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Lane Therrell FNP, MSN, RN MSN, RN, NP

Family Nurse Practitioner

Nurse Practitioner, Coach, Writer

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Lane Therrell FNP, MSN, RN has 6 years experience as a MSN, RN, NP and specializes in Family Nurse Practitioner.

Lane is growing her integrative wellness coaching practice, Best Health Interest, while teaching advanced practice nursing at Samuel Merritt University and working as a freelance writer. Prior to becoming a family nurse practitioner, Lane enjoyed a 20-year career in agricultural public relations and worked as a freelance writer specializing in the outdoor market. She loves nature, animals (especially mules), and art, and her idea of a good time is horsepacking in remote wilderness areas. Lane lives with her husband, John, in rural northern California.

Lane Therrell FNP, MSN, RN's Latest Activity

  1. Lane Therrell FNP, MSN, RN

    Helping Patients Make Healthier Food Choices

    Agreed. We really need to get back to basics and common sense, don't we?
  2. Lane Therrell FNP, MSN, RN

    Helping Patients Make Healthier Food Choices

    Nutrition is a significant part of everyday health for all ages. However, most nurses and healthcare providers don’t get much classroom or clinical instruction on nutrition and managing dietary change during their basic education. (DiMaria-Ghalili et al., 2014). And yet, in spite of our relatively weak academic foundation, we routinely advise our patients to “eat a healthy diet.” Lasting dietary change begins with a patients’ ability to make healthy, or at least healthier, food choices. One of the foundational skills involved in making those healthier choices is reading food labels. But, if nurses and other healthcare providers have not learned these basics, who is teaching our patients this skill? As an NP in primary care, I observed that most of my patients who would benefit from meeting with a dietician or nutritionist did not actually “qualify” for these types of specialist encounters due to insurance limitations. And many of those who qualified failed to make and keep “extra” appointments. So, food label reading remained an untaught, unlearned skill. Do you feel confident enough in your own food-label reading abilities to teach your patients the basics? I had to do some extra studying to get myself there. Here’s how I’m leveraging what I learned. The 3 Most Important Parts of a Food Package I like to set the stage by pointing out 3 distinct parts of a food package—the front of the package, the nutrition facts panel or “label,” and the ingredients list. These three parts contain key pieces of information that work together to help consumers make healthier food choices. Here’s what to look for, understand, and decide for each part of a food package. Front of Package Food manufacturers know the front of the package is the first thing consumers see on a grocery store shelf, so it’s prime marketing real estate. That’s why you’ll want to take a close, thoughtful, look at the front of the package through the eyes of a skeptic. Look for: When you tune in and look carefully at the front of a food package, you’ll likely become aware of things you’ve never noticed before, even if it’s your favorite brand. Look at the names, descriptions, colors, images, designs. Be alert for key marketing words and phrases like reduced sodium, no sugar added, natural, low fat, or gluten free. What do these components suggest about what’s inside the package? And do the words and phrases really mean what you think they do? Understand: The big takeaway is that the front of a food package is designed to sell the product, not to tell you what’s in it. And when you understand that attractive is not the same thing as healthy, you realize that many packaged foods are not as healthy as they may seem at first glance. The appealing colors, images, and words that make a food product look and sound attractive can also create a “health halo,” an intangible feeling of goodwill and good health associated with the product. Food manufacturers keep this idea in mind when they design packaging and advertisements, because marketing studies repeatedly show that when you think a food is healthier, you'll eat more of it. (Egan, 2019). It’s also important to understand that marketing words may carry hidden meanings or implications. For example, the word “reduced,” as in reduced-sodium or reduced-fat, means the product has 25% less fat than the original version. (Egan, 2019). While that’s a step in the right direction, be aware that the total amount, even when reduced, may still be far more than ideal. Furthermore, whenever an ingredient such as gluten is taken out of a food, something else—like extra sugar or salt—is generally added back in its place. These added ingredients may be more unhealthy than the original ingredient that was removed. Decide: The front of the package is your first stop in gathering clues for deciding whether the product supports your health or not. Notice what you’re drawn to, and what you’re looking for: Does what attracts you match up with what you know will support your health goals? Of course, if you aren’t sure what your health goals are stop and get clear about them before you go any further. Nutrition Facts Panel After you’ve looked at the front of the package with a critical eye, continue your quest for information by looking at the nutrition facts (NF) panel, also referred to as the nutrition facts label. This federally regulated piece of information tells you how much of which nutritional component is in the product. The NF panel is your go-to resource for discovering how many calories are in your favorite foods. And it also reveals the percentage of fat, carbohydrates, protein, sodium, vitamins, and minerals that are present. The NF began appearing on food labels in the early 1990s, as required by the Nutrition Labeling and Education Act. (Egan, 2019). Look for: No matter what your dietary goals happen to be, or how they may change, the NF panel can help you make choices that support them.  