiology and treatments for heart failure, patients are ultimately responsible for managing their self-care behaviors which can be complex. Noncompliance with a recommended course of treatment is the primary cause of poor healthrelated outcomes in heart failure patients (Biddle et al., 2019).
Adherence rates to treatment plans range from 35% to 50% (Biddle et al., 2019). Many factors affect these rates, such as disease acuity, self-care behavior explicit to illness, social and financial standing of the patient, and communication methods used by the provider (Biddle et al.). Many complex treatments for heart failure patients involve education and counseling to help modify lifelong health behaviors. Health literacy, skills, and motivation are all obstacles that can place a daily burden on these individuals.
Chronic heart failure (CHF) is highly prevalent in older individuals and a significant cause of morbidity, mortality, hospitalizations, and disability. Checking weight is critical in heart failure patients in preventing symptom exacerbations. Although the healthcare industry promotes high-quality, patient-centered care for health failure patients, it appears heart failure patients continue to have high readmission rates (Biddle et al., 2019). Effective self-care is invaluable in maintaining physical fitness stability and improving health outcomes in patients with heart failure (da Conceição, dos Santos, dos Santos, & da Cruz, 2015). This study aims to see what percent of heart failure patients practice healthy heart self-care behaviors, such as daily weights, limiting fluids, eating a low-sodium diet, taking their prescribed medications, and exercising regularly.
Literature Review
A literature review was conducted by searching the Open Athens online library using the following key terms: adherence, heart failure, quality of life, self-care, and health promotion. Inclusion criteria consisted of articles about heart failure, quality of life, and self-care, from peer-reviewed journals. Exclusion criteria included studies published before 2013 and non-English language studies. In this study, the term "heart failure" describes a group of disorders that have affected the heart's pumping ability; such complications generally include ischemic heart disease and cardiomyopathy (Norris, 2019). Ischemic heart disease is caused by atherosclerosis. As cholesterol particles build up in the arteries' walls, plaque forms, and blocks the blood flow to the heart. Cardiomyopathy is anything that causes the heart muscle to lose its ability to pump well. Alcohol abuse, some medications such as chemotherapy, viral infections, coronary artery disease, and hypertension are some causes of cardiomyopathy (Johns Hopkins Medicine, 2021).
Congestive heart failure impacts the sufferer's quality of life significantly (Ravindran, Vaishnaruby, Karthik, & Merciline, 2019). Ravindra et al. (2019) conducted a study to recognize the deficits in cognition impairment in the domains of attention, executive functions, working memory, psychomotor speed, and visuospatial ability in patients with congestive cardiac functions. Cognitive impairment was found to compromise patient decisionmaking capabilities leading to poor self-care outcomes and quality of life (Ravindran et al.).
Self-care behavior adherence such as daily weighing and understanding when to seek help when symptoms occur is essential to optimize heart failure patients' outcomes and prevent exacerbations. Jaarsma, AbuSaad, Dracup, and Halfens (2013) examined self-care behaviors of 128 hospitalized heart failure patients. During their hospitalization, the Self-Care Behavior Scale, developed for this study, was used to assess limitations in knowledge, judgment, and decision making. Through the hospital's educative support program, each patient in the
intervention group was provided teaching and guidance about the different aspects of heart failure treatments. The intervention group also received a follow-up phone call one-week post-discharge. The phone call was from a support nurse. The nurse assessed potential problems and also set up home visits for the patient. During the home visits, the visiting nurse reinforced heart failure education with the patient and family. If the patient had any concerns between home visits, the patient was encouraged to call the nurse (Jaarsma et al., 2013).
The research concluded that intensive education significantly enhanced self-care behaviors in heart failure patients one month after discharge. The comparison group, who received standard care only at discharge, also had enhanced self-care behaviors at this time. Selfcare behavior scores were significantly lower at both three and nine months, yet the intervention group was still practicing more self-care behaviors than the control group (Jaarsma et al., 2013).
Despite the intensive education and support in this study, the research points out the patients' limitations include knowledge, judgment, decision making, and skills. Improving these patient limitations through supportive educative nursing interventions would enhance self-care behaviors, self-care behavior support strategies, and social support (Jaarsma et al., 2013).
