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J.Adderton BSN, MSN

Clinical Leadership, Staff Development, Education

Experienced nurse specializing in clinical leadership, staff development and nursing education.

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J.Adderton has 28 years experience as a BSN, MSN and specializes in Clinical Leadership, Staff Development, Education.

J. Adderton MSN has over 20 years experience in clinical leadership, staff development, project management and nursing education.  As project manager, she developed and implemented a nurse clinical mentor program for home health, as well as, leadership training boot camps and content development for on-line nursing education. Her years of experience provide the expertise needed to write on a variety of topics, however, promoting student success is a favorite topic.  When Jane moved from a large city to a small "one-light" town, she saw first hand the health challenges faced in rural communities.  This motivated her to earn a master's in Rural Nurse Case Management to better understand the needs of her community.  She is married, an empty nester and a classic car enthusiast.

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  1. Parkinson’s disease (PD) is a progressive, incurable disorder of the nervous system that causes problems with motor control and many other non-movement symptoms. It’s linked to a loss of brain cells that produce and store dopamine, the chemical involved in body coordination. More than 1 million people are living with PD in the U.S., and around 60,000 cases are diagnosed every year. The incidence of PD increases with age and approximately 4% of cases are diagnosed before age 50. April is Parkinson’s Awareness Month, and we can do our part by dispelling common myths surrounding the disease. Common Myths Myth 1: Parkinson’s is a motor disorder that only affects movement. Fact: PD a movement disorder causing symptoms like tremors, muscle rigidity, slow movements and flat facial expressions. However, non-movement symptoms also lead to disability, often lowering quality of life. Non-movement symptoms may include: Problems with attention, language, memory Dementia Constipation Fatigue Orthostatic hypotension Mood disorders, such as depression and anxiety Sexual problems Sleep disorders Incontinence Myth 2: Everyone with PD has a tremor. Fact: It’s true that tremors are the most common and noticeable symptom of PD. However, some people with PD will never experience tremors. Myth 3: PD medications stop working after 5 years. Fact: Medications can be very effective in helping people manage symptoms of PD and live a full life. Levodopa is one of those drugs and works by converting into dopamine once it enters the brain. Levodopa can be effective for many years (even decades) but over time, some may see a decrease in its effectiveness. But, it's not the levodopa that stops working. As the disease progresses, there is a decrease supply of the enzyme needed to convert levodopa to dopamine. Myth 4: Outside of medication, there is little that can be done to manage PD. Fact: There are many ways a person can lessen the symptoms of PD. Lifestyle changes, such as exercise and a healthy diet, can make the impact of PD on everyday life more manageable. Research has shown patients who exercise for just one hour every week showed significant improvement in daily life. Other positive steps include: Learn about the disease and become an active participant in your care. Build a support system and stay socially active See a movement specialist Connect with other people facing PD Participate in research Myth 5: Parkinson’s disease is genetic Fact: The exact cause of PD is unknown but researchers believe both genetic and external factors that contribute to disease development. Only 5-10% of PD cases are linked to genetics and there’s no one genetic mutation that leads to all diagnosed cases. Myth 6: Deep Brain Stimulation (DBS) is an experimental treatment. Fact: DBS has been used successfully for decades when medications become less effective in easing symptoms. Myth 7: Parkinson’s medications make symptoms worse. Fact: It is a common misconception that levodopa and other PD medications make symptoms worse, speeding up the disease progression. This myth was dispelled decades ago by a large study that found the symptoms in people taking levodopa were no worse than symptoms in a placebo group. The study also reported people taking the levodopa experienced an improvement in their PD symptoms. Myth 8: Parkinson’s disease is fatal. Fact: Parkinson’s disease is progressive, but does not directly cause death like a heart attack. With good self-care and medical follow-up, a person with PD can live a productive life for many years. As PD advances, a person may experience other problems such as difficulty swallowing, falls or pneumonia may occur. However, many people live out their lives never experiencing these complications. Take the #KnowMorePD Quiz To promote Parkinson’s Awareness Month, the Parkinson’s Foundation developed a quiz so you see if “what you think you know” is myth or fact. Take the Quiz Here You Could Be a Winner! Take the quiz and you’ll be entered into a weekly drawing through May 3rd for a $25 Amazon gift card. At the end of the month, a grand prize winner will receive a new Kindle Paperwhite preloaded with all 12 of the foundation’s PD education books. Let’s Hear Your Ideas What creative way are you raising awareness around PD this April? References 7 Parkinson’s Disease Misconceptions Myths and Facts Parkinson’s Disease Michael J. Fox Organization
  2. The Office of Inspector General (OIG) recently conducted a “pulse survey” to get an inside look at the ability of U.S. hospitals to care for patients and staff during the pandemic. The results were published in the brief Hospitals Reported That the COVID-19 Pandemic Has Significantly Strained Health Care Delivery and an article in Becker’s Hospital Review compiled a snapshot of the more eye opening statistics in the report. Let’s take a look at how well hospitals held up while fighting the pandemic. Survey Details As part of the survey, The OIG interviewed hospital administrators from February 22-26, 2021. The interview questions focused on these 3 questions: What are your most difficult challenges in responding to the COVID-19 pandemic right now, and what strategies have you been using to address the challenges? What are your organization's greatest concerns going forward? How can the government best support hospitals? Administrators from 320 hospitals in 45 states, the District of Columbia and Puerto Rico participated in the “pulse survey”. Participating hospitals represented a wide variety of institutional sizes and characteristics. The Stats The survey gives us a front row seat to the most significant obstacles hospitals encountered in responding to COVID-19. Let’s take a look at the statistics pertaining to staffing, care delivery, vaccinations, supplies and finances. Care delivery Forty hospitals reported over 90% inpatient occupancy in the Feb. 22-26th timeframe and 90% of ICU beds were being used at 56 hospitals. Patients experienced longer hospital stays as a result of ICU and emergency department bottlenecks. One hospital reported 13 of its 17 ED beds were occupied from Feb. 22 to 26th by COVID-19 patients waiting on an inpatient bed. Staffing Higher than normal staff turnover was experienced in many hospitals, with 36 hospitals reporting they faced a critical staffing shortage as recent as 1 week prior to the survey. Higher turnover rates among nurses were reported. A Texas hospital serving a high-poverty and socially vulnerable community reported an increase in their annual nurse turnover rate from 2% before the pandemic to 20% in 2020. One CEO stated their cost for using agency nurses was between $60 and $70 hourly before the pandemic. The hospital is now paying up to $200 per hour. One teaching hospital typically hires students that trained at the hospital once they become nurses. At survey time, the hospital had 200 open positions and only 100 students set to graduate this year. Vaccinations A significant amount of staff time was spent on running vaccination clinics. For example, one administrator said it took 25 staff members working an 8 hour shift to give 600 vaccinations. Frustration was reported over underused distribution capacity because vaccination supply was unpredictable. One hospital reported having the resources to vaccinate 5,000 people a week, but only received 2,000 weekly doses. Supplies Even though availability of PPE had improved since the beginning of the pandemic, some hospitals still didn’t have a dependable supply source. Even in February 2021, 19 hospitals reported still being unable to order N95 masks. Finances Some hospitals experienced a dip in revenue related to a decrease in patient visits. One administrator reported a 25% reduction in revenue. Other Key Takeaways Not interested in reading the OIG’s full report? Here are a few additional “takeaways” from the pulse survey. Patient care has been affected by staffing shortages which has led to staff exhaustion and trauma. Hospitals having difficulty balancing resources between high acuity COVID-19 patients and those needed for routine hospital care. Hesitancy among hospital employees and the community toward self vaccination. Exacerbation of disparities in access to healthcare and health outcomes. Financial instability related to the cost of caring for COVID-19 patients, which is more severe in rural hospitals. The Road Ahead Hospitals, Federal, State and Tribal agencies have been working alongside the U.S. Department of Health and Human Services to address the challenges faced when providing patient care over the past year. Here are a few steps that have been taken within the collaboration to minimize barriers: Addressing staff shortages, burn-out and trauma Increasing knowledge and guidance on the prevention of treatment of COVID-19 Supporting vaccination efforts Assisting hospitals in maintaining financial security, especially for underserved areas The pandemic has also shed more light on long-standing systemic problems within the U.S. healthcare structure. Let's Hear From You Are there any challenges you experienced in your practice that are not touched on here?
  3. J.Adderton

