Continuous Glucose Monitoring Systems Reducing Hypoglycemia and Improving Patient Health Outcomes

Continuous Glucose Monitoring Systems Reducing Hypoglycemia and Improving Patient Health Outcomes

According to the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of death in the United States. Type 2 diabetes is one of the most commonly occurring chronic diseases, which affects about 90-95% of those diagnosed. According to a 2018 study published in Health and Quality of Life Outcomes, there were over 415 million adults between 20-79 years living with diabetes globally. The American Diabetes Association estimates that over $327 billion is the annual cost of diabetes care in the United States alone.

A serious complication of diabetes is hypoglycemia, a blood sugar level less than 70 mg/dL. Hypoglycemia comes on suddenly and patients display symptoms such as profuse sweating, tremors, irritability, altered mental status, loss of consciousness, among others. Hypoglycemia has several adverse effects including cardiac arrhythmias, seizures, and can be fatal in severe cases. The fear of inadvertent hypoglycemia is among the biggest barriers patients face while working towards glycemic control. Hence, one may conclude that frequent hypoglycemic incidents are disruptive to the normal life, and may result in injury, increased medical costs, loss of wages, and the need for constant monitoring by another person.

Real-time continuous glucose monitoring (CGM) may provide an ideal solution for individuals with a high risk of hypoglycemia. CGM measures glucose levels continuously via a transdermal glucose sensor and sends data to one or more monitoring devices. It is configurable to alert the user and/or designated provider when blood glucose levels are too high or too low. In a 2017 study, David Rodbard, MD, demonstrated that the use of CGMs resulted in significant reduction of hypoglycemia risk and improved patients’ quality of life. Since the invention and subsequent improvement of the quality of monitoring and reporting, CGM systems have become very reliable tools for real-time monitoring of blood glucose and prevention of dangerous hypoglycemia. CGM systems also help reduce health care costs and improve quality of life and productivity of patients.

A Brief Introduction to CGM Systems

The first CGM system hit the market in 1999. Early CGM systems were bogged down with issues related to accuracy, delayed transmission, and patient teaching. Rapid advancements in technology have influenced development of highly accurate, versatile, and user-friendly CGM machines. In 2015, the American Association of Clinical Endocrinologists and American College of Endocrinology included CGM systems into their clinical practice guidelines. Three medical device manufacturers—Abbott Laboratories, Medtronic, and Dexcom Inc.—have emerged as leaders in today’s CGM marketplace at a global level.

CGM’s Role in Preventing Hypoglycemia and Improving Quality of Life

The main idea behind the introduction of CGM systems was to achieve enhanced real-time blood glucose monitoring of diabetic patients and prevention of abnormal glycemic highs and/or lows and its accompanying complications. Multiple studies have successfully demonstrated that diabetic patients are at a risk of undetected hypoglycemia. According to a 2017 study published in Diabetes Technology & Therapeutics, 22% of sudden unexpected deaths in persons under 40 with type 1 diabetes were due to hypoglycemia. The study concluded that using CGM systems helped reduce hypoglycemia and improve glucose control.

Inadequate glycemic control is associated with complications that lead to reduced quality of life, work absenteeism, increased hospitalization, among others. Fear of hypoglycemia and its associated costs may discourage patients from adhering to a treatment plan formulated by their primary care provider. And yet, the Diabetes Technology & Therapeutics study estimated an annual savings of $936-$1,346 per person in hypoglycemia prevention with the use of CGM systems.

A recent randomized controlled trial published in The Journal of Clinical Endocrinology & Metabolism found that type 1 diabetics on real-time CGM systems demonstrated a marked improvement in glycemic control and enhanced of quality of life in the form of reduced incidences of hospitalization, work absenteeism, and lesser fear of hypoglycemia.

Furthermore, recent advances in wireless and data-enabled cellphones have enabled medical technology corporations to improve the functionality and accuracy of CGM systems. Modern CGM systems can now send information to the patient and designated caregivers when the blood glucose levels are too high or too low. CGM systems help promote safety and efficacy of glycemic control for both type 1 and type 2 diabetics and reduces the risk of hypoglycemia significantly.

The benefits of CGM systems are yet to be completely utilized by health care providers and patients due to lack of awareness, suspicion about the safety, efficacy, and cost of these systems. Using CGM systems may lead to long-term financial savings and improved quality of life for patients. It is up to primary care providers to educate patients and families to benefit from available technologies and improve their health.

It Takes a Village: Nurses Work to Provide Culturally Competent LGBTQ Care

It Takes a Village: Nurses Work to Provide Culturally Competent LGBTQ Care

As a gay man, Austin Nation, PhD, RN, PHN, understands the health care barriers faced by many lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients. As a nurse and educator, he’s working to increase awareness and address the health disparities that continue to exist in the LGBTQ community.

