Chronic Pain by Genevieve M. Clavreul, RN, Ph.D.

Chronic Pain What nurses don't know about pain management By Genevieve M. Clavreul, RN, Ph.D. What is pain? There are many definitions. The most widely accepted is the one used by The International Association for the Study of Pain, which defines pain as “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.” The American Academy of Pain defines it as “an unpleasant sensation and emotional response to that sensation.” Margo McCaffrey, MS, RN-BC, FAAN, a specialist in the nursing care of patients with pain, is credited with providing the definition most appropriate for use in clinical practice. She says pain is “whatever the experiencing person says it is, existing whenever and wherever the person says it does.” Isn’t Pain Subjective? Pain Assessment ScaleMost nurses feel that they have a good understanding of pain. We have, after all, nifty charts, diagrams and whatnots that we use to help our patients describe just how much discomfort they’re experiencing. On a scale from one to 10, with one being no pain, and so on; or my favorite, the happy/sad face pictorial chart where we ask the patient to choose the appropriate smiley/frownie face. Being able to accurately gauge the intensity and source of pain is a critical component to the nursing team’s ability to provide optimal patient care. However, there is a difference between treating the patient in pain and treating a patient living with chronic pain. My personal experience has lead me to question how well nurses are educated and trained to address the needs of patients living with chronic pain, and the regime of medication that is used to treat them. Many a competent and compassionate nurse has been thwarted and confounded when confronted by such a case. Regrettably, inappropriate care can set back a patient’s recovery, cause additional negative sequelae, and in some cases, threaten a patient’s well-being. Patricia’s Withdrawal Recently, my daughter Patricia underwent a long-awaited knee replacement surgery (for the record, she gave me permission to out her, so no HIPPA violation here). Patricia suffers from chronic pain and is on a long-term regimen of Kadian, a time-released morphine, and Narco for breakthrough pain. As the date for her surgery approached, she received the reminder call from the surgical nurse not to eat or drink after midnight. She took this to mean not taking her medication since it fell within that “no eat or drink” time. Which is why my daughter went into surgery that morning at 0700 without any pain meds on board. As my other daughter Chris and I waited patiently during the surgery and post-op recovery, I wondered how Patricia would react to being without her meds for so long. Chris and I entered her room later that morning just as a nurse was bringing in additional blankets to address Patricia’s uncontrollable shaking. My fears about withdrawal were realized. The nurse assured us that Patricia was simply suffering from a post-anesthesia “cold” and that he’d bring some more blankets in shortly and have her feeling all toasty and warm “real soon.” The Consult I took the opportunity to assess her myself — because as you know, you never stop being a nurse. Her color was extraordinarily pasty and pale, her lips appeared gray, you could see her muscles twitch with the naked eye and her extremities shook as if she had palsy. I shared my observations with the nurse and he assured me, once again, that it was simply a normal response to the anesthesia. At this time I reminded him that she was accustomed to taking both Kadian and Narco and had been doing so for many years, and because of the impending surgery had not taken her usual dose. To which he responded that she was ordered a PCA pump, but I could see that it was set to an amount that was nowhere near the level of her pre-surgical dose. Keep in mind that I had also talked at length on this very issue with the surgeon, the anesthesiologist, and every nurse (and there were many) I came in contact with prior to the surgery. So, I had to wonder, did the various physicians, nurses, technicians and others who are part of the pre-op and post–op process really read and integrate all the information that they demand from their patients? If they had, they would have taken steps to avoid putting my daughter into opioid withdrawal syndrome. Finally, the nurse informed me that he would ask for a pain consult and he stepped away to the nurses station to place the call. A short time later, a physician whose specialty was pain management arrived. After a brief series of questions, he ordered that Patricia return to her former pain management regime and the PCA dosage be increased as well. As he left, he commented to me that he found it frustrating that so many patients were placed in similar opioid withdrawal “crisis” after following the surgical nurse's instructions to “take nothing by mouth” after midnight. What they should do, he said, was take their scheduled pain medication, but do so with the most minimal amount of water needed to swallow. Needless to say, once Patricia was back on her pain treatment regime and the PCA dosage increased, the color returned to her cheeks, her lips lost their grey pallor and all signs of shivering ceased. Educating Ourselves Understanding chronic pain is an area where more education and instruction is needed. This is not to say that most nurses don’t do their utmost to alleviate their patient’s suffering, because they do. But treating chronic pain is not as simple as writing out a prescription and reminding the patient to take the medication as prescribed. Addiction is a very real possibility and the need to monitor for that outcome is critical. Nurses who want to learn more can contact a group such as