    Moyamoya Disease | Knowledge Brush-Up

    I recently cared for a 40 year old male patient diagnosed with moyamoya disease who was being admitted to inpatient rehabilitation. He had a history of recurring hemorrhagic strokes with the last one occurring immediately before admission. I had never heard of the disease and desperately needed to beef up I’d like to share some highlights of what I learned. What is moyamoya disease? Moyamoya disease is a rare chronic condition caused by blocked arteries at the base of the brain. It’s also a progressive disease that gets worse over time. The Japanese were the first to describe and name the condition. Moyamoya means “puff of smoke” and describes the hazy appearance of the tiny vessels that compensate blood flow around blocked arteries. These collateral vessels are fragile and break easily causing bleeding in the brain. What are the causes? The exact cause of moyamoya disease is unknown. However, family history may play a role, especially in people of Japanese origin. There are several conditions that are associated with moyamoya-like changes, including: Neurofibromatosis type I Sickle cell disease Down’s syndrome Moyamoya-like changes may also occur in people who have undergone head or neck radiation to treat pituitary tumors and craniopharyngiomas. Who does it affect? Moyamoya disease has been diagnosed in people worldwide, however, Asians are more likely to have the condition. Other demographics include: More likely to occur in females Risk of developing less than 1 in 100,000 Ages range from 6 months to 67 years, but More likely in children age 5 to 15, and adults 30 to 40 What are the symptoms? The symptoms of moyamoya disease usually first appear with a TIA, ischemic or hemorrhagic stroke. The most common symptoms include: Headache Limb numbness, weakness or paralysis that is usually on one side of the body Aphasia- difficulties with speech or understanding others Visual changes Developmental delays Involuntary movements Seizures People with recurring strokes may experience difficulty thinking and memory problems that worsen over time. How is it diagnosed? To diagnose moyamoya disease, physicians consider the patient’s symptoms, past and present medical problems, the medications they are currently taking and any family history. Diagnostic imaging is performed to identify arterial narrowing and collateral blood vessels that have the “puff of smoke” appearance. A diagnosis is usually made with MRIs showing Decreased blood flow to the internal carotid artery and cerebral arteries Collateral blood flow at the brain’s base The diagnosis is confirmed by an angiogram. Other diagnostic tests include: Computed Tomography Angiography (CTA) Computed Tomography Perfusion imaging (CT) Other cerebral blood flow studies, such as Transcranial Doppler ultrasonography Xenon-enhanced CT Positron emission tomography (PET) Single photon emission computed tomography (SPECT) What are the available treatments? There isn’t an available treatment that reverses artery narrowing and blockage. Therefore, the focus of treatment is aimed at: Reducing the risk of repeated strokes Creating a new blood supply to the affected areas of the brain Medications and surgical interventions are both used to slow the disease progression. Medication interventions The type of drug therapy used in treating moyamoya depends on how the disease is manifested. Antihypertensive are used to control blood pressure in patients with hemorrhagic strokes. Anticoagulants and antiplatelets are used in patients with ischemic strokes Surgical interventions The goal of surgical interventions is to prevent further strokes by revascularizing blood flood to the inside of the brain. Surgical procedures may provide direct or indirect revascularization. Direct method through cerebral bypass Indirect methods such as, EDAS, EMS and burr holes Other treatments Physical, speech and occupational therapy are used when patients have experienced long-term damage from strokes. These therapies help regain function and develop ways to promote independence. What is the prognosis? Predicted moyamoya progression is challenging because causes are not well understood. Prognosis largely depends on how fast arterial blockage occurs and how much damage it causes. The speed of progression depends on the patient’s ability to develop an effective collaborative blood flow, the age symptoms first appeared and the degree of disability. Some patients experience a slow decline with occasional TIAs or strokes, while others experience a more rapid decline. It’s estimated that 50 to 60 percent of people with untreated moyamoya will experience poor outcomes, such as physical deterioration and irreversible neurological deficits. The prognosis is much better if a patient undergoes surgical intervention before suffering a major stroke. Have you cared for a patient with Moyamoya disease? What was your experience? References Moyamoya Disease Weill Cornell Brain and Spine Center Moyamoya Disease Medscape
  4. J.Adderton