An assistant professor of nursing at California State University, Fullerton (CSUF), Nation lived through the 1980s AIDS crisis, and has worked with many patients in the HIV/AIDS community. While he acknowledges an HIV diagnosis is no longer a death sentence thanks to increased funding and better treatment, Nation has also seen how young gay black and Latino men continue to be disproportionately affected by HIV/AIDS. The Centers for Disease Control and Prevention (CDC) report that 1 in 2 black men and 1 in 4 Latino men will be diagnosed with HIV during their lifetime.

“We’re not reaching all of the people we need to reach,” Nation says. “In order to get to zero new HIV infections, we need to figure out how to engage these populations.”

While treatments have transformed HIV into a chronic but manageable illness, many people are not aware of how prevention efforts that use antiretroviral treatment, and pre-exposure prophylaxis (PReP), an HIV-medication that when taken consistently, can lower the risk of getting infected by more than 90%. Despite being widely available, the CDC notes that while two-thirds of the people who could benefit from PrEP are black or Latino, they account for the smallest amount of prescriptions to date.

To that end, Nation has worked to address the tenuous relationship many people of color and members of the LGBTQ community have with the health care system. Statistics from the Kaiser Family Foundation show that LGBTQ patients often face challenges and barriers in accessing health services including stigma, discrimination, the provision of substandard care, and outright denial of care because of their sexual orientation or gender identity.

“I’ve led LGBTQ cultural competency trainings to teach nurses and nursing students how to provide inclusive services and care for LGBTQ patients,” Nation says. “By knowing whether a patient is gay, lesbian, transgender, straight, or bisexual, and how to best communicate, nurses can identify potential health disparities and care for their patients more effectively.”

On the CSUF campus, Nation has also been a part of the university’s Faculty Noon Time Talks, discussing health care disparities within the African American community. In addition, he is working with faith leaders to adopt a more inclusive environment for LGBTQ individuals who may be reluctant to come out and subsequently don’t receive HIV testing or prevention counseling.

“I also teach a public health course at CSUF where we discuss vulnerable patient populations including the LGBTQ community,” Nation says. “I try to integrate real-world experiences into the course curriculum.”

Nation believes that all nurses can help to achieve diversity and meaningful inclusion, whether they are part of the LGBTQ community or an ally. “Have a voice and be an advocate,” he says. “One person can make a difference.”

Navigating Cancer Care with LGBTQ Patients

As an oncology nurse and LGBTQ advocate, Megan Ober, RN, MS, BSN, OCN, a case manager at the Palliative Care Clinic at the UC Davis Comprehensive Cancer Center in Davis, California, often finds herself bridging the gap between providers and LGBTQ patients.

“Many health care providers work under the assumption that all patients are heterosexual,” says Ober. “It’s important to create a welcoming environment for LGBTQ patients in order to educate them on cancer risk factors and ensure they receive preventative screenings.”

Ober says LGBTQ patients often feel they are being judged and are reluctant to share their sexual orientation or gender identity out of fear of being turned away from health care providers. This distrust can lead to some LGBTQ not seeing a doctor regularly for check-ups and screenings, delaying diagnoses and not receiving information on treatments that might help either their physical or emotional health.

Over the years, Ober has given presentations to staff on LGBTQ disparities in cancer care and risk factors that lead to greater cancer incidence and later-stage diagnoses. These disparities include:

  • Anal cancer. It’s rare in the general population, but 34 times more prevalent in gay men.
  • Cancer screenings. According to the American Cancer Society, lesbians and bisexual women get less routine health screenings than other women including breast, colon, and cervical cancer screening tests.
  • Breast cancer. Lesbian women have higher rates for breast cancer including nulliparity (never having given birth), alcohol and tobacco use, and obesity.
  • Cervical cancer in transgender men. Since most transgender men retain their cervixes, they are also at risk of cervical cancer but are much less likely to obtain Pap smears and regular cancer screenings.

 

Resources to Bring Better Care to LGBTQ Patients

For nurses who want to educate themselves further about LGBTQ health topics, the following information can help:

  • Lavender Health has held virtual coffee hours for nurses working with LGBTQ populations. Their website offers events, resources, and more to help both providers and members of the LGBTQ community promote wellness.
  • The National Resource Center on LGBT Aging offers cultural competency training for staff at nursing homes and others who care for seniors. They also have downloadable guides on creating an inclusive environment for LGBTQ seniors.
  • The U.S. Department of Health and Human Services offers a free downloadable guide, Top Health Issues for LGBT Populations Information and Resource Kit.
  • On a national level, organizations such as the National Alliance of State and Territorial AIDS Directors (NASTAD) has partnered with the Health Resources and Services Administration’s HIV/AIDS Bureau (HRSA-HAB) to launch HisHealth.org, a free online tool that helps nurses and other medical staff learn how to engage HIV-positive young black LGBTQ patients and young black transgender patients by taking a whole-health approach to wellness.
  • Organizations such as the Human Rights Campaign and their Healthcare Equality Index can help with training and best practices such as making changes to electronic medical records and hospital paperwork to incorporate sexual orientation and gender identity and criteria that hospitals can use to become Equality Leaders.
  • The National LGBT Health Education Center has a free downloadable guide, “Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff.” The guide discusses using preferred pronouns and preferred names, understanding diversity and fluidity of expression, making LGBTQ patients feel comfortable, common health issues among the LGBTQ population, and much more.

