The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

While Parkinson’s can be a difficult disease for many patients to deal with, there’s now a new online tool that can help them initiate helpful—and in fact, crucial—dialogue with their health care workers.

We spoke with Karen Jaffe, MD, co-founder and vice president of InMotion, a community center for people with Parkinson’s and other movement disorders. A retired OB/GYN physician, Jaffe was diagnosed with Parkinson’s in 2007. She gave us important information that nurses need to know about the “Do Tell” Your Doctor Tool.

What is the “Do Tell” Your Doctor Tool, why was it created, and how does it work?

Sample word cloud, as delivered via email upon completion of the “Do Tell” Your Doctor Tool

The “Do Tell” Your Doctor Tool aims to improve communication around “off periods” between people with Parkinson’s and their doctors. “Off periods” are the re-emergence of Parkinson’s symptoms, which can be hard to identify because they differ for each person and sometimes from day-to-day. These factors can make it difficult for people with Parkinson’s to communicate about their symptoms with their family, friends, and health care professionals.

The tool is based on a clinically validated questionnaire developed by Duke University, called the Wearing-off Questionnaire 9 (WOQ-9). Users review nine Parkinson’s symptoms and rank how bothersome each symptom is (for example, “Very Bothersome,” “Bothersome” and “Somewhat Bothersome”). After completing the questionnaire, users will receive a customized word cloud via email that visually displays the symptoms they chose, with the largest words depicting the most bothersome symptoms. They can then bring these results to their next doctor’s appointment to help guide and prioritize the discussion about their Parkinson’s symptoms.

As part of the “Live Well. Do Tell.” steering committee, my organization, InMotion, had the opportunity to participate in beta testing for the tool to ensure that it’s user-friendly.

What do nurses need to know about it?

People with Parkinson’s who experience “off periods” may not discuss their symptoms or communicate the impact to their health care professionals, as they may believe that the re-emergence of symptoms is just part of their condition, or they may rationalize the impact because they fear it signals their condition is progressing. The intent of the tool is to initiate better dialogue between people with Parkinson’s and their health care professionals about their symptoms and about “off periods.”

How can they utilize this tool or recommend that their patients use it?

If patients are having a hard time talking about their symptoms, pointing them to this tool may provide them and their care partners with a guide to recognizing and recording symptoms that may be overlooked.

The tool is an easy online resource that people with Parkinson’s can use in advance of their doctor’s appointments. With the resulting word cloud shared via email, they’ll be armed with an actionable item they can share with their health care providers, who can in turn help them better manage their Parkinson’s symptoms to live well.

Why is it important for this tool to exist? What does it provide that is new?

Many factors make it difficult for people with Parkinson’s and their care partners to distinguish their most bothersome symptoms, and many often have a hard time articulating the impact of their symptoms during a doctor’s appointment.

The “Do Tell” Your Doctor Tool can impact the care people with Parkinson’s may receive—offering a visual guide that helps to recognize and record a person’s bothersome symptoms and providing a resource they can bring to their next doctor’s appointment to spark discussion and lead to more effective communication.

The need for this kind of tool was first identified in the “Live Well. Do Tell.” Statement of Need, which serves as the foundation of the initiative and outlined actions for the Parkinson’s community to help identify and communicate about “off periods.” The Statement of Need was developed based on learnings and insights from a multidisciplinary steering committee of leaders in the Parkinson’s community who collaborated to discuss unmet needs in understanding and communicating about Parkinson’s symptoms.

The “Do Tell” Your Doctor Tool is available online at LiveWellDoTell.org/takeaction.

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Acupuncture, aromatherapy, supplements, and the like—more and more people across the nation are using these therapies. Because a number of these people will be your patients, it’s important for you, as a nurse, to know complementary and alternative medicine and about how to get more education if you’d like to implement them into your practice.

First, let’s make some distinctions: while “complementary” and “alternative” both represent the same types of therapies, they are different. Both words refer to non-mainstream treatments such as aromatherapy, meditation, massage, etc. However, when a health care provider uses complementary medicine, it’s used in conjunction with common, Western medicine. When the provider uses alternative medicine, it’s used in place of common, Western medicine.

Within this article, we will use the abbreviation CAM, which stands for complementary and alternative medicine. The focus here is not on if it’s used with or without Western medicine, but how it is used with patients at all.

Why Learn About CAM?

If CAM isn’t used yet at every health care facility, then why should nurses learn about it? “Patients are using them. Time and time again, research finds that the majority of the population is using integrative health products, and this rate is much higher for patients with higher socioeconomic status and/or patients who suffer from chronic health conditions,” says Jessie Hawkins, PhD, director of the Franklin School of Integrative Health Sciences. “Without guidance from their care providers, patients are left to self-educate through online sources. This results in reduced efficacy at best and injury at worst.”