Paying attention to the serving size, calories, percent daily value, added sugars and other nutrients listed on the NF panel will help you decide how consuming the product will affect your goals. The FDA updated the appearance and requirements of the NF panel in 2016 to better assist consumers in making healthy food choices. The revised NF panel emphasizes total calories, makes serving size information more prominent, shows added sugars, and should be official on all US packaging by 2021 (Egan, 2019). Compare the original and new NF panels for more details. (Side-by-Bide Comparison: Original Label versus New Label, 2019). Understand: The numbers on the NF panel are most helpful to you when your personal intake goals are clear. Are you cutting calories? Reducing sodium? Reducing sugar? The NF panel shows you the extent to which consuming an individual product can help support your efforts to meet your goals. And when you look at the NF panel for everything you consume, it can help you see your real-time and cumulative food intake in the context of your overall dietary goals. In fact, the NF can be used to help you see and track your “food numbers” in much the same way you may already be tracking other health numbers, like blood sugar and blood pressure. The key here is learning to notice the numbers associated with food. It’s not so much about the numbers themselves as it is about the trends over time. The bottom line is: The NF panel cannot help you if you don’t have clear goals and sincere commitment to meeting them. Decide: Use the numbers from the NF to help you decide how the product supports or detracts from your daily intake goals. Ask yourself: Does this food support my health goals? How will choosing this food now influence my other food choices throughout the rest of the day? Use the numbers to help you decide whether to consume the food inside the package you’re looking at or make a different choice. What are the options are available to you? Knowing the array of options available to you is a major step in making healthier choices. If you determine the product does not support your health goals, will you choose to consume this food anyway? Or will you look for a different, more supportive, option? Or might you choose to do something else, like schedule extra exercise to offset any over consumption of a specific nutrient? Ultimately, what action will you take? Ingredients List Finally, take a look at the ingredients list. Ingredients lists are printed in descending order by quantity. (Bjarnadottir, 2019). the item listed first on the list is the most prevalent ingredient. Don’t let the ingredients confuse you. Instead, use the list as a way to spark your curiosity about what’s in your food, and start conversations with your health professionals and your family. Look for: When looking at the ingredients list, pay special attention to the number of items listed, the order in which they are listed, and any specific ingredients of interest. In general, shorter ingredients lists indicate a product has undergone minimal processing. Look for shorter lists and ingredients you recognize. Be alert for allergens like dairy derivatives (whey protein), nuts, and shellfish. Avoid products listing sugar as a first ingredient. Pay attention to the order of items listed. Be alert for ingredients you cannot pronounce or are unfamiliar with, as these may indicate the presence of toxic chemicals and dyes, hidden sugars, non-nutritive fillers etc. Compare the nutrients list to the nutrition facts panel to see how the two correspond. Let the comparison and your conclusions guide you to discover the best ways to support your health. Understand: Because ingredients are listed in descending order, the product contains the most of the first thing on the list. This helps you put the product’s nutritional value in perspective, in light of your health goals.  For example, if one of your health goals is to reduce the amount of sugar in your diet, and you’re deciding whether to eat a certain product, but the first ingredient listed sugar, you may decide to choose a different product. The ingredients list also relates back to the front of the package. If something has been taken out, the ingredients list is where you can find out what has been added back instead. Decide: Ultimately, what’s in the package ends up in your body. Cross reference the ingredients list with the front of the package and the nutrition facts panel. Ask yourself: Does this item contain ingredients that I wish to consume? What is the most prevalent ingredient in the product? Does this ingredient support your health goals? Is this product is as advertised, or is the marketing misleading? Will you decide to consume this product? Do you feel confident and satisfied about your choice? Additional Tips Here are some additional helpful tips for teaching your patients how to make healthier food choices: Keep examples of food packaging in your clinic, exam room, or office so you can provide quick hands-on demonstrations with real products the patient is familiar with. Encourage patients to get familiar with food labels at home where they have time to practice reading them, coming up with additional questions, and figuring things out. Challenge patients to evaluate the packaged foods already in their home pantry to see whether they support their health goals or not. If not, offer support for small improvements such as looking for a low sodium version of a favorite brand, or trying a different brand with less sugar. Advise patients to take their reading glasses with them to the grocery store. Encourage patients to plan enough time in the store to read labels and make their healthiest decisions before they put items in the cart. The bottom line is, your patients can’t eat a healthy diet if they don’t have the tools for making healthy choices in the first place. Learning how to read labels on packaged foods is a good first step toward making choices and decisions that support health goals. If you learn how, you can teach your patients whenever you have the chance. And you’ll be able to back up your instructions to “eat a healthy diet” with practical advice. Question for Discussion How can you use information about food packaging to help your patients manage dietary change?
  3. Lane Therrell FNP, MSN, RN