While it can be difficult for nurses to begin a conversation about a patient’s sexuality and sexual health, Ober says it’s important for providers to ask in order to care appropriately for LGBTQ patients.

“Rather than assuming all patients are heterosexual, I recommend nurses introduce themselves and ask a patient how they would like to be addressed, their chosen name, and their preferred pronoun,” Ober says. “There’s a great training video on YouTube called ‘To Treat Me You Have to Know Who I Am’ that showcases a mandatory employee training program that was launched for health care providers in New York.”

Ober also cautions against assuming the personal info on a patient’s chart is correct. Often, people who are transgender may identify as a different gender than the one listed on their electronic medical record.

“Rather than greeting a patient with a title such as Mr. or Ms., I encourage nurses to ask patients how they would like to be addressed,” Ober says. “Shifting from a heteronormative model to one that is more inclusive acknowledges that patients and families aren’t all the same. The woman sitting by your patient’s bedside may be her wife, rather than her sister or friend.”

Nurses Lead the Way with Change

Caitlin Stover, PhD, RN, chair of the national Gay and Lesbian Medical Association (GLMA) Nursing group says both nurses who identify as LGBTQ and those who are allies can work to create an inclusive environment for LGBTQ patients.

“I’m an ally that joined GLMA and now I’m chair of the organization,” Stover says. “There are so many resources out there that can help nurses become better patient advocates and deliver culturally sensitive care to LGBTQ patients.”

Stover says while many nurses across the country are doing great work in creating an inclusive environment in their hospital units and establishing trust and rapport with LGBTQ patients, there are still many nurses and providers who have not received education on LGBTQ health issues.

“It’s important for nurses to strip themselves of preconceived notions, judgements, and assumptions,” Stover says. “Our job is to provide the best possible care, regardless of a patient’s age, ethnicity, gender, or sexual orientation.”

She cites the Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients downloadable PDF created by GLMA as a good starting point for nurses who are seeking advice on how to communicate with LGBTQ patients using sensitive language. The document also includes guidelines for forms, patient-provider discussions, and more.

Continued Education Leads to Better Health Outcomes

Learning about LGBTQ patients isn’t a topic that is always covered in nursing school. A national survey conducted in 2014 found that 43% of nursing faculty who taught in bachelor’s degree programs across the United States reported limited or somewhat limited knowledge of LGBTQ health. Between 23-63% of respondents indicated either never or seldom teaching LGBTQ health, although a majority of respondents felt LGBTQ health should be integrated into the nursing courses they teach.

In 2013, Columbia University Medical Center in New York launched the LGBT Health Initiative, based at the Division of Gender, Sexuality, and Health at the New York State Psychiatric Institute and the Columbia University Department of Psychiatry in association with the Columbia University School of Nursing. The goal of the initiative is to bring together research, clinical care, education, and policy to fight stigma and improve the health of the LGBTQ community.

Janejira J. Chaiyasit, DNP, AGNP-C, an assistant professor at Columbia University School of Nursing and a nurse practitioner at ColumbiaDoctors Primary Care Nurse Practitioner Group, says students at the Columbia School of Nursing receive training on LGBTQ cultural competency as part of their studies.

“We highlight the unique health disparities, risks, and health needs of the LGBTQ patient population to increase awareness, so that our future providers and care takers will offer appropriate care and ask the right questions,” Chaiyasit says.

At Columbia, Chaiyasit has seen how promoting inclusivity and culturally competent care has led to better patient care and health outcomes, and how training staff and students adequately prepares them to care for LGBTQ patients.

“If a patient doesn’t feel comfortable, how can we expect them to divulge their personal health concerns to us, and, in return, enable us to give them the best care?” Chaiyasit says.

And despite progress that has been made nationally, Chaiyasit says there’s a continued need for nurses to learn about the differing health needs of the LGBTQ community.

“LGBTQ patients have a lot of health disparities and changing the preconceptions of health care delivery for this community is a way to close the gaps—reducing ER visits, reducing the time to access health care for medical and psychosocial issues, and increasing the rate of preventative health screenings,” Chaiyasit says. “For example, many health care professionals are unaware of the health needs for trans patients, specifically these patients’ needs for transition-specific hormone therapy care and maintenance to achieve the desired gender features. This is really important as it impacts physical and mental health as a whole.”

In addition to nurses becoming more aware of gender-neutral language, many hospitals have begun customizing their patient intake forms to ensure they are LGBTQ-inclusive.