the American Society for Pain Management Nursing (www.aspmn.org). They have chapters in many states, including one in Southern California. Their mission is to advance and promote optimal care for people affected by pain by promoting best nursing practices. Like many organizations, their meetings have a topic, a speaker and a Q&A. In addition to the meetings, the members themselves are an excellent resource to answer questions related to pain management, and I’ve found that many have extensive networks that include other experts. Action Plan There are many things that nurses can do to better understand this issue. We can ask that our hospital’s nursing education department provide continuing education in pain management, as well as provide opportunities for the nursing team to have “personal” time with physicians and nurses who specialize in pain management. Nurses can lead the charge in advocating for other interventions that may help reduce the need for opioids. Recently there has been a push to encourage the use of long-term physical therapy, aqua therapy, exercise, acupuncture and even yoga to address chronic pain. The results from these therapeutic interventions have been positive and can help reduce the patient’s dependence on medication. There’s a lot about pain management that even the experts don’t know, so the next time you have such a patient, don’t be shy about asking questions. Consult the experts on staff regarding care protocol. Booked Solid, Forever In closing, let me share with you a little story about unintended consequences. Not that long ago, the State of Washington legislature decided that it was in the best interest of their constituents who were being treated with opioids for chronic pain that they be required to see a physician specializing in pain management for assessment and to receive their prescriptions. On the surface, the legislation helped to ally the fears of the medical/nursing community that people living with chronic pain would have their needs met, and hopefully reduce illicit opioid distribution and minimize addiction, misuse and so forth. Unfortunately, what everyone failed to take note of was the shear paucity of pain management experts licensed in Washington — at that time there were two in the whole state. Needless to say, this placed an extraordinary burden on not only the patients, but the two sole practitioners as well. As they say, the road to you-know-where is paved with good intentions.

PARADIGM BYTES Newsletter for Paradigm 97 July 12, 2012 PARADIGM DEFINED: 1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated. Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it. MISSION STATEMENT We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience. ***~~~***~~~***~~~*** SNIPPETS Female genital mutilation (FGM) (Circumcision) Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. Procedures can cause severe bleeding and problems urinating, and later cysts, infections, infertility as well as complications in childbirth increased risk of newborn deaths. About 140 million girls and women worldwide are currently living with the consequences of FGM. FGM is mostly carried out on young girls sometime between infancy and age 15. In Africa an estimated 92 million girls 10 years old and above have undergone FGM. FGM is a violation of the human rights of girls and women. Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. However, more than 18% of all FGM is performed by health care providers, and this trend is increasing. FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death. Procedures Female genital mutilation is classified into four major types. Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. No health benefits, only harm FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies. Immediate complications can include severe pain, shock, haemorrhage, tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. Long-term consequences can include: recurrent bladder and urinary tract infections; cysts; infertility; an increased risk of childbirth complications and newborn deaths; the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated both immediate and long-term risks. Who is at risk? Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, about three million girls are at risk for FGM annually. About 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 92 million girls age 10 years and above are estimated to have undergone FGM. The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas. Cultural, religious and social causes The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities. Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed (type 3 above), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage "illicit" sexual intercourse among women with this type of FGM. FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and "beautiful" after removal of body parts that are considered "male" or "unclean". Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support. Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination. Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation. In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement. In some societies, FGM is practised by new groups when they move into areas where the local population practice FGM. International response In 1997, WHO issued a joint statement with the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) against the practice of FGM. A new statement, with wider United Nations support, was then issued in February 2008 to support increased advocacy for the abandonment of FGM. The 2008 statement documents evidence collected over the past decade about the practice. It highlights the increased recognition of the human rights and legal dimensions of the problem and provides data on the frequency and scope of FGM. It also summarizes research about why FGM continues, how to stop it, and its damaging effects on the health of women, girls and newborn babies. In 2010 WHO published a "Global strategy to stop health care providers from performing female genital mutilation" in collaboration with other key UN agencies and international organizations. Since 1997, great efforts have been made to counteract FGM, through research, work within communities, and changes in public policy. Progress at both international and local levels includes: wider international involvement to stop FGM; the development of international monitoring bodies and resolutions that condemn the practice; revised legal frameworks and growing political support to end FGM (this includes a law against FGM in 22 African countries, and in several states in two other countries, as well as 12 industrialized countries with migrant populations from FGM practicing countries); in most countries, the prevalence of FGM has decreased, and an increasing number of women and men in practising communities support ending its practice. Research shows that, if practising communities themselves decide to abandon FGM, the practice can be eliminated very rapidly. WHO response In 2008, the World Health Assembly passed a resolution (WHA61.16) on the elimination of FGM, emphasizing the need for concerted action in all sectors - health, education, finance, justice and women's affairs. WHO efforts to eliminate female genital mutilation focus on: advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation; research: generating knowledge about the causes and consequences of the practice, how to eliminate it, and how to care for those who have experienced FGM; guidance for health systems: developing training materials and guidelines for health professionals to help them treat and counsel women who have undergone procedures. WHO is particularly concerned about the increasing trend for medically trained personnel to perform FGM. WHO strongly urges health professionals not to perform such procedures. http://www.who.int/mediacentre/factsheets/fs241/en/ ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Nurse leaders happy with ruling on ACA The Supreme Court’s decision Thursday to uphold the Affordable Care Act means nurses can continue preparing for significant changes to the healthcare system. Those changes began soon after passage of the law in March 2010, and will become more substantial when the core measures go into effect by 2014. "This decision means millions of people will have access to the basic healthcare and preventive services that they’ve lacked," said Karen A. Daley, RN, PhD, MPH, FAAN, president of the American Nurses Association, which has been a staunch supporter of the ACA since its passage. http://news.nurse.com/article/20120628/NATIONAL01/107090007 *********************** U.S. FDA checks dictionary on corn syrup vs sugar WASHINGTON (Reuters) - U.S. food and beverage makers who add high-fructose corn syrup to soda, breakfast cereal, and other items will not be able to label it "corn sugar," under a decision by federal officials that frustrated corn processors but won praise from the sugar industry and some health advocates. Both sides say they have consumers' interests at heart and are trying to minimize confusion about the term "sugar." The U.S. Food and Drug Administration, which decides what goes on food labels, has ruled against the corn groups. The agency said calling high-fructose corn syrup "sugar" would mislead people - and could harm them. "FDA's approach is consistent with the common understanding of sugar and syrup as referenced in a dictionary," the agency said in a letter posted on its website late on Wednesday. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_125788.html ****************** Joint Commission Center for Transforming Healthcare Releases Tool to Tackle Miscommunication Among Caregivers (OAKBROOK TERRACE, Ill. – June 27, 2012) An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. In addition to patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. Today, the Joint Commission Center for Transforming Healthcare is releasing a new Hand-off Communications Targeted Solutions Tool™ (TST) to assist health care organizations with the process of passing necessary and critical information about a patient from one caregiver to the next, or from one team of caregivers to another, to prevent miscommunication-related errors. Ineffective hand-off communication is recognized as a critical patient safety problem in health care. The “hand-off” process involves “senders,” the caregivers transmitting patient information and releasing the care of that patient to the next clinician, and “receivers,” the caregivers who accept the patient information and care of that patient. The Hand-off Communication TST was created to measure the effectiveness of hand-offs within an organization or to another facility, and provide proven solutions to improve performance. Using the tool and the solutions from the Center’s Hand-off Communications Project, health care organizations have reduced readmissions by 50 percent, and have reduced the time it takes to move a patient from the emergency department to an inpatient unit by 33 percent. Health care organizations also reported an increase in patient and family satisfaction; staff satisfaction; and successful transfers of patients. Health care organizations were able to complete their Hand-off Communications Project in approximately four months, using minimal resources. In fact, no staff was added and only minor changes were made to the roles and responsibilities of existing staff. ... http://www.jointcommission.org/center_transforming_healthcare_tst_hoc/ ; **~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Don't Let Your Supermarket Make You Fat Where you shop for groceries influences what you buy. Use these budget-friendlystrategies to buy healthy food anywhere. That depends on where you shop for groceries, according to a new study. Shopping at deep-discount supermarkets, especially if they're far from home, is linked to higher body weight and more belly fat than buying groceries at neighborhood markets closer to home. The researchers say this is may be because people who trek to discount supermarkets tend to shop less frequently and buy more nonperishables and less fresh produce. Regardless of where you grocery shop, use these 5 budget-friendly strategies to buy healthy food every time: ... http://www.realage.com/food/how-to-eat-healthy-on-a-budget?eid=1010657443&memberid=4687812 ********************** FDA approves Belviq for treatment of obesity On June 27, the U.S. Food and Drug Administration approved Belviq (lorcaserin hydrochloride) for the treatment of obesity. It is to be used in combination with a reduced-calorie diet and exercise for chronic weight management. The drug is approved for use in adults with a body mass index (BMI) of 30 or greater (obese), or adults with a BMI of 27 or greater (overweight) and who have at least one weight-related condition such as hypertension, type 2 diabetes, or dyslipidemia. ... http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm?utm_source=BenchmarkEmail&utm_campaign=eNewsletter_July_2nd_2012&utm_medium=email ; ********************* Glaxo melanoma drugs beat chemo in pivotal trials (Reuters) - Late-stage trials of two experimental skin cancer drugs from GlaxoSmithKline, each designed to block different pathways used by tumor cells, have found the drugs helped patients with fewer side effects than current chemotherapy. Both drugs, trametinib and dabrafenib, were tested in patients with a mutation in a gene known as BRAF. About half of all melanomas, the deadliest form of skin cancer, have the genetic aberration. Cancer occurs through genetic changes in cells allowing tumor growth factor receptors which activate various pathways, including a protein known as MEK. It is believed that BRAF-mutated melanomas should be particularly dependent on MEK, which is needed to amplify the cancer's genetic signal. http://www.reuters.com/article/2012/06/04/us-cancer-melanoma-glaxosmithkline-idUSBRE85308S20120604?feedType=RSS&feedName=healthNews ********************** Entire Genome of Human Fetus Deciphered WEDNESDAY, June 6 (HealthDay News) -- Researchers report they have decoded the entire genome of a fetus using only a blood sample from the mother and a saliva sample from the father. The scientists said prenatal genome sequencing using the noninvasive method could one day be used to determine if a fetus has any of the thousands of genetic disorders that are caused by a single, often devastating, mutation on one gene. In pregnant women, bits of fetal DNA move through the mother's body in the plasma, a component of blood. Unlike a sample of DNA taken directly from fetal tissue or from amniotic fluid -- such as when expectant mothers undergo amniocentesis to look for chromosomal disorders such as Down syndrome -- the DNA in plasma is in fragments. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_125978.html ********************* RANDOM FACTS: The border between North and South Korea is one of the most militarized areas in the world, according to the State Department, with a combined total of almost two million military personnel under the control of Pyongyang (1.2 million), Seoul (680,000) and foreign powers including the United States (28,000). Bonus Fact: North Korean arms outnumber those in the South by about two to one, including offensive weapons such as tanks, long-range artillery, aircraft and armored personnel carriers. However, much of the military equipment in North Korea is obsolete. ********************** 3 New Weight Loss Myths, Busted Who isn't for looking for fresh ways to slim down? The trouble is that, in time, the latest weight loss or diet trick doesn't work anymore -- you get lazy or don't quite remember what the tip was so you follow it in a halfhearted, or even diet-busting, fashion. Here are three current weight loss beliefs that have morphed into myths. ... http://shine.yahoo.com/healthy-living/3-weight-loss-myths-busted-202700634.html ********************* Nurses Reducing Alarm Fatigue - Beep, bleep, bong, beep, bleep--monitors and medical devices create a cacophony of sounds aimed at alerting nurses to changes in their patients’ conditions, but with the so many bells going off, nurses can become overwhelmed and tune out or turn off the devices. Marjorie Funk, PhD, RN, FAHA, FAAN, said that alarm fatigue can lead to bad outcomes and suggested ways to minimize the risk. “Devices with alarms beep endlessly, demanding our attention, but once the staff become overwhelmed by the sheer number of alarms, it has led to sentinel events,” said 2011 American Association of Critical-Care Nurses (AACN) Distinguished Research Lecturer Marjorie Funk, Ph.D., RN, FAHA, FAAN, a professor at the Yale University School of Nursing in New Haven, Conn., at the association’s 2012 National Teaching Institute and Critical Care Exposition (NTI) in Orlando, Fla. ... http://www.nursezone.com/Nursing-News-Events/more-news/Nurses-Reducing-Alarm-Fatigue_40081.aspx ************************** Less folic acid in pregnancy tied to autism: study (Reuters Health) - In a new study of California moms, women whose children had autism recalled getting less folic acid through food and supplements early in their pregnancies than those whose kids didn't develop the disorder. Meeting recommendations for folic acid -- at least 600 