    Pay Raises, Bonuses and Incentives:  Where Are We?

    Wow! Mind if I ask what state you live in?
  5. J.Adderton

    Pay Raises, Bonuses and Incentives:  Where Are We?

    I think you most likely represent the majority.
  6. I live in Alabama and the pandemic has opened my eyes to how nurses pay in my state trails behind compensation in most other states. This has been the case throughout my 27 years of nursing, but I always thought it was because of our lower cost of living. Currently, Alabama is ranked the 3rd lowest in nursing pay when compared to compensation in other states. The high number of people with chronic illness contributed to the ranking of #10 in states with the highest number of COVID-19 deaths per capita. To better understand the pay gap, I try to learn more about any staffing and pay issues in other states. I’ve compiled information from recent news articles to discover how employers in other states are showing nurse appreciation through pay incentives. Houston Methodist Offers “You Rock” and “Hope” bonuses Houston Methodist hospital is offering a bonus to thank workers for persevering in 2020 and to also to spread hope for the months to come. COVID-19 vaccination is not mandatory for employees, but it is included in the bonus eligibility criteria. In November 2020, Houston Methodist gave a “you rock” bonus to recognize employees for their hard work during the pandemic. The Houston Methodist system consists of 8 hospitals with around 26,000 employees. Vanderbilt Nurses Get Pay Raise Vanderbilt University Health System, in Nashville, announced pay raises for their nurses early in the pandemic. In April 2020, a local new station brought forward a complaint from a nurse frustrated with the dramatically higher pay rates of travel nurses. In a statement released by VUMC, administration announced a pay increase for all nurses and nurse managers involved in direct patient care. Texas Children’s Hospital Receive Special Stipend In January, Houston's Texas Children’s Hospital recognized employees' hard work during the pandemic with a special stipend. Full-time employees received a $500 stipend and part-time employees were given a $250 stipend. These same stipends were distributed in April 2020 before the pandemic’s peak. Wake Forest Baptist Health Increases Pay for 60% of Employees Wake Forest Baptist Health announced plans on March 3rd to pay increases for about 60% of their total employees. CEO, Dr. Julie Ann Freischlag, expressed gratitude in a news release, stating “I have personally witnessed their dedication to our patients and their families and have seen them provide such comfort and assistance, no matter their job”. The initiative will include the following: Increase base pay to $15.00 per hour, or Increase pay by 2%, whichever is greater Increase in minimum nurses pay rate Nurses in professional salary plans to receive a $1.00 increase. Night, evening and weekend shift differentials will be adjusted based on market analysis The health system has more than 20,000 employees and about 12,000 will see pay increases in April 2021. CVS Shows Gratitude In December 2020, CVS gave nearly 200,000 workers a $250.00 bonus for their hard work during the pandemic. In addition, the company adjusted pay for some employees to help off-set loss of income related to the virus. Virginia County Gives Hazard Pay Bonus High risk workers in Virginia’s Fairfax County received a one-time hazard pay bonus of up to $2,000 in February 2021. Eligible employees include those working in the following positions: Medical transport providers Hospital workers Dental staff Medical staff Mortuary services Non Medical support staff Long term care staff Home health workers A Fairfax Board of Supervisors member, Jeff McKay shared the following statement with a local news channel: "Our first responders and other members of our county staff put their lives on the line every day, risking contracting COVID-19 in their work with the community." COVID-19 Vaccination Incentives Some companies are offering incentives to their essential workers who choose to be vaccinated. The incentives are designed to ease any of the work barriers employees have in getting the one or both doses. Here are a few companies offering incentives: Aldi The grocery store will pay hourly employees up to four hours pay if they get vaccinated (two for each dose) and pay the cost of administration. Dollar General Offers a one-time payment equal to 4 hours pay to employees who opt for vaccination. However, it does not make it a requirement. Darden Restaurants Darden Restaurants is offering paid time off for vaccination, two hours pay for each COVID-19 dose. The pay will be based on workers total earning including tips. Darden Restaurants operates chains including Olive Garden and Longhorn Steakhouse. Have You Received An Incentive? Let’s shed more light on what the industry is doing (and not doing) to acknowledge hard work and risks employees are faced with the coronavirus. Let’s share what’s going on in our corner of the country. References Cumulative COVID-19 Cases and Deaths
  7. On March 2nd, a former Yale nurse pleaded guilty to altering fentanyl vials intended for outpatient surgical patients. The nurse, Donna Monticone, worked at the Yale Reproductive Endocrinology and Infertility clinic in Orange, Connecticut and was responsible for ordering and stocking narcotics needed for procedures. According to the U.S. attorney’s office, the nurse began stealing fentanyl in June 2020 for her own personal use. Monticone would remove the drug from secured vials, inject herself, then replace the fentanyl with saline. No Protection from Pain When Monticone pled guilty, she confessed to actions that are in direct conflict to nursing ethics and standards. Specifically, she admitted to the following: Knowing that the fentanyl vials she replaced with saline would be used in surgical procedures as an anesthetic. Knowing patients could experience serious bodily harm without an anesthetic. Injected herself with fentanyl while working at the clinic. Eventually taking vials of fentanyl home for self injection. Refilling the empty vials at home with saline and returning them to the clinic’s fentanyl stock. Bringing around 175 vials of fentanyl vials she had taken from the clinic and discarded them in the clinic’s trash. Investigators discovered that between June and October 2020, approximately 75% of the fentanyl administered to clinic patients for surgical procedures was either diluted or consisted only of saline. “I Screamed” Patients detail the extreme pain they experienced during procedures at the Yale fertility center. One patient recalls suddenly realizing the anesthesia she’d been given during a painful egg harvesting procedure was not working. She shared her story with a local news station, stating, “It made me scream. I remember screaming in the middle of the procedure from pain”. Attorney Josh Koskoff represents four victims who had IVF procedures while in extreme pain. He describes the women as feeling betrayed and dismissed when clinic staff did nothing when they reported the pain. Koskoff also questions how the complaints continued to go on for several months without a thorough investigation by the clinic. Yale’s Response Yale’s director of university media relations released a statement about the what is being done to reassure the public and prevent this from happening again. Here is a look at what steps are being taken: The clinic informed law enforcement of the theft and notified patients about the issue. Informed patients there is no reason to believe the nurse’s actions harmed their health or treatment outcome. A combination of pain medication is used during clinic procedures and are adjusted if signs of discomfort. Making needed changes in procedures, record-keeping and storage to prevent diversion in the future. Bond and Sentencing Monticone was released on a $50,000 bond and will return for sentencing on May 25th, facing a maximum prison sentence of 10 years. Healthcare Workers at Increased Risk Nurses stealing opioids for their own personal use is nothing new and there’s no shortage of news articles reporting criminal charges for diversion. Now, the pandemic is intensifying the risk of substance abuse among healthcare workers. During COVID-19, it’s not unusual for nurses to feel like their best is not good enough and the emotional, mental and physical toll can be overwhelming. Navigating life during a pandemic is stressful already, but add to the mix the extra challenges healthcare workers have faced over the last year. For example: Long shifts and work hours Fear of being infected by the virus Fear of passing the virus on to vulnerable patients Fear of passing the virus on to loved ones Busy/chaotic work environments and unable to take time to talk to peers about stress and anxiety Loss of outlets for stress due to social distancing Financial hardships due to lay-offs and cancelled shifts during early pandemic The pandemic has only added “fuel to the fire” in healthcare workers who are already at risk for substance use disorders. What Do You Think? Donna Monticone surrendered her nursing license and went to rehab. I do believe she should face the consequences of her actions. But, I also think the stigma and shame of being a nurse with an addiction prevents too many from seeking help. What do you think… is there a bigger picture than what the news reports?