“At Columbia, we piloted intake form questions, which were ultimately implemented across the Nurse Practice Group, that allow patients to select, or even write in, their preferred gender identity pronouns,” Chaiyasit says. “A complete patient history helps to ensure each patient gets the care and services they need.”

In the Spotlight: DNP Candidate Jonathan Llamas

In the Spotlight: DNP Candidate Jonathan Llamas

Sometimes nurses know they are destined for a lifelong nursing career; for other nurses, it’s as if the career chooses them.

That’s how Jonathan Llamas DNP (c), BSN, RN-BC, PHN, found his way to nursing. Knowing the career would be a good fit for his compassionate nature and his innate ability to have empathy for others, Llamas applied for nursing school right out of high school.

“I knew the work was selfless and inspiring,” he says, “but I went into nursing school with some naiveté. I knew I had the qualities to be a successful nurse, but I didn’t understand the amount of hard work and dedication required for me to excel in the heavily science-based coursework.”

Llamas was unprepared and struggled with the demands of the course load. Looking back, Llamas sees how his path started to become rockier, even as he wanted to succeed. He lacked the mindset to focus on his work. “I didn’t commit the time necessary for me to be successful,” he says.

Transferring to community college, Llamas finished his prereq courses, but says his lackluster GPA set him up for a cycle of rejections from other nursing programs. Determined, Llamas pressed on but struggled with setbacks that would have had other students choosing another path.

“Based on my GPA, my community college counselor said, ‘You don’t have what it takes to be a nurse,’” says Llamas. Feeling demoralized by the comment, Llamas still felt that nursing was his calling. He just had to find a way to get there. “I had to prove to myself I could do it,” he says, “and that I could do well under pressure.”

The toll from the rejection was growing though. As a first-generation college student from a supportive Filipino family, Llamas recalls his mother’s upset at all the rejection for him and it struck a nerve.

“I looked in the mirror and thought, ‘How do I want to be remembered? Do I want to be a father who inspires his kid to rise above adversity or fold under pressure?’” Llamas says. “I didn’t want to be the latter. I wanted to make something of myself.”

Determined to succeed, Llamas applied to West Coast University’s nursing program, and they gave him another chance. He didn’t throw it away and graduated in 2013. I learned that if I wanted to be successful, I have to apply myself,” he says. “I carry that now. If you want something, you have to work for what you want. We are all different in terms of the resources we have initially. We are not all starting at the same starting line.”

“Hopefully my story will inspire others,” says Llamas. He wants students to be academically and mentally ready at the outset so they aren’t surprised by the intensity and high expectations of nursing school. “You have to sacrifice to be successful,” he says. “It’s hard, but it’s temporary. Do your research, and know why you want to be a nurse. Have a vision for yourself and your future.”

As Llamas has learned, there is a level of commitment to nursing that is necessary to be an exceptional nurse. “There’s a difference between your passion and your purpose,” he says. Having the inherent ability to be a successful nurse often makes one’s passion for nursing grow stronger, he says. “I understand that nursing requires sacrifice, but the most rewarding thing you can do is provide such incredible care to a patient.”

For Llamas, persistence has paid off. He is set to graduate this spring with his DNP from Loma Linda University and juggles his academic load with a full-time schedule as a psychiatric mental-health nurse. “I am fortunate to have hit this stride in my career,” he says. The advanced degree will help him reach his future goals of influencing change in nursing by providing a different form of influence beyond the bedside. He envisions working as an NP, becoming an educator to help future nurses, and using his platform to help other nurses.

“If you had said to me 10 years ago that I would accomplish this, I would have said you were crazy,” he says. “If I have impacted someone’s life for the better, then I have lived a life worth living. I feel blessed, humbled, and grateful for the opportunities that have come my way.”

 

Preparing Tomorrow’s Nurses Today: The Role of Simulation Nursing in the 21st Century

Preparing Tomorrow’s Nurses Today: The Role of Simulation Nursing in the 21st Century

Nursing education is the foundational pillar that enables future nurses to become competent and knowledgeable in their respective practices. This education was normally provided to nursing students through various didactic theoretical lectures and practical clinical training but recently, the use of advanced simulation technology as an adjunct educational tool has slowly become a significant addition to student centric learning.

History of Simulation

The concept of simulation practice can be traced back to the fields of military, aviation, and nuclear power (with military having used simulation the longest), dating back to the 18th century. Simulation was initially created as a cost-effective strategy for training professionals because it was considered exorbitant to train in these areas in the real world. As the years progressed however, the healthcare profession realized the practicality and usefulness of incorporating advanced simulation technology into educational practice and as a result, spurred the growing movement of simulation in healthcare training settings and educational establishments around the world.

The Impact of Simulation on Nursing Students

The emergence of computer technology has led to the development of innovative tools for healthcare professionals such as simulation technology and patient simulators Simulation technologies have had a profound effect on the nursing profession because it allows nursing students to apply their recently learned skills and knowledge to solve real life scenarios in a safe and structured setting.