micrograms per day -- in the first month of pregnancy was tied to a 38 percent lower chance of having a kid with autism or Asperger's, researchers reported last week in the American Journal of Clinical Nutrition. Folic acid -- the synthetic form of the B-vitamin folate -- has been added to breakfast cereals and other grains in the United States since 1998 because of evidence showing deficiencies in pregnant women made it more likely their babies would have brain and spine birth defects. Questions have remained about whether lack of the vitamin, or difficulty processing it, might increase the risk of mental retardation and certain developmental disorders as well. ... http://www.reuters.com/article/2012/06/06/us-less-folic-acid-idUSBRE85519G20120606?feedType=RSS&feedName=healthNews ********************** RANDOM TIDBITS: Advertisements for coffee in London in 1657 claimed that the beverage was a cure for scurvy, gout and other ills. Almonds are the oldest, most widely cultivated and extensively used nuts in the world. In 1932 James Markham obtained the 1st patent issued for a tree. The patent was for a peach tree. Rice paper isn't made from rice but from a small tree which grows in Taiwan. Willow bark, which provides the salicylic acid from which aspirin was originally synthesized, has been used as a pain remedy ever since the Greeks discovered its therapeutic power nearly 2,500 years ago. The first American advertisement for tobacco was published in 1789. It showed a picture of an Indian smoking a long clay pipe. ***************************** Infection Control Center: Nurses' first priority is excellent patient care; therefore, it's imperative to keep in mind your infection control nurse duties. The role of infection control nurses - and all nurses - is minimizing infections in the hospital, patient home, outpatient setting, or wherever patient care takes place. This Infection Control Center is dedicated to infection control best practices, real-life experiences and discussion among nurses dedicated to infection control and prevention. The center features blogs, videos, articles and more to help you understand the role of nurses in infection control, but you don't have to be an infection control nurse to benefit from the information below. http://nursing.advanceweb.com/resourcecenter/main.aspx?rpid=48 *************************** How Long Should You Take Osteoporosis Drugs? Researchers at the Food and Drug Administration (FDA) have taken a close look at the long-term benefit of bisphosphonates, a class of medications widely prescribed to treat osteoporosis. An FDA review of clinical studies measuring the effectiveness of long-term bisphosphonates use shows that some patients may be able to stop using bisphosphonates after three to five years and still continue to benefit from their use, says Marcea Whitaker, M.D., a medical officer at FDA’s Center for Drug Evaluation and Research. Whitaker is one of the co-authors of the FDA review, which was published in the May 31, 2012 issue of The New England Journal of Medicine. If you're one of the 44 million Americans at risk for osteoporosis—a disease in which bones become weak and are more likely to break—you may be taking bisphosphonates. This class of drugs has been successfully used since 1995 to slow or inhibit the loss of bone mass. Doctors commonly prescribe such brand-name drugs as Actonel, Atelvia, Boniva, and Fosamax (as well as a number of generic products) for osteoporosis. In fact, more than 150 million prescriptions were dispensed to patients between 2005 and 2009. According to the review, further investigation is needed on the long-term risks and benefits of these drugs. "These drugs clearly work," Whitaker says. "We just don't know yet the optimum period of time individual patients should be on the drug to both maximize its effectiveness and minimize potential risks." http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm309688.htm ************************* Work-related empowerment of nurse managers: A systematic review. Nursing and Health Sciences, 06/29/2012  Evidence Based Medicine Trus M et al. – The empowerment of nurse managers correlated positively with job satisfaction, perceived organizational support, role satisfaction, and managerial self–efficacy, and correlated negatively with emotional exhaustion and own health outcomes. Different theoretical approaches ensure a clear understanding of empowerment, but difficulties arise when the findings are synthesized across studies and settings because of the different theoretical frameworks used to conceptualize empowerment. ... http://www.ncbi.nlm.nih.gov/pubmed/22676260 *************************** RANDOM FACTS: Star Wars is the most successful movie-related toy line ever sold, with 250 million action figures sold between 1978 and 1986. Imagine those numbers since the digitally re-mastered re-release, new trilogy and Clone Wars cartoon series! Bonus Fact: Han Solo's ship in the Star Wars trilogy, The Millennium Falcon, was inspired by a hamburger with an olive on the side. ******************* FDA says Covidien device can get stuck in brain (Reuters) - A Covidien Plc device for rare malformed blood vessels can get stuck in the brain and has been linked to nine patient deaths, U.S. regulators warned. The device, made by Covidien unit ev3, uses a spongy material to block off blood flow to abnormal tangles of blood vessels before they are removed by surgery. The material is delivered to the brain through a tube inserted into a groin artery, known as a catheter. But the catheter can get stuck in the spongy material while inside the brain, causing serious complications including hemorrhage and death, the U.S. Food and Drug Administration said in a notice posted to its website on