Older patients who have chronic conditions and congestive heart failure have a poor health-related quality of life. These patients' particular needs make selfcare a challenge, leaving them dependent on others for survival (Falk, Ekman, Anderson, Fu & Granger, 2013). The study's objective by Durante et al. (2019) was to find out from the caregiver what contributions they gave to aid in self-care maintenance and management in treatment adherence and symptoms monitoring. The researchers found that although the caregivers described contributing to the patient's heart failure self-care maintenance and management, some of their practices were incorrect. This study pointed out how clinicians should routinely assess and educate caregivers to ensure best practices are utilized, considering caregiver contributions can improve patient outcomes in areas of concern such as treatment adherence and symptom monitoring and management of symptoms as they occur (Durante et al.).
Daily weighing is recommended by the American College of Cardiology/American Heart Association guidelines to manage heart failure (Donlansky et al., 2017). A significant contributor to hospitalizations is the rapid increase in weight due to fluid retention or decompensating heart failure. Only 40% of patients practice weighing themselves daily, and less than 33% understand how to manage the information they gather about their weight gain (Donlansky et al.). The most valuable component of heart failure management is demonstrating the ability to adhere to a daily weight regimen. In the study by Donlansky et al., the aim was to investigate if cognitive function predicted adherence to daily weights and actual weight gain as an indicator to report. The researchers found that daily weighing was not influenced by cognitive function in patients with heart failure. Still, as cognitive function diminished, the heart failure patient experienced clinically significant weight gain (Donlansky et al.).
In a study by Lu et al. (2016), the patient's baseline knowledge level was generally low. Despite an improvement in knowledge after educational interventions, the improvement was still not ideal. Education cannot be used as the only factor in predicting if a patient will be compliant or not with their weight monitoring (Lu et al.).
Methods
Design
This research project was a mixed-method descriptive study using a five-question yes or no questionnaire. At the end of the questionnaire, participants were given two additional questions asking why they were practicing selfcare or why they were not practicing self-care.
Sample
The 16 participants were recruited from a heart failure clinic associated with a 327-bed acute care hospital located in rural west-central Illinois. Data were collected between January 4, 2021, and February 1, 2021. The study was approved by the Institutional Review Board and the participating health system's Research Review Committee. Eligible participants had a diagnosis of heart failure and were under the care of their heart failure cardiologist or nurse practitioner. The age range of the participants was 40-99. If the participant did not want to share their age, an "other" option was available. Exclusion criteria included anyone who did not have a heart failure diagnosis or who was cognitively impaired. All participants spoke English.
Procedure
After patients checked in to the heart failure clinic for their cardiologist's appointment, they were asked if they would like to participate in a research project by the principal investigator. The patients who agreed to be in the study were provided with a detailed explanation of the study protocol. The informed consent was the acceptance to participate by the patient. A plain white business envelope was provided to place the survey once completed to protect the participant's privacy and confidentiality. The principal investigator collected the sealed envelope and stored it in a locked cabinet in the phase II cardiac rehab gym. There were no patient identifiers. The survey was completely anonymous. The study risks included the possibility of the participants feeling psychological discomfort or stress related to revealing through the survey possible noncompliance of daily weights. The participants could quit the study at any time. As a benefit, participation in the study will contribute to a better understanding of how well patients understand and manage their congestive heart failure symptoms.
Results
Listed below are the questions from which the quantitative data was collected for this study.
Quantitative Data
The following Yes/No questions were on the heart failure survey questionnaire:
1. I weigh myself every day
2. I limit the amount of fluids I drink
3. I eat a low salt diet
4. I take my medications as prescribed
5. I exercise regularly
This study identified that 100% of the patient participating reported taking all their medications as prescribed. Less than half of the patients, 43.75%, reported exercising regularly. Of the 16 participants, 68.75% reported weighing themselves daily and eating a low sodium diet. Lastly, most of the patients, 75%, reported limiting the amount of fluids they drink. Of the two participants in the 40-49 age group, yes was answered to all the questions except number two, "I limit the amount of fluid I drink." Both patients in this age group answered no to this question. There were no participants in this study who identified themselves in the 50-59 age range. Three participants reported being in the 60-69 age group. Of the three, only one person identified as not practicing daily weights. All patients in this age group answered yes to practicing the remaining self-care practices. The 70-79 age group was more diverse in their self-care behaviors. Of the six patients in this group, four answered yes to weighing daily and limiting fluids. Less than half answered yes to eating a low salt diet, and 100% answered yes to taking medications as prescribed. Half of this group answered yes to exercising regularly. Answers were also varied in the 80-89 age group. Three out of four answered yes to weighing daily, with 100% responding yes to limiting fluids and taking medications as prescribed. One out of three answered yes to exercising regularly. One patient identified as "other" in this study replied yes to practicing all self-care practices listed on the heart failure questionnaire.