In a typical simulation session, two students are often asked to participate and mimic the roles of a registered nurse or a certified nurse assistant (CNA). The rest of the remaining students are then asked to go to a separate room and observe the scenario through a one-way mirror and a live video stream. At the start of the session, the facilitator usually gives report on the patient, which allows the students to familiarize themselves with the patient’s situation, history, charts, and medications in order to successfully manage and implement high quality nursing care for the patient. As the simulation progresses, the facilitator controls the patient’s prognosis and provides cues to the team to enhance the realism of the situation. Once the simulation is completed, the students are then asked to head back to the debriefing room to discuss their experiences.

During the debriefing session, the students learn through self-reflection, group interaction, and questions asked by the facilitator. The use of group discussion engages students in reflective learning and enables the group members to consider a situation from multiple perspectives and consider other alternatives in order to broaden their scope of practice and clinical understanding. By performing simulation scenarios on a regular basis, students are able to develop better critical thinking skills, decision-making abilities, and application of theoretical knowledge in real-life situations.

Facilitating Simulation into Nursing Practice

According to the Institute of Medicine (IOM), approximately 98,000 people die every year from medical errors in U.S. hospitals, and a significant number of those deaths are associated with medication errors. This means that adverse events affect nearly 1 of 10 patients in the hospital setting. Based on this staggering number, the IOM called for a systematic change in healthcare practices and identified simulation practice as a resource to address the needed reform. By fostering experiential learning, simulation ingrains good nursing habits early, while discouraging bad nursing habits from forming before it becomes second nature.

In addition to allowing individuals to hone their nursing skills, simulation has also proven to increase student confidence and self-efficacy once they transition into the clinical setting. Nursing efficacy is an important aspect in nursing practice because it gives the students the confidence required to provide excellent nursing care to their patients. By incorporating what they have learned in simulation, more students are self-reliant in their capabilities, which are invaluable in ensuring that patient safety is implemented in the hospital setting.

Implications for Future Nursing Practice and Further Study

The shortage of availability of clinical sites is quickly becoming the norm for many nursing schools due to changing healthcare reform and the struggling economic crisis. One solution to combat the shortage of clinical sites however is to utilize simulation practice to replicate essential aspects of clinical situations for beginning nursing students. The National Council of State Boards of Nursing is currently conducting a landmark, longitudinal study to examine the knowledge and clinical competency outcomes of students when simulation technology is used in the place of actual clinical experiences. Although calls for additional research in these areas need to be performed, simulation is still quickly gaining momentum as the gold standard for effective learning practice in nursing education.

Nursing with Diabetes: Tips for Coping on the Unit

Nursing with Diabetes: Tips for Coping on the Unit

“Diabetes is so prevalent in our society, and I feel as though I have a better understanding of my own patients with diabetes,” says Heather Weber, an RN who works in a busy outpatient GI department. She has type 1 diabetes, and she has experienced what it is like working as a nurse with diabetes. “I recently had a GI sickness at work, and as a result, my blood sugar dropped rather quickly after lunch,” she relates. “My coworkers noticed that I was diaphoretic and quickly sat me down, giving me some apple juice to drink. I ended up going home since I was sick with a GI bug, but only once my blood sugar was stable enough to drive. I was grateful for my coworkers’ assistance.”

Since diabetes is such a major problem amongst the population, it only stands to reason that nurses can have diabetes, as well. According to the American Diabetes Association, 30.3 million people in America have diabetes. In addition, 1.25 million adults and children have type 1 diabetes. How can nurses manage their condition? Nurses have a difficult time eating a balanced diet due to skipping meals. They are also on their feet most of the time, putting them at risk for complications of the foot, such as ulcers.

Fortunately, many nurses want to share their experiences to help others navigate the challenge of balancing diabetes and providing excellent patient care. Diabetes educators strive to help all people who have diabetes, and they are an excellent resource for nurses who want to manage their diabetes.

Nurses generally know how to handle their condition. They know diabetes front and back through the job, and they are intelligent professionals who know how to adapt those ideas for themselves.

“I can usually slip away for a few minutes or have a coworker cover for me so that I can test and/or eat a snack,” explains Weber. “When I worked as an ICU nurse doing twelve-hour shifts, I would typically eat snacks to prevent low blood sugars as I did my charting at the nurses’ station.”

Tips like this are invaluable because they are grounded in the actual experience of being a nurse with diabetes.

Fran Damian, MS, RN, NEA-BC, works at Boston Children’s Hospital and is a staff member at Diabetes Training Camp. She has tricks that she uses, as well. “Managing well with diabetes requires good planning and being well prepared with extra supplies all the time,” she says. “I live a healthy lifestyle as much as possible. That includes regular exercise and a well-balanced diet. I feel best when I eat a lot of fruits, vegetables, and lean protein, and I drink a lot of water …. [I] always have glucose tablets on me in case I start feeling low.”