Thursday. ... http://www.reuters.com/article/2012/06/29/us-fda-covidien-idUSBRE85S0YL20120629?feedType=RSS&feedName=healthNews ********************** Male Nurses Helping Change the Face of Nursing With healthcare emerging as one of the nation’s fastest growing industries and the demand for nurses continuing to rise, more men are showing heightened interest in the nursing profession. The growing number of men in nursing is promising for several reasons – one being that more men entering the field could help address the nursing shortage. Yet despite the narrowing of the gender gap, men can still face major hurdles as a minority in nursing. While men were critical in creating the world’s first nursing school in India more than two thousand years ago, nursing has primarily been a career associated with women. This association is frequently reinforced in pop culture and the media, and as a result men are often asked why they became nurses instead of physicians.... http://jjnursingnotes.com/JUNE12/index.html#careers ************************* Magnet Status Magnet designated hospitals are considered the best of the best with an environment where staff are engaged and patients are satisfied. Hospitals across the country are prompted to pursue Magnet status for a variety of reasons, but the common thread throughout is a desire to build an environment that promotes high staff engagement and quality patient care. The vision of Magnet, which was developed by the American Nurses Credentialing Center, is that these organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. Magnet designation represents a facility's continued commitment to quality outcomes and in order to be successful the hospital as a whole has to be dedicated to excellence. Bedside First Every level of staff must be devoted to achieving this goal, from the staff nurses to the managers to the CEO. ... http://nursing.advanceweb.com/Archives/Article-Archives/Reaching-Magnet.aspx ************** Magnet Research: Raising the Bar Almost 30 years of evidence documents the program's mission. To view the Course Outline and take the test online, click here (https://nursing.advanceweb.com/CE/TestCenter/Course.aspx?CourseID=956&CreditID=1) Learning Scope #383 1 contact hour Expires April 23, 2014 You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) toADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better. *********************** (The following article is free...) Evidence-Based Guidelines for Blood Transfusion The AABB has initiated a process to develop evidence-based guidelines for blood transfusion to assist clinicians, other health professionals, and patients in their transfusion decisions. In this article, the author discusses the process of developing the recently published guidelines for plasma transfusion using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Blood transfusion is one of the most common of all clinical interventions. In many instances, physicians order blood transfusions after conducting a detailed analysis of the patient's clinical presentation, laboratory values, and consultations with transfusion and hematology professionals to make certain that this therapy is indicated. However, in other instances, physicians have been known anecdotally to order transfusions for more subjective and questionable reasons, including desires to "increase patient's sense of well-being" and to reach unnecessarily high posttransfusion laboratory values. ... http://www.nursingcenter.com/evidencebasedpracticenetwork/JournalArticle.aspx?Article_ID=1330461 *************** Quiz Time (answer at end of newsletter) Registered nursing is the top occupation in terms of job growth through 2020: True False ***************** (This is an excellent article for all of us) Watch your language: Culture change for the medical record Clinicians should adopt the selective use of “skin failure” to communicate that the skin is an organ, and like other organs, it is prone to failure. Interestingly, our society accepts that as adults age, they may succumb to heart, kidney and other organ failures. When a 90-year-old patient at the end of life dies of heart failure, oversight agencies do not tag the cardiologist with multiple deficiencies. Should that same resident develop a “pressure ulcer,” however, surveyors will cite and raging relatives will sue. ... http://www.ltlmagazine.com/article/watch-your-language-culture-change-medical-record ****************************** Study unpicks gene changes behind breast cancer (Reuters) - Scientists have mapped the complete genetic codes of 21 breast cancers and created a catalogue of the mutations that accumulate in breast cells, raising hopes that the disease may be able to be spotted earlier and treated more effectively in future. The research, the first of its kind, untangles the genetic history of how cancer evolves, allowing scientists to identify mutational patterns that fuel the growth of breast tumors, and start to work out the processes behind them. "These findings have implications for our understanding of how breast cancers develop over the decades before diagnosis in adults and might help to find possible targets for improved diagnosis or therapeutic intervention in the future," said Mike Stratton, who led the research team. Breast cancer kills more than 450,000 women a year worldwide and is the most common cancer among women, accounting for 16 percent of all cases, according to the World Health Organization (WHO). ... http://www.reuters.com/article/2012/05/17/us-cancer-breast-genetics-idUSBRE84G0XT20120517?feedType=RSS&feedName=healthNews ********************** FDA approves Perjeta for type of late-stage breast cancer On June 8, 2012, the U.S. Food and Drug Administration approved Perjeta (pertuzumab), a new anti-HER2 