Qualitative Data
Two questions, numbers six and seven, were offered for patients to answer at the end of the heart failure questionnaire. Question six asked why the patient was practicing self-care activities, and question seven asked why the patient was not practicing self-care activities. A total of 14 excerpts were coded from the analysis of questions 6 and 7 following an initial descriptive coding cycle method (Miles, Huberman, & Saldana, 2014; Saldana, 2009). First Cycle coding allows for assigning codes to data chunks. Using descriptive coding, data were labeled or coded by a word or short phrase. This helped identify the topic and laid the groundwork for Second Cycle coding, resulting in 14 codes and seven themes (Miles et al., 2014). See Table 1. Table 1 Selected codes and themes
I was told to Doctor orders
Keep chest clear Prevention
Keep edema under control
Question Seven
Lazy Self-blame
Inability to make meals Dependency
Trying to cut down salt Motivation
Low salt not always available Inconvenience
Bad weather
A total of 16 participants were allowed to elaborate on why they were practicing self-care (Question 6) or why they were not practicing self-care (Question 7) to obtain qualitative data. Of the 16 participants, 68.75% answered question six and 25% answered question seven. Table 2 lists the age groups of the participants and how they answered question number six. For this question, there were no answers from the age group 60-69. Table 3 lists the age groups and how they answered question number seven. Age groups, 40-49 did not respond to this question.
Table 3 Question Six: Why do you practice self-care?
40-49 Age Group 70-79 Age Group 80-89 Age Group
To get healthier It is good for me Doctor recommended it
Better heart health Doctor's orders Keep edema under
Doctor said so To keep chest clear
Heart To stay well
Because I want to stay alive
Doctor told me to
I was told to
Table 3 Question Seven: Why are you not practicing self-care?
40-49 Age Group 70-79 Age Group 80-89 Age Group
Lazy I cannot make my own meals I try every other day
Dependent on assisted living Sometimes I don’t get it done Low salt is not always available Don’t get out to walk in bad weather
I am trying to cut down on salty snacks
Too cold in the winter
Discussion
The burden of heart failure is alarming in terms of increasing incidence, frequent hospital readmissions, high mortality, and substantial medical costs. Adherence to self-care practices is vital to improve health and prevent life-threatening exacerbations. Although there is evidence of self-care practices' effectiveness, such as daily weights, literature shows only 10.3% of heart failure patients can provide self-care management due to impaired cognition, depression, lower education level, and poor family functioning (Lu et al., 2016).
This study supports the evidence that heart failure patients do adhere to self-care practices such as daily weights. Further investigation is needed on how heart failure affects a person's cognition and the formation of their self-management beliefs and behaviors. The evidence does support the need for ongoing education and assessment for caregivers and heart failure patients as the heart failure patients' cognition declines.
Motivation, dependency, prevention, self-blame, inconvenience, and wellness were the main themes that evolved from the data collected for this research project. Dependence, compliance, and cognitive function were the most apparent themes found in the literature review.
Limitations
This study had several limitations. First, the data collection period was cut short due to a prolonged wait time for the approval to conduct the study. Initially, the data collection would be on Wednesdays and Fridays. Later, it was determined that heart failure patients were only being seen on Wednesdays. Second, the principal investigator had to read the survey questions to several heart failure patients because they could not read due to poor eyesight. Therefore, the principal investigator may have influenced their answers. Other limitations included a small sample size at one location, so the results could not be generalized to other heart failure patients.
Implications for Future Research
All the data gathered in this study was self-reported, as were many studies found in the literature review. Selfreported data may be affected by measurement errors due to the patient's health literacy. Future studies, using objective data entirely or studies that combine selfreported data and objective data, would increase the study's validity. Furthermore, incorporating multiple heart failure clinical sites across the region would provide more data for subsequent analysis. A larger sample size would allow the researcher to optimize data collection to determine their study's validity better.
Conclusion
Practicing self-care behaviors is essential for preventing disease progression in heart failure patients. This study demonstrates that heart failure patients perceive themselves as adhering to healthy self-care practices. Statistics prove that many heart failure patients and caregivers do not fully understand selfcare behaviors for mitigating heart failure exacerbations leading to hospital admission. Further investigation is needed to determine if the study's patients had recent hospital admissions because of fluid volume overload. More information would be required to decide whether the patient perceived themselves as following self-care behaviors as they were instructed. Health literacy and support systems are vital to the success in the prevention and management of heart failure.
REFERENCES AVAILABLE UPON REQUEST