With so many patients using CAM, Mollie Aleshire, DNP, MSN, FNP-BC, PPCNP-BC, FNAP, DNP program director and clinical associate professor at the University of North Carolina at Greensboro School of Nursing says, “It is essential that nurses have knowledge about common CAM and obtain information to elicit use of CAM therapies from the patient history.”

“It’s important to help patients get information from reliable sources and to know if a suggested alternative treatment, such as herbal supplements, may interfere with the medications they are currently prescribed or may be detrimental to their health,” says Tina M. Baxter, APRN, GNP-BC, president and CEO of Baxter Professional Services, LLC.

“Patients are now looking for alternative therapies. A lot of people don’t want to go with pharmaceutical drugs anymore,” says Jennifer Burns, NMD, founder of Burns Integrative Wellness Center. “It’s nice to have other modalities to help the patients.”

“It’s important for nurses to learn about alternative therapies because they offer patients new avenues that may improve their conditions and overall health,” says Linda Steele, PhD, MSN, BSN, APRN, ANP-BC, program director for Walden University’s nurse practitioner programs.

The Most Commonly Used CAM

According to Baxter, there are eight most commonly used CAM therapies in health care: acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and vitamins/herbal supplements. These, she says, are the most researched and studied.

“For example, aromatherapy oils are now used post-op in some hospitals to reduce anxiety and pain after surgery so that patients will require less pain medications. Meditation has been used in psychiatry through progressive muscle relaxation, guided imagery, and mindfulness meditation to augment the practices of cognitive behavioral therapy and dialectic behavioral therapy. Tai Chi has been shown to improve balance and flexibility for older adults and thereby reducing falls in long-term care and community settings,” explains Baxter. “Herbal supplements such as CBD oil have shown some efficacy in reducing seizures, pain, and anxiety. Hypnosis is a treatment that is offered for smoking cessation and obesity treatment. Massage therapy and acupuncture have been demonstrated to be beneficial in addiction treatment. Therapeutic touch has been demonstrated to help with pain in some instances by manipulating the energy fields that surround the body.”

Audrey Christie, MSN, RN, a self-employed holistic wellness practitioner, says that CAM has become more common because of evidence illustrating their benefits. “Things like aromatherapy in labor and delivery units, as well as mindfulness and meditation or Reiki-style practices, are becoming more and more mainstream,” Christie says. “They can help with pain reduction, mindset, relaxation, anxiousness, and many other aspects of the body-mind connection. In recent years, science has been beginning to catch up to what we have known intuitively for years.”

Hilary Erickson, RN, BSN, a labor and delivery nurse and creator of Pulling Curls says that if patients are pregnant with breech babies, she will often recommend that they see a chiropractor, as she believes that a skilled practitioner may help prevent them needing a C-section.

Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”

Getting Educated

Don’t be like your patients and simply look up information about CAM online. If you want to implement it into your practice, it’s necessary for you to get some kind of formal education.

“Integrative health is a concept that is rapidly growing and expanding worldwide. Sales of dietary supplements are up year after year, and the industry itself is a multi-trillion-dollar global market. Patients are using alternative therapies, and that use is increasing,” says Hawkins. “Continuing education in integrative health is one of the best career investments a nurse can make.”

But there are other reasons to study CAM. “Nurses should be skilled in the therapy before providing it, and it should abide within hospital policies so that they can maintain the standard of care the hospital wants them to provide—and so that they are protected,” cautions Erickson.

A number of our sources recommend that nurses first look to the American Holistic Nurses Association for educational opportunities in CAM. The organization offers certification as well as online training programs.

“There are some complementary certificates available, such as the two-year program with alternative therapies expert Dr. Andrew Weil,” says Steele. “Many nurses also get certified as a licensed massage therapist or acupuncturist.” Steele also notes that some conferences, like the annual one offered by the American Academy of Nurse Practitioners, may offer CAM single sessions and in-depth training.

“We train nurses to become board certified health coaches, herbalists, and aromatherapists. We focus on these specific areas because they are the dominant integrative health fields in nursing practice,” says Hawkins, speaking of the Franklin School of Integrative Health Sciences.