“Our unit was pretty good if we were slammed and did not get lunch,” says Danielle Kreais, MSN, RN, CPNP-PC. She got her diagnosis and learned to cope, all while working a busy OB unit on nights. “The manager ordered lunch meat sandwiches and chips for us. There was another diabetic I worked with and the advice she gave me was to make sure I always had one of those Nature Valley bars in my work bag, in the glove box of my car, and my locker. The peanut butter ones have protein and they are a carb, so it was a great combo if lunch was missed.”

She continues: “She told me for lows to keep those peppermint striped candies [in your pocket] that are soft, and you can chew them. They are enough to bring your sugars up, plus they don’t melt.”

Nurses newly diagnosed with diabetes would do well to carry glucose tablets at all times to prevent low blood sugar. Be sure to tell your manager and your coworkers what’s going on so that they can help you when needed. Snacks and water are essential to good blood sugar control. Don’t forget to use your resources, such as endocrinologists, dieticians, and diabetes educators to plan the right meals and strategies for you to use on the job.

Although tips from nurses can be invaluable, they are nothing like the kind of focused information that can come from a certified diabetes educator (CDE). These are medical professionals who are responsible for teaching all people with diabetes in all situations how to manage their lives and prevent complications.

One such expert is Lucille Hughes, DNP, MSN/Ed, CDE, BC-ADM, FAADE, director of diabetes education at South Nassau Communities Hospital in Oceanside, New York, and treasurer of the American Association of Diabetes Educators. Considering some of the challenges nurses can face when dealing with diabetes on the job, she had tips for some of the most common ones.

Nurses often don’t get the chance to eat during a shift, and this can severely impact blood sugar levels. “When nurses with diabetes find themselves in this situation, planning and being prepared is the best medicine,” says Hughes. “Keeping snacks on hand that are a blend of carbohydrates, protein, and fats can be a tremendous help in these situations.”

“Meal planning is the secret to living with diabetes and being a healthy person,” Hughes continues. “Investing in a good lunch bag (or two) will allow you to plan and pack all the essentials to eating and snacking healthy. Being unprepared and finding yourself at the mercy of a vending machine is not a good situation to be in. It is very unlikely you are going to find a ‘healthy’ lunch or snack option.”

In addition to poor nutrition, nurses also face significant impact to their feet, and this can cause foot related complications for nurses who have diabetes. “First and foremost, investing in a good pair of comfortable shoes is essential for anyone who spends most of their day on their feet,” says Hughes. “Calluses and skin evulsions due to rubbing of a shoe on a toe, heel, or ankle area can be dangerous and yet avoidable.”

Here are six tips that Hughes has on how to find shoes that fit and how to determine if they are a healthy choice:

  1. When trying on a shoe in the store, make sure it feels comfortable. If it isn’t comfortable, don’t buy it.
  2. Many think that new shoes require a bit of breaking in and you must endure the associated pain. This is not true. If new shoes start to hurt, immediately remove them and don’t use them again.
  3. Don’t think that the only shoes you can wear as a nurse with diabetes are unfashionable ones. There are many options for shoes that fit, so do your due diligence and find shoes that will protect your feet.
  4. In addition to finding the right shoes, foot inspection is vital in protecting your feet. Check them every day. Use a mirror to see the bottoms and sides of your feet. If you notice any redness, cuts, or blisters, see your podiatrist immediately. Take care of small changes immediately before they expand into something unmanageable.
  5. Podiatrist. Yearly, no exceptions. More often if necessary.
  6. Finally, any time you see a medical professional, ask them if they will take a look at your feet at your office visit. This could be your primary care doctor, your endocrinologist, or any other specialist you may see—within reason, of course. Many dentists would have trouble with this request. Seriously, though, any professional who looks at your feet could possibly see a problem early enough to stop it. Use these resources.

Nurses spend so much time taking care of others that the self is often forgotten and ignored. Unfortunately, this is unhealthy for any nurse, but particularly troublesome for a nurse with diabetes. Yet, these challenges are not insurmountable, although they may take a little work. Planning your diets and meals are key to ensuring that you will have food on hand for sudden lows. Meal planning can also help you keep your high blood sugar under control. For your feet, planning is again essential. You must find shoes that are comfortable—no questions asked.

Following these steps, nurses with diabetes should be able to function well as nurses—and many are! If you find yourself troubled by mixing diabetes and nursing, let your doctor know. They may be able to refer you to any number of professionals who can help. The most important item, though, is to catch things early and always plan how to confront any challenges.

The Power of a Brain Dump: How to Untangle Your Mind

The Power of a Brain Dump: How to Untangle Your Mind

As you probably already know, a cluttered home can lead to alarming levels of anxiety, stress, and feeling overwhelmed. Professional organizers encourage us to clean off a cluttered desk because it decreases productivity. And decluttering the physical environment is a crucial practice for running a well-kept and smoothly operating life.