  8. With the COVID-19 pandemic, many students are having to leave behind in-person classes for online. Although online courses are not new, students often feel they’re not getting what they need. It’s true, these courses can be challenging, but there are effective strategies you can use to be successful. Treat It Like A Traditional Course Online courses require discipline and a good strategy is treating them just as you would an in-person class. Without discipline, it is easy to put off coursework until later, adding unnecessary stress. Be Persistent You will meet challenges in on-line classes, such as: Technical difficulties Time management issues Feeling isolated from your classmates Persistence is a big key to online success. When you’re faced with a problem, keep trying, ask for help and persist through the challenges. Be Accountable Students are routinely given reminders for assignment due dates and exams during in-person classes. But in on-line courses, it is up to you to know due dates and allow yourself enough time to complete assignments. It may help to have an “accountability partner” you check in with to stay organized and proactive with coursework. Manage Your Time Unlike in-person classes, online courses aren't taught in real-time and don’t have set class times. This flexibility is what draws many students to online learning, but it’s a drawback for procrastinators. Without time management, you will find yourself cramming for exams and turning in incomplete assignments. Let’s look at some valuable tips for improving your time management skills. Make a master calendar of major assignment due dates and plot out your exams. Factor in scheduling conflicts (other classes, family life, etc) so you can allow enough time for study and coursework. It helps to create a weekly calendar and plot out time for reading, lecture videos, forum participation, studying, and completion of assignments. Give yourself a “heads up” by setting reminders to complete weekly tasks. Self check throughout the semester by asking yourself ... Am I dedicating enough time for coursework? Am I cramming before exams? Do I often underestimate the amount of time I need to complete coursework? Create A Good Study Place Having a regular study place will help you to establish a routine, stay organized and limit distractions. You can do this by: Having all your course materials (books etc) in your study place. Choosing a place that is quiet and away from family, roommates, televisions, games, and anything else that will draw your attention away. Avoiding internet surfing during study. It will steal chunks of your valuable time. Make your space comfortable (lighting, seating, etc). Be A Good Communicator There will be times when you’ll need to ask for clarification or help in your online classes. Be persistent in communicating with your instructor and keep in mind- they don't know you need help unless you reach out. There are several ways you can do this: E-mail During office hours Discussion groups and forums Telephone Be sure to read the course syllabus and make note of the instructor’s preferred method of communication. Be An Active Participant Participating in your online class is key to success. There are several ways you can actively participate, including: Check in frequently, at least every day, to stay updated on announcements and discussion board responses. Engage with other classmates on discussion boards or forums (ask questions, seek clarification. Try creating a “virtual” study group with class peers. Want More Tips? Many colleges have great tips and strategies for online success available on their websites. Here are a few to get you started: Walden University - Online Classes 101 Minnesota State - What Makes A Successful Online Learner? Rasmussen College - What I Wish Someone Had Told Me BEFORE Taking Online Courses Forbes Online - 9 Tips For People Taking Online Classes Share Your Strategy What tips or advice do you have to help others adjust to online learning?
  9. The week of February 22-26 is National Eating Disorder Awareness Week and a great time to learn more about eating disorders. I thought I would share some facts about bulimia and a little of my own experience with the disorder. My Story My childhood was stressful at times and I became a natural "worry wart". In all the anxiety, food just seemed to pull me back into a better place. In my teens, I read the book "When Food is Love" and I promptly highlighted anything that reminded me of my situation and behavior. I remember the book being a rainbow of fluorescent yellow, blue and pink highlighted sentences. I continued to overeat and comforted myself with food throughout my 20’s. I went through a difficult divorce in my early 30’s after 5 years in an abusive marriage. I continued to rely on food, but something changed. I moved from overeating to eating large volumes of food in a short period of time. I would then obsess about how much I just ate with an overwhelming feeling of guilt and shame. Eventually, I began a relentless cycle of obsessing about food, binging and then acting on the compulsion to feel better by forcing myself to throw up what I had just binged. What is bulimia? Bulimia (bulimia nervosa) is an eating disorder and a serious health problem. In fact, some cases are severe enough to be life threatening. People with bulimia have recurrent episodes of eating more at one time than most other people would. To help with perspective, a person binging will eat much more food than is in a meal, often several thousand calories. You can click here to read more about the binge-purge cycle, including triggers and how it emotionally, physically and socially impacts quality of life. What is purging? The definition of binging is fairly straightforward, but purging is a little more complicated. Purging is an unhealthy way of getting rid of the calories binged to avoid weight gain. It’s common to only think of forced vomiting as the way bulimics rid their bodies of a purge. However, the following methods are also used to purge: Excessive exercise Misuse of laxatives (pills, enemas etc.) Misuse of diuretics Strict dieting Bulimia Statistics Bulimia affects individuals of any gender, ethnicity, age or socioeconomic status. However, it most often occurs in females, teens and young adults. Here is the lifetime prevalence of bulimia in the U.S.: Women 1.5% (approximately 4.7 million females) Men 0.5% (approximately 1.5 million males) What are the causes of bulimia? Causes of eating disorders usually come from a number of different factors, each building upon the others. Here are some of the factors that may increase the risk of bulimia. Biological Factors There is a genetic link, and your risk may be greater if you have a sibling, parent or child with a history of an eating disorder. There is also evidence that being overweight during adolescent or teen years may also increase risk. Psychological/Emotional Factors Psychological and emotional issues can contribute to eating disorders. These may include: Depression Anxiety disorders Past trauma Environmental stress Negative self-image Substance abuse Being overweight as a child Dieting You may be at higher risk for an eating disorder if you routinely diet. Even though bulimics binge, many also severely restrict calories between binge-purge episodes. This is a vicious cycle- restrict, binge-purge, restrict, binge-purge…... Society Pressure We are constantly bombarded with images and attitudes of society’s desire for thinness. In some people, the pressure to be thin plays a part in developing an eating disorder. Visit the National Association for Eating Disorders Risk Factors webpage for a detailed list of risk factors. You can also read about weight stigma and its impact on body image here. What are the signs of bulimia? Everyone experiences bulimia differently, however, there are some common behaviors that raise a red flag. These may include: Weighs frequently Distorted image of their body Sees self larger than actual size Reluctant to eat at restaurants Frequently dieting Mood swings Frequent trips to bathroom after meals Large amounts of food in home Irregular mealtimes Large amounts of food missing (home, work etc.) Frequent use of laxatives and/or diuretics Mood swings Excessive exercise Isolates from family and friends What are the symptoms of bulimia? Bulimia is typically a progressive disorder and there are some common symptoms that indicates someone has moved beyond just showing warning signs. Again, everyone is different, so the presence of symptoms depends on how long they have been bulimic and the frequency of their binge-purge cycle. Symptoms of bulimia nervosa may include: Weight constantly fluctuates (up and down) GI symptoms that are not related to any illness Swollen cheeks or jaw area Broken blood vessels in eyes Brittle hair and nails Poor sleep habits Discolored teeth (from gastric acid) Calluses on back of fingers and/or hands from self-purging Irregular menstrual cycles Screening Tool The National Association of Eating Disorders offers a free on-line screening tool for eating disorders. It’s geared toward individuals ages 13 and above. You can access the screening tool here. Stay Tuned Part Two of All About Bulimia Nervosa will explore how bulimia is diagnosed, levels of severity, effects on health and available treatments. I will also share what I did (and still do) to prevent my own issues with bulimia from becoming "active" once again. Let’s Hear from You What "red flags" and symptoms have you experienced or observed that’s missing from this article? References Bulimia Symptoms & Common Side Effects
  10. J.Adderton