“These therapies complement a nurse’s practice by providing additional tools that can be used to boost overall quality of life as well as patient compliance with wellness programs. For example, much of the research on aromatherapy is specific to pre-procedural applications such as anxiety relief before a surgical intervention. For many applications of herbs and essential oils, there is high quality evidence supporting its use,” explains Hawkins. “Sometimes this evidence also clarifies its use. For example, recent research we conducted found that children with an autism spectrum disorder respond differently to pre-procedural aromatherapy than the general population. This helps to demonstrate not only that these interventions work, but with which populations they are found to be effective.”

Most nurses can streamline their training at Franklin because they have general health education. Nurses train via interactive distance learning—so they can still work—and most complete their programs within a year.

While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of education they need depends entirely on the state in which they are practicing.”

“Medicine is evolving, as is the state of health. It’s critical to explore options and be at the forefront of new therapies. In fact, most nurses took an oath to continue educating themselves,” says Christie.

CAM and Patients

While many patients will be using some form of CAM, you may encounter some who aren’t. As a result, you’ll need to explain it to them to make them comfortable.

“Never force them,” says Christie. “I try to come from a place of explaining it on their level. If you think of something like a breathing technique and work from there—often in conversation and assessment—you can find a connection to discuss with the patient and make them comfortable. If they never get to comfortable, I try to send them with some education to learn more about the therapy on their own time.”

Steele suggests that nurses begin by giving basic tips to their patients to improve their overall health and wellness. “Ask the patient to identify what types of therapies they have heard about and what their level of comfort with them is. Always assure them that they will have access to different medical recommendations, including alternative therapies, if and when they are ready to take that step,” says Steele. “Stress the idea of complementary medicine and nursing as a blend of both Western traditional medicine and Eastern modalities, which are more than 2,000 years old. Patients become much more comfortable when they realize they have choices in their health care.”

Baxter says that she explains to patients that there is research and evidence for the prescribed therapy as well as how the therapy may benefit them. “I would be very careful, as some clients are concerned about promoting a specific religion when you talk of medication and Tai Chi. I encourage the clients to think of it as learning to ‘quiet your mind’ and ‘learning to move your body to promote healing’ as opposed to supporting a particular ideology,” she says.

Cautions to Keep in Mind

With any kind of health therapy, there are cautions to be aware of. For example, just because vitamins and other supplements are sold over the counter, that doesn’t mean that they are safe at all times. Steele says that there are still precautions nurses should take. “As with any medical or physical therapy, all have side effects and can cause potential harm or injury to the patient,” she says.

“Avoid a one-size-fits-all approach. Like medications, what works for one person may not work for another. I have clients who do not respond well to aromatherapy but may respond better to some acupressure,” says Baxter. “I would make sure that if I am recommending any treatment, I would first research it for the evidence that it may be effective and make sure that you are qualified to provide the service that is offered. For example, Tai Chi is of great benefit to older adults, but I am not a certified instructor. I do know some basic moves from a video that I will often demonstrate to the other health care providers to show them the movements, but I refer clients to a certified instructor if they want to take the class.”

Hawkins stresses that nurses need to know if their individual state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well.

“Nurses should be aware that alternative therapies are not free from risks and contraindications. Many of these therapies interact with conventional medications or treatments, and many others pose risks to patient health,” says Hawkins. “There are also restrictions on how these therapies should be used, even on otherwise healthy patients. For example, some essential oils can slow breathing in infants. Others can cause someone who does not typically burn to get a sunburn. Studying integrative health provides the framework needed to keep patients safe.”

The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, was recently elected to the National Academy of Medicine, and part of what those who selected her considered was her research on gene-environment interaction and its effects on blood pressure among African Americans.

“African American women have the highest incidence and prevalence of hypertension among any ethnic, racial, and gender group in the United States,” explains Taylor, who works at NYU Rory Meyers College of Nursing as the first Vernice D. Ferguson Endowed Chair. “It is important for me to understand not only the genetic or hereditary underpinnings of this health disparity, but also the psychological and/or environment interaction with genomic risks that may influence development of hypertension.”

In her research, Taylor says that she’s focused for the most part on African American women and children. Most of her studies have drawn on two or three generations of African Americans. While the ages of the children studied have often been wide, in her most recent study, she targeted children from head start programs, who ranged in age from 3-5 years old, along with their biological mothers.

“We have had a lot of discoveries in our research and have disseminated our findings in journals ranging from nursing, medical, public health, genomic, and interdisciplinary. Overall, we have found that gene-environment interactions for certain factors such as parenting stress, perceived racism and discrimination, and others significantly influence increases in blood pressure,” says Taylor.

She admits that she wasn’t shocked by the findings: “The findings were not all that surprising as I expected that social determinants of health were significant factors in health outcomes and looking at the combinatorial effects with genetics and epigenetics only further illuminates that magnitude of interaction on health outcomes such as hypertension,” Taylor says.