    Billing for Time Spent on Survivorship Care Plans?

    Thank you so much for this response. Your patients are indeed lucky to have you! I have noticed, too, that the oncologists are not as engaged as I wish they could be in survivorship concerns. Unfortunately, the "encouragement to share (survivorship plans) with their PCP" rarely happens, and even more rarely do the PCP's give survivorship plans any attention if and when they are shared. Patients are lucky if they bring in a survivorship care plan and their PCP makes the effort to scan it into their chart. And then it sits there, never to be noticed again. Yet we all know (or SHOULD know), the consequences of cancer treatment are lifelong. And the idealist in me says we shouldn't all have to be Oncology nurses to receive the right attention and treatments. I recently worked with a private health coaching client who survived a rare facial-nerve neuroma "successfully" treated with radiation 15 years ago. I use quotation marks around the word successfully because her sequelae-related symptoms (incuding partial facial paralysis and vagus nerve involvement) are worsening with age. She recently destroyed the documents relating to her treatment in an effort to clean up her home. In this case, the patient did not have a survivorship plan, nor did she understand the value of maintaining her own records to share with future providers. No one had ever taken the time to help her understand the potential long-term sequelae of her treatment or how to engage in self-management or self-advocacy.
  4. Lane Therrell FNP, MSN, RN

    How Technology Use Can Impact Our Health

    Balancing technology use will continue to grow as an important topic at the forefront of preventive health. My favorite way to balance tech-time is to plan for genuinely unplugged time in nature. "Genuinely unplugged" includes leaving cell phone and fitness tracker behind. When I do decide to take my cell phone along on a hike for safety, I carry it tucked away so I can enjoy the sensory input of my surroundings without being distracted by constantly taking selfies for social proof. Long hikes on marked trails are easily measured in miles covered-- no device necessary.
  5. Lane Therrell FNP, MSN, RN

    Billing for Time Spent on Survivorship Care Plans?

    Thank you so much for pointing me toward these resources. From where I sit in primary care, I see that the needs of cancer survivors are ongoing over time, and highly variable. This means survivorship care plans would ideally be updated and revisited over time, as the patient ages and progresses through life. Instead, it seems that survivorship care plans are all too often considered to be one-off documents created as a paperwork formality in the immediate aftermath of acute treatment. And patients don't fully appreciate their value, either. I would truly love to see a shift toward better care for survivors.
  6. Lane Therrell FNP, MSN, RN

    Billing for Time Spent on Survivorship Care Plans?