    When Willpower Isn’t Enough

    Findings from a large-scale international study, recently published in The New England Journal of Medicine, found a drug used to treat diabetes is also effective against obesity. Researchers report when semaglutide is given in high doses to people struggling with obesity, the amount of weight loss seen far exceeds the amount lost by participants in trials of other weight management medications. About the Trial The researchers conducted a double-blind trial with nearly 2,000 adult participants that met the following criteria: A body-mass index of 30 or greater Did not have diabetes The participants injected themselves with either a subcutaneous 2.4mg dose of semaglutide or a placebo at 129 centers across 16 countries. To give you a perspective of just how large a dose participants received, the recommended dose of semaglutide for Type-2 diabetes is .5mg subcutaneously once a week. Both study groups, semaglutide and placebo, also participated in lifestyle interventions that included: Face-to-face phone counselling sessions with registered dieticians every 4 weeks Reduced calorie diet Increased physical activity Behavioral and motivation strategies Incentives such as kettlebells or food scales in recognition for reaching set goals “Game-Changer” Findings The study's authors found 75% of participants taking 2.4mg semaglutide lost more than 10% of their total body weight and more than one-third lost greater than 20%. Dr. Rachel Batterham, one of the study’s authors, states “No other drug has come close to producing this level of weight loss--this is really a game changer.” Other significant study findings include: Participants lost an average of 15.3kg or an impressive 33.7lbs. Improvements were also observed in participant risk factors for heart disease and diabetes, such as Waist circumference Lipids Blood sugar Blood pressure Participants reported improvements in overall quality of life What is Semaglutide? You may recognize semaglutide by it’s brand names, Ozempic and Rybelsus, and both are used in the treatment of type-2 diabetes. Ozemic comes as a single use subcutaneous injection pen for self administration and Rybelsus is the brand name for the oral form. Action for Weight Loss Semaglutide is a “mimic” drug because it has similar effects on the body as the hormone GLP-1. GLP-1 is a natural hormone that is released from the small intestines and acts to improve blood sugar levels by: Stimulates the release of insulin from the pancreas. Reduces the amount of glucose stored in the liver Causes a feeling of “fullness” and less hunger Basically, semaglutide mimics the action of GLP-1 to decrease our appetite, which lowers caloric intake, and ultimately leads to weight loss. How is it Different? Even though Semaglutide has almost the same structure as human GLP-1, it is synthetically manufactured and structurally modified. The modifications prevent the drug from being broken down and the effects last longer. This is why semaglutide can be administered just once a week. Potential Side Effects Researchers reported some participants did experience side effects that were short lived and generally resolved without any long-term effects. According to manufacturers, semaglutide on the market for diabetes management may cause the following side effects: Nausea Vomiting Diarrhea Abdominal discomfort Constipation Heartburn More serious side effects include: Symptoms of allergic reaction (rash, itching, swelling of face, tongue or throat) Difficulty breathing or swallowing Decreased urination Swelling of legs, angles or feet Vision changes Semaglutide for weight management hasn’t been studied long enough to know the effects (if any) of taking the higher doses for longer periods of time. Additional Considerations We now know that obesity increases the risk of death in individuals with COVID-19. The pandemic has increased the focus of how obesity impacts other serious illnesses, such as heart disease, type-2 diabetes, liver disease, and certain types of cancers. The benefits of semaglutide for weight management are far reaching in both personal health and health policy. Currently, most insurance companies do not cover medications for weight loss. Semaglutide is covered when prescribed for diabetes, but is expensive at nearly $1,000 a month. However, the study’s findings may persuade insurance companies to cover the use of semaglutide for weight loss, especially given the high cost of bariatric surgery. What other implications do you think the study findings may have in the future? References Ozempic
  11. J.Adderton