Although Taylor says that her research is important because of what she did discover, “One important aspect of the research is that we are able to identify genetic risk for chronic diseases such as hypertension in children as young as three prior to them developing the disorder. Early identification of risk provides an opportunity for nurses and other health professionals to intervene to reduce risk of developing hypertension as in previous generations. Interventions based on the research with this population may require focusing on social determinants of health and lifestyle modification in addition to or rather than conventional pharmacological methods.”

Critical Care Nurses Spread Holiday Cheer with Elf on a Shelf

Critical Care Nurses Spread Holiday Cheer with Elf on a Shelf

Don’t say that the American Association of Critical-Care Nurses (AACN) doesn’t know how to have fun—during the holidays, they definitely do. AACN is currently in the midst of their second annual Elf on the Shelf social media photo sweepstakes. And it’s hilarious.

(If you don’t know what The Elf on the Shelf is, he’s a doll that is said to watch over children during the holidays for Santa. Some parents have gotten creative and set up entire scenarios for him each night—and many put him in a different place in the home each evening, so that in the morning, children think he is watching them. Adults in general have done many other things with The Elf on the Shelf, many of which are also hilarious.)

Nurses at units all over the country are taking your average Elf on the Shelf and dressing him up, sending him on adventures, and making him a part of the health care community.

We asked some nurses who have participated the following questions:

  1. Tell us about your Elf on the Shelf.
  2. What was the response to your Elf on the Shelf (from patients, colleagues, etc.)
  3. What other activities does your team do to bring holiday spirit into the unit?
  4. How does that help your unit?

The answers from three nurses, and photo of their Elves on Shelves follow.

If you’d like to enter the AACN sweepstakes, visit their Facebook page here. Note that it ends on December 23, 6 a.m. Pacific time.

Now, on to the Elves…

Heather Woods, BSN, RN, NRP, Critical Care Manager at Schneck Medical Center, Seymour, Indiana:

1. We are starting our third year with our Elf on the Shelf. I was just beginning as a manager in 2016. I bought the elf to help boost morale on my units to encourage team bonding, creativity, and build good old Christmas spirit. The nursing staff had a contest on naming our elf. It has now become our tradition, and staff asked where our elf was this year.

2. The patients, families, nurses, physicians, and other employees love to see what adventures our elf has on the unit.  It amazes me how creative everyone gets with “Levophred” and “Amio.”

3. To bring Christmas spirit into the units, we adopt families and collect gifts for them. We go caroling together at the local nursing home. We pass socks, mittens, and blankets out to residents. (These items are provided by the staff.) This year, we added a wreath-making class into our activities. We do a traditional-themed Christmas party with secret Santa gifts as well. All of our events are decided upon with our unit-based council.

4. All of these activities really help boost morale in our ICU and Moderate Acute Adult Care Unit (MAACU) and bring our team together. I am very lucky to lead such a caring group.

Natalie Kresak, BSN, RN, Assistant Nurse Manager ICU, University Hospitals, UH Parma Medical Center, Parma Ohio:

1. The elves were inspired by all the employees in the Medical ICU at UH Parma Hospital. We work tirelessly and compassionately to provide the best care and experience for all our patients and their families just like Santa’s elves do! I made the elves using my cricut machine and decided the weekend after Thanksgiving (of course this was my weekend to work) to surprise the staff returning Monday to turn the unit into “Santa’s workshop” and spread the Holiday cheer.

2. The staff, families visiting, and all employees enjoyed the sight of the holiday elves. It brought a smile or laugh to them at times when sometimes that was impossible, given the setting.

3. We decorate every year with holiday-themed décor. We are a medical ICU department so we make heart rhythms out of garland and hang them up and add snowflakes to the windows of patients’ rooms with kind words on them. The staff also participates in a secret gift exchange to help spread the cheer amongst us all and partakes in a holiday party at a local restaurant or employee’s home.

4. This helps our unit feel more like home for the holidays to those who have to work and be away from their families, but also to the patients and families who are missing out as well. It brings us closer, sharing in gifts or treats that we exchange too!

Elf on the ShelfAlexandra Del Barco, BSN, RN, PCCN, TCRN, Senior Clinical Nurse I, and Tiffany Coleman RN, CCRN, TCRN, Clinical Nurse II, Neurotrauma Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center in Baltimore, Maryland:

1. Two years ago, Tiffany Coleman introduced “Trauma Trixie” to our Neurotrauma Critical Care Unit. Tiffany hoped Trauma Trixie would bring holiday cheer to the unit as a center-piece for our decorations. She also anticipated Trauma Trixie would give us an advantage in winning the holiday decorating contest sponsored by the Shock Trauma Center Healthy Work Environment Committee. (This contest judges holiday decorations on units throughout the Shock Trauma Center to determine winners in various categories such as Craziest or Most Elegant.)