    Does anyone in this group know which CPT codes are appropriate to use when spending time working on survivorship care plans? And... if there are no billing codes specific to this activity, why not? I'm worried that cancer survivors aren't getting what they need in primary care over time, but if there's no financial incentive for providers to spend time addressing this essential component of care, it will continue to be overlooked. Thanks in advance for any and all wisdom from oncology specialists.
  7. Lane Therrell FNP, MSN, RN

    Any Telehealth Billing Experts in Informatics?

    Does informatics specialty education include specific information about billing for telehealth? I have some very specific questions about billing for remote patient monitoring and chronic care management services, and I'm just not sure who to ask, or what types of specialists would have the information I'm looking for. Any guidance that gets me pointed in the right direction is appreciated.
  8. Lane Therrell FNP, MSN, RN

    4 Reasons Nurses Need Mentors

    One of big ideas I took away from being mentored was that textbook cases are great, and things often work differently in the real world. This can be a challenging concept for students and new nurses to wrap their heads around. Now that I'm the mentor, I enjoy helping new nurses navigate the gray areas between academics and real-world practicality.
  9. Lane Therrell FNP, MSN, RN

    What Advice Would You Give to Future Nurses?

    Thanks for keeping it real, Nancy. This is oh so very true.
  10. Lane Therrell FNP, MSN, RN

    What Advice Would You Give to Future Nurses?

    Well said. It's true that my nursing licenses, credentials, and experiences have opened doors for me in writing, business, and academia that would have remained closed to me otherwise. If you have any doubts about whether you'll fit into a traditional nursing job description long term, think outside the box by asking, "What else can I do with a nursing license and credentials?"
  11. Lane Therrell FNP, MSN, RN

    What Advice Would You Give to Future Nurses?

    This is the best advice EVER.
  12. Lane Therrell FNP, MSN, RN

    What Advice Would You Give to Future Nurses?

    Communication skills top my list of must-haves for aspiring nurses. Specifically face-to-face and on-the-phone interpersonal communication skills. In our time crunched, tech driven, digitally connected world it's tempting to assume we already know everything we need to know about communication, but my experience shows the otherwise. The nurses who are able to to communicate genuinely and authentically with patients are the ones who make the most impact and enjoy their careers the most.
  13. Lane Therrell FNP, MSN, RN

    Is this for Me?

    There is a lot of fabulous advice in this thread, and I agree with all of it. I was 42 when I got into nursing school, and I overpaid for my nursing degree, but I don't regret going to nursing school. My nursing credentials have opened doors for me that would have remained closed otherwise. One thing I haven't seen mentioned in this thread is classroom technology. I struggled with it. It had been 15 years since I'd been in school, and so much had changed with online courses, etc., so be ready for that. But if I can do it, you can too! I'll echo the question: Is nursing really for you? And I'll challenge you to probe a bit deeper: What was it that disappointed you about working as a mechanic? What did you like and dislike about being in the military? Get really clear about these things. Understand that nursing is hierarchical (in some ways a bit like the military). As a CNA and as an RN you'll be implementing doctors' (and other providers') orders. If you want the creative flexibility to give the orders and "fix things" from the top of the pecking order, then you're looking at advanced practice nursing (which would mean more time spent in school, and more student loans). Your mechanical skills, military background, and life experiences are all big plusses no matter what you decide to do. Please keep in touch and let us know what direction you take.
  14. Lane Therrell FNP, MSN, RN