    A Staffing Perfect Storm

    Do you think pay increases would help retain nurses? I work in a hospital that will not hire contract nurses, just keep working with critical staffing shortage.
  12. More than 30 years ago, The Institute for Safe Medical Practices (ISMP) initiated a voluntary error reporting program to better understand the common medication errors made by healthcare providers. Today, the ISMP’s Medication Errors Reporting Program (MERP) receives hundreds of error reports every year from practitioners across the nation. The report submissions provide the unique opportunity to learn more about how we can minimize the risk of errors in our own practice. The Top Ten List The ISMP recently reviewed the 2020 editions of their newsletter, the ISMP Medication Safety Alert!, to determine what errors should be included in the annual top 10 list. The following criteria were used to identify and rank errors for the list: Most frequently reported problems Problems causing the most serious consequences Errors and hazards that have been ongoing and Can be avoided or minimized with system or practice changes You can check out the full top 10 errors and hazards list here. But for now, let’s take a closer look at the top 5. Inappropriate use of extended-release opioids to opioid-naive patients The ISMP, as well as the Food and Drug Administration (FDA), have warned practitioners for decades about the potential harm and death that can occur when prescribing time-released opioids to patients who are not opioid-tolerant. A big part of the issue..... practitioners often don’t understand a patient’s opioid status when prescribing narcotics. A patient’s opioid status refers to: Opioid naive: patients who are not chronically receiving opioid therapy on a daily basis Opioid tolerant: patients who are chronically receiving opioid therapy on a daily basis For example, fentanyl patches should only be ordered for opioid-tolerant patients for treatment of severe pain that needs long-term and round the clock management. Prescribing fentanyl to an opioid-naive patient can be dangerous and may lead to an overdose. To learn more about the safe use of long-acting opioids, read the ISMP’s guideline, Targeted Medication Safety Best Practices for Hospitals. Not using smart infusion pumps with dose error-reduction systems (DERS) in perioperative settings “Smart pumps” have become the standard in infusion devices because of their ability to reduce medication errors. Smart pumps are programmed with dose error reduction software (DERS) which incorporate drug libraries, usual drug concentrations, dosing units and dose limits. And, when an actual/potential dosing error is detected, the smart pump is also programmed with different alerts, such as clinical advisories, hard and soft stops. The technology is valuable in critical care areas, such as perioperative, where high alert medications are used frequently. Check out this article to learn more about smart infusion pumps with DERS. Oxytocin Errors In 2007, the ISMP added IV oxytocin to their list of high alert medications. Oxytocin is frequently used by perinatal healthcare providers to induce labor. Common errors associated with IV oxytocin include: Prescribing errors Look-alike vials Look-alike drug names (ex. Pitocin and Pitressin) Medication preparation and labeling errors Medication administration errors Problems with hand-off communication Are you interested in learning more about errors associated with oxytocin? Check out this ISMP report for more information. Placing infusion pumps outside of COVID-19 patient rooms It makes sense that some hospitals would place infusion pumps outside the room of COVID-19 patients by using tubing extensions. Hypothetically, this practice conserves PPE, reduces the risk of staff exposure, and allows for staff to hear and respond to pumps more timely. But, in reality, the length and diameter of the long extension tubing impact priming, flow rates, and administration times. Here are a few examples of how this practice can be risky: Medication remaining in the extension tubing provides a bolus dose to the patient when the extension tubing is flushed. Alarms that warn of occlusion could be impaired at lower flow rates or become more frequent at higher flow rates. Long extension tubing increases the risk of: Becoming tangled and unintentionally disconnected Increasing the risk of falls Bar scanning of the patient and medication may be more difficult, increasing the risk of error You can read a special alert released by the Emergency Care Research Institute on the use of large volume infusion pumps during the pandemic here. COVID-19 Vaccine Errors The ISMP reviewed vaccination errors that were voluntarily reported since mid-December 2020. Reported errors included: Multiple errors made, specifically with the Pfizer-BioNTech vaccine, when the person administering the vaccine did not use enough diluent, causing an overdose. Unclear labeling led to patients receiving IM injections of a monoclonal antibody instead of the Moderna vaccine. Vaccines were unnecessarily wasted because of inadequate scheduling processes or “no-shows”. Vaccines were administered to individuals younger than the recommended age. A small number of allergic reactions were also reported. Read the ISMP’s full COVID-19 vaccination error report with recommendations for prevention here. Interested in Learning More? Be sure to check out the ISMP’s website for urgent medication safety alerts about serious potential errors. You can access the Medication Safety Alert page here. Let’s Hear From You Have you had a “near miss” with any of the above errors? Also, would love to hear about any medication hazards you’ve experienced related to the pandemic.
  13. The sprays, wipes and liquids nurses frequently use to prevent infection could be harmful to lung health. A new study, published in JAMA Network Open found workplace exposure to cleaning chemicals significantly increases the risk in COPD among nurses. In the study, researchers used data from an on-going study of more than 116,000 registered female nurses, in 14 states, dating back to 1989. The study focused on women who were still nurses and without lung disease in 2009. The nurses completed questionnaires every other year to track work history and lung health from 2009 to 2015. Occupational Exposures and COPD COPD is not only the third leading cause of death worldwide, but a chronic condition that often can lead to long term disability. Cigarette smoking remains the major risk factor for COPD in the U.S. However, data suggests that 15% to 20% of cases are caused by occupational exposures. Workplace exposures can also contribute to the disease burden of someone with COPD. In the past, studies on occupational exposure and COPD have investigated broad categories of causal agents, such as vapors, dust, gases or fumes and only on a limited number of occupational settings. Significant Increase in Risk According to the study findings, nurses were between 25% and 36% more likely to develop COPD based on