Our unit staff worked together to create different scenes with Trauma Trixie as well as to find creative ways to make miniatures of the equipment we frequently use on our patient population such as a Stryker frame to prone patients made out of Yankauers and a Halo vest made from pipe cleaners. Tiffany even created an Instagram page for her @ntcc_trauma_trixie.

2. Trauma Trixie helped the unit staff to bond as we all brainstormed different creative ideas on what poses and accessories she would take on next. Families thought it was creative and the administration did as well! The first year was such a success that we won the 2017 Holiday Decorating Contest!

3. Our unit loves decorating for the holidays to get in the holiday spirit. We have a Secret Santa gift exchange for those that want to participate and hold a unit holiday party. At this year’s party we will be exchanging Secret Santa gifts as well as announcing our 2020 unit goals.

4. Doing activities such as working together to decorate Trauma Trixie, exchanging Secret Santa gifts, and having a holiday party definitely helps with teamwork, unit morale, and nurse satisfaction. Neurotrauma Critical Care is a very difficult unit to work on primarily because of the nature of our patients’ injuries–traumatic spinal cord and brain injuries. Having activities that boost unit morale are important in fostering a healthy work environment.

10 Healthy Gifts to Give this Holiday Season

10 Healthy Gifts to Give this Holiday Season

If you’re looking for special gifts to give to people you love or care about this holiday season, give them something they might not expect—even if you are a nurse—a healthy gift.

Teri Dreher, RN, iRNPA, CCM, a Board Certified Patient Advocate and founder of Seniors Alone Guardianship & Advocacy Services and NShore Patient Advocates, came up with a ton of great ideas for health-related gifts that she shared with us.

As for figuring out how to give healthy gifts, Dreher says, “Think in terms of gifts that support a healthy lifestyle and emotional well-being or that emphasize relationships over material things. Such gifts come in all shapes and price points. With a little thought, you can find such gifts for everyone on your list—from your nearest and dearest to your children’s teachers and your neighbors.”

 

 

1. A fitness track or smart watch.

For the person who wants to start up or increase their fitness program. “These irresistible gadgets can be highly motivational,” says Dreher.


 

2. A health club membership or session with a personal trainer.

These are great for someone who has been told to start a fitness program, but needs motivation. (We add that you should make sure this will be received well. Some folks might get upset if they wouldn’t want it.)


 

3. A getaway for two.

“People who take vacations live longer. Surprise your honey or your bestie with a long weekend somewhere warm and fun.”


 

4. A massage gift card.

“Who is the most stressed-out friend you have? Gift them with a soothing massage—a gentle reminder to slow down and take care of themselves.”


 

5. A pet.

“People would get out to walk a dog, thereby getting exercise as well as living longer and healthier. This is a personal gift, though, and should be wanted/needed and come with an offer to sit when the loved older person needs a break. Also think about the lifespan of each party. An older rescue dog who is housebroken may be ideal for a lonely senior. It gives them a reason to get up and care for someone else and is a source of unconditional love and affection. A mild-mannered rescue cat would be a wonderful gift. An older cat would be calmer and sleep on the lap of an older person, providing comfort for both of them.”


 

6. A gift card for a bookstore or books that will encourage learning or mental, physical, and spiritual growth.

“[Put them] in a basket with coffee/tea, a special mug, a warming neck wrap for sore muscles, etc. Wrap everything in love, not hints to control of change the person. Play on their interests.”


 

7. A season of snowplowing.

“The link between heart attacks and snow shoveling is real. A winter of snow-clearing services make a great gift for an older family member.”


 

8. An air fryer, hot pot, or sparkling water maker.

“These kitchen appliances encourage easy, healthful food prep. Pair with a cookbook and starter supplies.”


 

9. Nuts, dried fruit, or a fruit basket.

“A healthier alternative to cookies or candy. You’ll be surprised how many people will love this.”


 

10. A little of your time.

Don’t forget senior orphans—elderly people who are alone. “Not only do they have no one to exchange gifts with this holiday season, they may be silently struggling to get by. Bringing over an occasional meal and offering a little company allows you to keep an eye on them. And if at some point you see that they need help, contact your local senior organization or social service agency. Don’t let them fall through the cracks,” says Dreher.