But, your closet is not the only thing you need to declutter!

You need a way to untangle your messy mind, because nursing is a stressful occupation and nurse burnout is a real thing. A simple “brain dump” is the best decluttering tool for that job. What’s a brain dump? Merriam-Webster defines it as “the act or an instance of comprehensively and uncritically expressing and recording one’s thoughts and ideas (as on a particular topic).”

Here’s why you need to do a brain dump at the start of the new year.

When your thoughts, priorities, and plans are disorganized, it can send you into a state of overwhelm that’s hard to climb out of. New Year’s is the perfect time to declutter your mind and gain some fresh ideas to set new goals and plan new projects in 2019. Like most nurses, you probably have loads to do and as weeks and months pass, your to-do list continues to grow. Your brain is like a computer, and can only store or process so much information before it slows to a crawl or freezes altogether. You may have experienced a human version of the dreaded computer spinning wheel or slow loading progress bar. It may have been a case of mental brain fog (confusion), or total brain freeze (panic!), or a brain on an endless loop of obsessive thought. But there is a way to speed up your own “operating system” when you’re faced with a mile long list of priorities and tasks.

Here’s how to do a brain dump, quickly and easily.

The technique is as simple as taking a notebook and a pen and writing down everything that’s clogging up your mental space. Allow all your thoughts, feelings, tasks, and notions to spill out onto the page, where you can see them. Write quickly and freely. Don’t worry about grammar, spelling, or punctuation. If you like, you can set a timer for 15 or 30 minutes and write as fast as you can to beat the alarm. You might wind up with a page or two, or if you have a lot on your mind, ten pages worth of material.

Here’s what to write about when you do a brain dump.

You can choose a general writing prompt, like “The most important things that happened to me in 2018.” Or you can make a long list of routine to-do’s that are weighing you down. Or vent your feelings of frustration or rage in scrawled red ink. Feel free to explore at length in a rambling, stream of consciousness style,  how you feel about your life in a private shorthand that only you can read. The trick is to treat the process like psychotherapy and spill out your thoughts and feelings without censoring them. Let your subconscious mind have its say and give your conscious mind (the nice, orderly, good citizen) a well-earned break.

Phew! You should feel much better now that you’ve untangled your mind and cleared some space for fresh inspiration.

Here’s to a happy and healthy New Year for all you superhero nurses out there!

Three Qualities of Effectual Leadership

Three Qualities of Effectual Leadership

The concept of effectual leadership is an important aspect in the field of nursing and health care. Leaders have a significant role in creating a culture and mindset that not only inspire but also unite individuals within a group or society. Since the perception of leadership is different to certain individuals however, various leaders around the world function and interpret leadership in unique and distinct ways. As a result of this realization, the following principles and philosophies are necessary to becoming an effective and successful leader in the health care arena.

1. Master and Perfect your Unique Craft.

Since all leaders have distinct leadership styles and abilities, every leader must learn to recognize and master their unique leadership craft. Understanding this concept is crucial because all leaders are responsible for the effectiveness of organizations and provide a guiding purpose to those who need them. In order for this to occur, an individual must be willing to listen to his or her inner voice and remain true to who they are. Only after the individual fully accepts themselves and their idiosyncrasies can they move on to the second step in the leadership hierarchy.

2. Appreciate the Fundamentals of Leadership.

Fundamental leadership is composed of various ingredients that an individual must grasp before he or she can successfully lead. The first ingredient is defined as the guiding vision, which is the individual’s overall goal for himself or herself. All leaders must have a clear idea of what he or she wants to do—professionally and personally—and the strength to persist in the face of setbacks or failures. This ingredient is vital because it exemplifies the importance of possessing a strong sense of conviction in both aspects of the individual’s life as well as the importance of knowing what you desire and how you plan to achieve it. The second and third ingredient in fundamental leadership is passion and integrity. Passion is when you put more energy into something than is required to do it. It is more than just enthusiasm or excitement, but ambition that is materialized into action to put as much heart, mind, body, and soul into something as humanly possible. In addition to this, integrity is also a much-needed component in becoming an effectual leader because it is based on honesty and a steadfast devotion to principle and ethics. Without these three ingredients, leaders will have a difficult time not only motivating others but also gaining the trust and support necessary to accomplish a shared goal or objective.

3. Embrace your Inner Self.

The third and most important step in becoming an effectual leader is learning how to embrace your inner self. The premise of authenticity is a central theme in effectual leadership because the most charismatic and effective leaders are those who are genuine representations of their innermost nature. One of the best ways individuals can gain this is by experiential learning, which provides the individual with a rich and solid foundation for the future. Through experiential learning, individuals are exposed to the repercussions of their choices and as such, decide for themselves whether or not to make the same choices in the future. This exposure ultimately shapes and forms the leader to become emotionally mature and develop the mental acumen required to be authentic and transparent leaders across the health care spectrum.