exposure to certain cleaning products. The percentages reported in the study were determined after accounting for whether the nurses were smokers or suffered from asthma. Researchers found weekly use of disinfectants to clean hospital surfaces increased COPD risk by 38%, while weekly use of chemical to clean medical instruments increased the risk by 31%. Women at Risk Although gender roles have changed over the past few decades, exposure to cleaning products at home and at work are more common in women. The majority of nurses are female, with males being only 13% of the nursing workforce. A 2014 survey by the US Bureau of Labor and Statistics found that women perform 55-70% of household cleaning, which is about 30% more than men. In the healthcare industry, exposure levels to cleaning products and disinfectants are particularly high. Irritation Causing Chemicals Orianne Dumas, lead study author and researcher with Inserm, states, “We found that exposure to several chemicals were associated with increased risk of developing COPD among nurses.” Glutaraldehyde and hydrogen peroxide, used to disinfect medical instruments were among the chemicals identified by Dumas. Glutaraldehyde exposure can cause throat, nasal and lung irritation, asthma and difficulty breathing, skin irritation, wheezing, burning eyes and conjunctivitis. Nurses were also regularly exposed to fumes from bleach, alcohol and quaternary ammonium compounds, which are used to clean surfaces and floors. All these chemicals are known to cause lung irritation and could lead to the development of COPD. However, Dumas states researchers only found an association in the study, not a cause-and-effect relationship. More Research Needed The study authors found further study is needed to determine how these cleaning products might cause COPD, and if they increase the risk of lung disease for workers in other professions. Findings also suggest the need for further research to determine exposure-reduction strategies that provide adequate infection control for healthcare settings. What Are the Alternatives? Hospitals could continue to protect nurses’ and patients’ health by using safer alternatives, such as ultraviolet light or steam for disinfecting equipment and surfaces. Another option is for hospitals to switch to “green” cleaning products that don’t emit harmful fumes. The key is finding a balance between safeguarding the health of nurses while maintaining the needed level of infection control. Additional Resources CDC Fact Sheet- Glutaraldehyde Cleaning Chemicals: Know the Risks
  14. Have you ever thought about leaving a job for something better but never put effort into “feeling out” the job market? Most of us have been in a career rut at some point and felt trapped in an unfulfilling job role. We wake up dreading the workday and literally countdown the days and hours until time off. If this describes you, it is possible to become “unstuck” and regain passion for your current job or move forward with finding a future job. The first step is to take a look at what barrier (or barriers) is keeping you trapped and career stuck. You’re Bound By Golden Handcuffs In nursing, recruitment and retention strategies may include pay incentives that keep you pulled in, such as with sign-on bonuses or baylor pay. However, money that is too good to resist can become golden handcuffs that keep you in a job that no longer makes you happy, affecting your overall quality of life. In this case, you can work on an exit plan, a budget and timeline, such as “Over the next year, I will cut back and live on a budget to save money. Then, I will look for a job that will give me a better work-life balance.”. Your Confidence is Wavering Sure, there will always be someone else with flashier skills or with a different talent than your own. But, this doesn’t mean you are less capable or your talents are not as important. Everyone, at some point, has compared themselves to their coworkers. Focus on your strengths while working on weaknesses to build your confidence and keep forward momentum. You’re Just Waiting…. Have you ever found yourself waiting “just until”? Perhaps you are waiting until your next evaluation to see if you receive a raise. Some nurses wait to see if “things get better”, such as a change in management, better staffing or a work culture overhaul. But, the waiting game can lead to significant amounts of time passing with the expectations of change falling flat. Not Sure What You Want In nursing, there are endless career options and job types. However, it is hard to your dream job when you aren’t sure of what you want. In order to move forward, it is important to ask yourself some questions, such as: What do I want from my career? What are my job “deal-breakers”? What am I most passionate about? What are the things I must have in a job? What skills do I have to offer? What skills do I want to improve or learn? What type of work culture and environment do I want? What is my expected salary? You may find the article “9 Questions That Will Help You Find Your Dream Career” helpful, even if you just want to stay in nursing but try something different. Your Job is Familiar and Comfortable A simple Google search will yield an endless amount of motivational quotes about stepping outside of our comfort zones. Although you may be unhappy in your current job, you know what to expect during the workday… you duties and interactions are familiar. Most likely, you have working relationships with co-workers and understand all the nuances specific to your work environment. The fear of the unknown keeps us trapped in unfulfilling work comfort zones. To offset your fear, it is important to determine if your fear is based in reality. For example, you may tell yourself “I will never find another job with hours similar to the job I have now.” and never explore other job openings or career opportunities. You Put Self Care on the Back Burner If you feel trapped at work, there is a chance you are not consistently practicing self-care. Have you lost work-life balance and burning the candle at both ends? It is easy to lose perspective and motivation when we are mentally and physically tired. Try simple acts of self-care, such as meditation, going for walks, taking a class or relax doing something you love to keep yourself centered. You Need to Expand Your Network Talking to nurses working in other settings and environments may shed light on career options you find interesting. There are several ways you can build your professional network. Online networking through LinkedIn or other professional networking sites Reach out to your existing contacts to ask for help, seek advice or look for inspiration. Attend a local nursing association meeting or conference The goal of networking isn’t just expanding your number of professional contacts but to also focus on a vision for yourself. Looking for a nursing job? A better career is out there... Visit allnurses Jobs Are you feeling trapped in a job? If so, what is keeping you from moving forward?
  15. J.Adderton