    The Future of Nursing: Reflections of a Nurse Educator

    Download allnurses Magazine Golden thread and soft skills The future of nursing parallels the future of medicine, which is bright with technological innovations. From robotics, telemedicine, smart sensors, artificial intelligence, gene editing and more, the game-changing technological advances available now and on the horizon promise incredible improvements in healthcare across the board. It’s an exciting time to work in the biosciences. And it’s also a time when clinicians and caregivers must remain vigilant in recalling the reason healthcare exists: To improve the lives of human beings. Communication is the golden thread that ties future to present and past, and connects individuals to one another. Communication involving digital screens and online connections creates convenience and leverages time and money but it also changes the nature and dynamics of human connections. I believe technology has created a real and relevant need for genuine human contact, a revival of the art part of nursing. In recent years other professions including medicine have formally acknowledged the value of “soft skills,” which include interpersonal communication. That’s because interpersonal communication skills really aren’t that “soft” after all. Communication skills are powerful, and mastering them can be just as rigorous, difficult, and demanding as learning other clinical nursing skills can be. There is an academic and technical rigor associated with communication skills that too often remains unrecognized in nursing. Nursing must treat soft skills as clinical skills that are worthy of development. My perspective Before I get too carried away, let me clarify my perspective. I entered nursing at midlife after a successful 20-year career in public relations for agriculture. I hold two master’s degrees in two very different areas of inquiry—rhetoric and nursing—which gives me a truly multidisciplinary academic background. I bring a mature, holistic, mindset to my practice that embraces a full spectrum of thought and ideas. My perspective matches the ideals of advanced practice nursing and offers the kind of outside perspective that exposes insular thinking and promotes innovation. And because I’ve been academically trained to deliver instruction in communication and leadership, I can teach people how to communicate more effectively. My diverse experience in classrooms and clinics has shown me that better communication translates into better nursing care. It has also brought to light a great opportunity, as I see it, for nurses at all levels of practice to improve their interpersonal communication skills. The Patient-Centered Illusion Patient. Centered. Care. Those three words when used together capture the essence of why I became a nurse. Yet, without effective interpersonal communication, patient-centered care is merely an illusion. In nursing, we perpetuate the illusion by failing to communicate effectively. Three ways this can happen are: 1) treating numbers instead of patients; 2) using words that separate patients from their health; 3) establishing plans of care for our patients instead of with our patients. Treating numbers At its core, patient-centered care is built on individual conversations between patients and providers of care. These conversations allow us to treat the patient, not the numbers. Too often, though we become so heavily invested in counting quality measures or improving patient satisfaction scores, that we forget to check in with the actual patient. We even get tempted to use lab results alone to develop care plans, short-circuiting full patient assessment. Delivering care that is truly patient-centered means addressing the needs of the individual in front of you, not blindly following an algorithm. Ultimately, no matter how advanced the technology becomes, the best way to discover what is going on with our patients is through careful assessments, focused conversations, and critical thinking. Disempowering words Consider how we use our medical vocabulary. Indeed, medical terms have a place, and we must communicate accurately and collaborate effectively with our highly educated colleagues. But we also must use words with our patients that are appropriate and easy to understand. Words that are unfamiliar or unsupportive to our patients can create and perpetuate gaps in understanding, and contribute to feelings of helplessness and lack of control. Any type of disempowering language in a clinical setting leaves patients disconnected from their health and disengaged from their health behaviors. Planning in a vacuum Too often we are guilty of establishing plans of care for our patients instead of with our patients. If the plan of care is not relevant to the patient, and they’re not invested in it, they won’t honor it. This goes beyond “teach back” all the way to buy-in. If the patient can’t tell you step by step what he’s going to do to honor the plan between now and when you see him next, he likely won’t. As an educator, I work hard to make abstract concepts relevant to my students. I tell them why it matters, and relate it to something they already know so they can remember and “own” the information. We must all do the same with our patients if we want them to engage and comply with their plans of care. The teaching aspect of patient education is not about reciting massive amounts of information to patients, it’s about making any new concepts and information relevant to their daily lives so they can own the plan and take appropriate informed action for themselves between visits. But we’ll never know what’s relevant to the patient if we don’t have a meaningful conversation first. Barrier, value, and taking action The biggest barrier to improving interpersonal communication in nursing is thinking we’ve already mastered it. We talk about effective communication a great deal, and we’re communicating all day every day, so we think we already know how to do it. But are we doing it well? Most of us are blind to the fact that we’re not being effective. And we’re missing an opportunity to teach interpersonal communication as a skill in nursing. Effective communication is so much more than delivering information to a patient in their native language, following APA style to the letter when writing a term paper, or composing a persuasive letter to a legislator. All of this is important, but interpersonal communication skills are worthy of close academic scrutiny. To break the barrier, nursing must value interpersonal communication as a skill and teach it as one. It’s not that we don’t value interpersonal communication at all in nursing, it’s that we don’t formally recognize it as a skill to be taught. If we did, we’d have communication labs the same way we have health assessment labs. What if nursing did treat interpersonal communication skills with the intellectual and clinical practical heft I think they deserve? I believe nursing would thrive, improve, and facilitate the delivery of true patient-centered care in an age of booming technology. The bottom line is: Communication skills are as important as clinical nursing skills. Without them, empathy cannot be expressed, ethics cannot be honored, and a true patient-centered environment cannot be created. What are we doing to support nursing students’ mastery of the skills underlying our target competencies and course objectives? Effective communication is the unnamed skill that supports virtually all the advanced practice competencies. And yet, who is teaching these fundamental skills to nursing students actively and experientially? Future benefits Advances in biomedical science are happening faster than the slow-moving wheels of academia and clinical practice can turn. Fortunately, effective interpersonal communication happens in real time and moves at the patient’s pace. Effective interpersonal communication is the single best mechanism I know for meeting patients where they are on their individual continuum of change. From that perspective, what could be more patient-centered than engaging in interpersonal communication? The best strategy for keeping healthcare patient-centric in response to technological integration is improving interpersonal communication skills. Communication skills improvement has great potential to improve outcomes in primary, pediatric, and geriatric care, among cancer survivors, and in any situation that involves patients with multiple chronic comorbidities. It is a topic that nursing scholars and doctoral candidates may wish to tackle. Nursing is both art and science. While our education and industry may be biased toward science, it’s the art part that keeps us focused on our purpose and our patients. I infuse this ideal into all my interactions with students, patients, and clients. And I leverage my background in communication to do so. I celebrate nursing for the connections it allows me to create with others. And as professionals, we can strengthen those connections by improving our communication. I challenge my fellow nurses to begin valuing communication more highly for the good of the future of nursing, and for the good of the patients we serve. No matter what technology emerges in the future, there will always be a need for nurses to connect with patients as they deliver quality care. The future of nursing holds great possibilities and opportunities which we can embrace by integrating effective interpersonal communication into everything we do. Article Sources: 5 Key Trends for the Future of Healthcare Communication in Nursing Practice Effective Communication Skills in Nursing Practice Effective Interpersonal Communication: A Practical Guide to Improve Your Life Integrating the Art and Science of Medical Practice: Innovations in Teaching Medical Communication Skills Nursing Students’ Perceptions of Soft Skills Training in Ghana The Most Important Soft Skills Employers Seek The Art and Science of Nursing: Similarities, Differences, and Relations What are the NP Core Competencies?
  15. Lane Therrell FNP, MSN, RN