therapy, to treat patients with HER2-positive late-stage (metastatic) breast cancer. Intended for patients who have not received prior treatment for metastatic breast cancer with an anti-HER2 therapy or chemotherapy, Perjeta is combined with trastuzumab, another anti-HER2 therapy, and docetaxel, a type of chemotherapy. HER2 is a protein involved in normal cell growth. It is found in increased amounts on some types of cancer cells (HER2-positive), including some breast cancers. In these HER2-positive breast cancers, the increased amount of the HER2 protein contributes to cancer cell growth and survival. Perjeta is a humanized monoclonal antibody, manufactured through biotechnology methods. It is administered intravenously and is believed to work by targeting a different part of the HER-protein than trastuzumab, resulting in further reduction in growth and survival of HER2-positive breast cancer cells. ... www.fda.gov/womens fda@service.govdelivery.com *********************** Roche's breast cancer drug gets FDA nod (Reuters) - U.S. health regulators have approved a new breast cancer drug from Roche Holding AG that the company hopes will become the standard treatment for women with an aggressive, incurable form of cancer. Roche unit Genentech announced Friday that the Food and Drug Administration approved the injectable drug Perjeta for women with a type of breast cancer known as HER-2 positive, which makes up about a quarter of all breast cancers and has no cure. Analysts predict the medicine could be another blockbuster cancer drug for the Swiss company. The FDA accepted the application for the drug under priority review, meaning the agency believes the drug may represent a potentially significant advancement over existing treatments. In clinical trials, the drug kept the cancer from worsening for 6 extra months, compared to the current standard of care. ... http://www.reuters.com/article/2012/06/09/us-roche-fda-idUSBRE85801L20120609?feedType=RSS&feedName=healthNews ************************** RANDOM FACT: Though it may seem that termites enjoy all wood, they will bypass ebony, a dense black wood from various tropical trees in Southeast Asia. ADDITIONAL FACT: The wood of ebony sinks in water because it is so dense. It is the wood of choice for the black keys on pianos. ************* New Monograph Aims to Decrease Central Line-Associated Bloodstream Infections (CLABSIs) (OAKBROOK TERRACE, Ill. – May 16, 2012) Central line-associated bloodstream infections (CLABSIs) are a serious form of health care-associated infections (HAIs), with a mortality rate of 12 to 25 percent in the United States alone. Reliable access to the bloodstream is one of the most essential components of modern medical care, but bloodstream access devices introduce a risk of bloodstream infection (BSI). The device that poses the greatest risk for BSI is the central venous catheter (CVC), also known as a central line. It is estimated that more than 5 million CVCs are inserted each year; any patient with a central line is at risk of developing a CLABSI, which is associated with increased morbidity, mortality and cost. The U.S. Centers for Disease Control and Prevention recently estimated the annual cost of CLABSI is more than $1 billion, and the estimated cost per patient is more than $16,000. The risk associated with CLABSI is even greater in developing countries, where the rates of HAIs related to devices are, in most cases, three to five times greater. ... http://www.jointcommission.org/new_monograph_central_line_associated_bloodstream_infections_clabsi/ ********************** Drop 50% More Body Fat with Whole Grains If you could make a simple diet change to drop more pounds and body fat, would you? Switching from refined-wheat foods, such as white bread or pasta, to whole-grain versions can boost your weight loss by 35% and help you melt nearly 50% more body fat. In a new study, 79 overweight or obese postmenopausal women were randomly assigned to eat a diet containing refined or whole-grain wheat products. After 12 weeks, both groups lost weight (7.9 pounds for the whole-wheat group and 5.9 pounds for the refined-wheat group). The whole-wheat group also shed 3% body fat, whereas the refined-wheat eaters shed 2.1%. ... Try these 9 quick- cooking whole-grains recipes for busy nights. http://www.realage.com/food/lose-body-fat-with-whole-grains?src=nl&dom=realage&list=tod&link=text&ad=food-nutrition&eid=1010657379&memberid=4687812 ********************** High-Fiber Foods for Better Weight Loss Make your weight-loss regimen a whole lot easier. Just munch on these high-fiber foods. We're talking about fresh fruits and veggies, whole grains, nuts and seeds, and hearty beans. They're not only low in fat and calories, they also cause a drop in appetite that'll keep you from grabbing that between-meal Twinkie. Fiber: A Dieter's Best Friend These high-fiber foods keep your mouth busy (very satisfying) longer than mushy, highly processed foods do. And because fiber resists digestion, you feel full longer. Translation: Sticking to your weight-loss nutrition plan requires little to no willpower. ... http://www.realage.com/food/fiber-rich-foods-boost-weight-loss?src=edit&chan=tip&con=tip&click=p1 ******************** Suzanne Somers' Top 10 Summer Slim-Down Tips Health-care advocate, entrepreneur, and New York Times bestselling author Suzanne Somers shares with you her top-ten favorite tips for keeping a slim, svelte, sexy body this summer. ... http://www.everydayhealth.com/suzanne-somers/top-10-summer-slim-down-tips.aspx?xid=aol_eh-diet_3_20120709_&aolcat=EFG&ncid=webmail17#/slide-1 ~~**~~**~~**~~ HUMOR SECTION While carpenters were working outside the old house I had just bought, I busied myself with indoor cleaning. I had just finished washing the floor when one of the workmen asked to use the bathroom. With dismay I looked from his muddy boots to my newly scrubbed floors. "Just a minute," I said, thinking of a quick solution. "I'll put down newspapers." "It's all right, lady," he responded. "I'm already trained." ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp. Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org http://www.nationalnurse3.blogspot.com/ RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 The Nursing Site http://thenursingsite.com . http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 National Do Not Call Registry If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** MOOG Medical Devices Group, Curlin Infusion Administration Sets: Class I Recall - Potential for Reverse Flow of Fluid There is a potential for a reverse pump segment in the administration set. This malfunction could reverse the flow of fluid or medicines backwards from what was intended. This may cause blood loss, an under-delivery of prescribed medicines or fluids, or a potential delay in therapy. Use of the affected administration sets may cause serious adverse health consequences, including death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm306327.htm ************************* Introvale (levonorgestrel and ethinyl estradiol) Tablets: Recall - Packaging Flaw Sandoz notified the public that it issued a voluntary recall of 10 lots of its generic oral contraceptive Introvale in the US, following a recent report of a packaging flaw. A consumer reported that the white placebo tablets were mistakenly in the ninth row (labeled “Week 9”) of the 13-row blister card, rather than in the correct position in the 13th and final row (labeled “Week 13”). Each three-month blister card contains 84 peach-colored active tablets and seven white placebo tablets in 13 rows, each representing one week. While the white placebo tablets can be clearly distinguished from the peach-colored active tablets, the risk of an unintended pregnancy for a patient taking the wrong tablet over several days cannot be excluded. The lot numbers involved in the recall are as follows: LF00478C, LF00479C, LF00551C, LF00552C, LF00687C, LF00688C, LF00763C, LF00764C, LF00765C and LF01261C. These lots were distributed only in the US between January 2011 and May 2012. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm307103.htm ********************* (Sorry, I missed this one) Bedford Lboratories™ announces a nationwide voluntary recall for the following three lots of Cytarabine for Injection, USP: Cytarabine for injection, USP 1 gram per viral - NDC #55390-133-01 Lot 2066986 - Exp. Date March 31, 2014 Lot 2111675 - Exp. Date April, 30, 2014 Lot 2131148 - Exp. Date May, 31, 2014 This voluntary market recall is being conducted due to a post-release investigation of the manufacturing area which determined a potential elevated risk of a lack of sterility assurance for these specific lots. To date, there have been no reports of any adverse events for the lots being recalled. Cytarabine in combination with other approved anticancer drugs is indicated for remission induction in acute non-lymphocytic luekemia of adults and children. it has also been found useful in the treatment acute lymphocytic luekemia and the blast phase of chronic myelocytic luekemia. Intrathecal administration of cytarabine is indicated in the prophylaxis and treatment of meningeal luekemia. ... http://www.fda.gov/Safety/Recalls/ucm293076.htm?source=govdelivery ************* Advanced Sterilization Products (ASP) Sterrad Cyclesure 24 Biological Indicator: Safety Communication – Potential Risk of Infection [UPDATED 07/06/2012] The FDA issued a clarification for personnel at facilities that utilize Sterrad sterilizers: The voluntary recall is for only certain lots of Sterrad Cyclesure 24 Biological Indicators. FDA review of ASP data showed that certain lots of Sterrad Cyclesure 24 Biological Indicators cannot effectively monitor the sterilization process throughout a 15-month shelf life. ASP made a change in December 2011 to the materials used to manufacture the product. Product lots manufactured prior to this material change are not subject to the recall. Refer to the list of affected lots found in ASP’s Recall Alert to determine if the product in inventory is subject to this recall. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm310624.htm ~~**~~**~~**~~**~~**~~ ADVERTISEMENTS from the members This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: JMVick1@att.net (Maria) June 24, 2012 jselph1@windstream.net (P. J.) June 25, 2012 ~~**~~**~~**~~**~~**~~ NOTICE: I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.... please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: lglnrse@gmail.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY There are a thousand hacking at the branches of evil to one who is striking at the root. --Henry David Thoreau Send me an e-mail--- would love to hear from you.... Frankie RNFrankie@AOL.com Correct answer: True. According to Bureau of Labor Statistics’ Employment Projections 2010-2020, the RN workforce is the number 1 occupation in terms of job growth through 2020. ^^^^^^^^^^^^^^^^^^ Nursing education by the numbers Data from the American Association of Colleges of Nursing show nursing is a growing, vibrant profession attracting men and women. 259,100: Total enrollment in all nursing programs leading to a baccalaureate degree in 2011—up from 238,799 in 2010 11.4%: Percent of male students in baccalaureate program—compared to 6.6% of men in the U.S. nursing workforce 15.8%: Percentage growth in enrollment in RN-to-baccalaureate programs from 2010 to 2011. 184: Number of doctor of nursing practice programs in the U.S. in 2011 Source: http://www.aacn.nche.edu