    Easy Win-Wins to Impress Your Clinical Instructor

    I taught at a community college and other faculty filed complaint that I was being bullied by the program director. You're right, it is traumatizing. The college President acknowledged bullying and hostile work environment. Six months later, I was told my contract was not being renewed. It was devastating. I did alot of research on bullying in nursing academics and unfortunately... there is plenty of research to support the claim.
  16. One of my favorite job responsibilities as a nursing instructor is nursing clinicals. It is an inspiring moment when a student is able to make the connection between classroom and hands-on nursing practice. As much as I enjoy clinicals, there are situations when student actions or behaviors can bring additional challenges to clinicals. I’ll share a few of these and, hopefully, provide you with a little helpful insight. STEP 1 Appreciate Your Instructor’s Responsibilities Your clinical instructor is legally obligated to safeguard student and patient safety. In addition, they can be held accountable for the negligent or wrongful actions of a nursing student. You can help your instructor make appropriate patient assignments by communicating your strengths, weaknesses and skill level. I have always appreciated students who perform ongoing formal and informal self-assessments on knowledge and skill. STEP 2 First Impression Really Is Important You have several "first impressions" to make on any clinical day- your instructor, patients, caregivers, clinical site staff and others. The dress code is what it is. There are certain uniform requirements as a nursing student you probably find overly strict, out-of-date or too restrictive for your own personal style. When I started nursing school 25 years ago, we were required to wear nursing aprons. It was an archaic uniform requirement, but it was also just that… a requirement. Updating your program’s dress code policy is may be a worthwhile project, but always follow current policy. Students are anxious as it is and a uniform reprimand at the day’s start only makes it worse. Be on time and eat before you come. First, I would like to acknowledge there are legitimate reasons you may be late to clinical (I.e. sick child, traffic, car problem). In these situations, be sure to follow your program’s instructions for notifying your instructor. Otherwise, leave early and allow time for the unexpected. Be sure you eat before you arrive. Asking if you can “go eat breakfast” 1 hour into clinical will probably not be well received. STEP 3 Value Your Program’s Relationship with the Clinical Site Identifying willing clinical sites for students is challenging and requires active relationship building. You can help your clinical instructor foster this relationship by: Caring for all patients with dignity and respect. Following the clinical facility’s policy and procedures (I.e. parking, non-smoking campus, patient confidentiality) Reporting any issues with staff to your clinical instructor immediately. Being realistic with facility staff expectations. Remember, the nurses are busy and stress levels may be elevated at times. Always receiving report and giving report to your assigned patient’s primary nurse. Avoiding “hanging out” at the nurse’s desk. Talk with your instructor if you are not sure what you should be doing. STEP 4 Avoid These Cringe-Worthy Faux Pas I value students who participate and focus on the present clinical. The following student behaviors take focus away from clinical, place your instructor in an awkward spot and should be avoided. Asking if group can be dismissed early because “no one will tell”. Asking questions about past or upcoming exams. Talking negatively or gossiping about other students. Talking negatively or gossiping about other faculty. Asking if post conference could be “skipped” for the day. Talking negatively about the overall nursing program. Talking negatively about the clinical site and/or staff. Arguing or disrespectful behavior toward facility staff. Studying or working on outside assignments during clinical. Asking if the student has to perform patient personal care. Complaining about “working all night” or not sleeping prior to clinical. Providing inappropriate information about personal life. Actions that risk student and/or patient safety. Finally, always avoid behavior or attitudes that diminishes, devalues or is uncaring towards any patient. STEP 5 Set Realistic Goals Pat Yourself on the Back I understand students are anxious and apprehensive. It raises a red flag when a student is overly confident and without any hesitation. Your clinical instructor appreciates a student who asks questions and seeks clarification. At the end of each clinical day, pat yourself on the back and reflect on what fear you overcame, what you learned and how you made a difference in your patient’s care. Do you have tips or stories to share? Would love to read your perspective. Additional Information: Seven Tips For Getting The Most Out of Nursing Clinicals