    What are the top 10 debatable nursing issues? And GO!

    A few additions: Patient choice in breastfeeding. Infant sleep training. Whether true patient autonomy is being preserved at all during shared decisionmaking (IF shared decisionmaking is even being practiced at the institution). I could go on, but this thread gives you a fabulous list to start. From one instructor to another, let me add that I think debatable topics should definitely be DEBATED more (and I mean truly debated, not merely "consensus-agreed") in nursing at all levels of practice, so I'm glad you're exploring this area.
  16. Lane Therrell FNP, MSN, RN

    What I Wish I’d Known About Continuing Education: Know Your Requirements [Part 1 of 3]

    Hats off to you, Winniewoman9060, for remaining certified post retirement. Being surprised by changing renewal requirements is definitely no fun. Maintaining credentials means meeting “… the renewal requirements in place at the time of … certification renewal.” As a point of clarification, the 75 hours I mentioned in the article were specifically for renewing my own FNP-BC certification. I’m not familiar with the specific renewal requirements for the RN-BC certification (which I’m assuming is synonymous with your ANCC Med Surg certification). I hope I didn’t create any confusion by providing my own example in the article, but I felt it was important to spread the word that the requirements we may think we know are subject to change during the renewal period. And if you don’t know what the changes are, you can really be blindsided. We’re all responsible for getting the information that pertains to our specific certifications straight from the certifying bodies themselves, not via hearsay.
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