Preventing Nurse Burnout

Preventing Nurse Burnout

Working as a nurse can be tough. Because they are so focused on patients, they may not see when they’re experiencing burnout—and that can lead to problems with themselves or with being able to properly care for patients.

But there are ways to recognize it and to counteract it. Sarah A. Delgado, MSN, RN, ACNP, a Clinical Practice Specialist with the American Association of Critical-Care Nurses says that there are ways to identify burnout as well as ways of coping with it.

What are some tips for nurses so that they can prevent burnout?

 The first step with burnout is to recognize when it’s happening. Some signs of burnout include:

  • Feeling that you have to drag yourself to work, and that tasks at work take more energy than you can muster
  • Feeling irritable, critical, or cynical with coworkers
  • Having physical symptoms such as headaches or stomach pains or trouble sleeping

Nurses may try to dismiss these symptoms, especially in the busyness of the holidays, because they feel compelled to power through, no matter what. The truth is that recognizing and addressing burnout can actually be energizing; just realizing that you deserve to feel better is the first step toward positive change.

Coworkers can help each other call attention to burnout. If you notice someone is struggling, it may be worthwhile to check in and ask how they are doing. Burnout can be a team problem if it is pervasive on a unit because it’s hard to come to work when the people you work with are dissatisfied, short tempered, or unable to sense the value of their work. So recognizing the symptoms and checking in with colleagues is an essential strategy.

Burnout is a complex phenomenon and while there are self-care actions that nurses can take to address it, factors in the work environment contribute to burnout. Worry that patient care is compromised by an inadequate staffing mix, feeling that administrators are not responsive to clinical issues, and poor communication among health care team members are examples of issues in the work environment that can led to the mental, physical, and emotional exhaustion of burnout.

Issues in the work environment are not insurmountable but a single member of the environment cannot address all of these issues alone. If you are a nurse working in an unhealthy work environment that contributes to burnout, maybe create a New Year’s resolution to talk to your colleagues about it. If you find that they share your feelings, there may be factors beyond your control contributing to the problem.

Consider forming a group and seeking support from management to identify specific steps toward a healthy work environment. The American Association for Critical Care Nurses has resources including the AACN Standards for Establishing and Sustaining Healthy Work Environments and an online assessment tool that units can use to evaluate their environment and identify ways to make it healthier.

What are the best action steps they can to take?

There is some evidence that mediation and mindfulness practices can significantly reduce anxiety and worry. There are resources online and applications to help learn these techniques. The National Academy of Medicine provides a list of resources.

Attending to the basics—sleep, exercise, and nutrition—also helps with the physical, mental, and emotional exhaustion of burnout. Sometimes, it is easier to advise others on self-care than to take the time to do it for ourselves. The American Nurses Association initiative Healthy Nurse, Healthy Nation provides a structure for nurses to think about their own self-care and develop healthy habits.

When you find yourself feeling relaxed and rested, think back to what you were doing at that time. Were you talking to a friend, exercising, drawing, spending time with family, reading a novel, or watching a movie? Being deliberate in engaging in the activities that bring joy can reduce the stress of burnout.

What kind of self-care should they do?

I think a key antidote to burnout is satisfaction in your work. There are some shifts that are so frustrating and so exhausting! Then there are also moments when you comfort a frightened family member, catch a change in a patient’s condition, or hear “thank you” from a colleague—moments when you know your actions have a positive impact on someone else. Those moments are priceless. Keep a log or a journal by your bed or create a note in your phone with a list of your priceless moments as a nurse, and take time to re-visit them from time to time. The way you felt in those moments is as real and as powerful as the negative emotions.

What else do they need to be aware of?

Leaders and organizations in health care are increasingly taking action on the issue of burnout. As mentioned, the ANA launched the Healthy Nurse, Healthy Nation project. The Critical Care Societies Collaborative, a collection of four professional organizations, also identified burnout as a priority issue. Information and videos from their summit on this topic can be found here. Finally, the National Academy of Medicine created an online resource, the Clinician Well-Being Knowledge Hub, that offers individual and system level strategies to combat burnout. I think this website can be validating; it is important to recognize that you are not alone in feeling burnout as a member of the health care workforce.

Making History: Q&A with ANA’s First Male President Ernest Grant

Making History: Q&A with ANA’s First Male President Ernest Grant

On January 1, 2019, Ernest Grant, PhD, RN, FAAN, became president of the American Nurses Association (ANA), the first man ever to hold the position. As a minority nurse trailblazer with more than 30 years of clinical and leadership experience, he was well equipped to break one of the remaining glass ceilings in nursing.

Grant, who holds a PhD in nursing, headed North Carolina’s nationally renowned Jaycee Burn Center at UNC Hospitals in Chapel Hill, where he started as a staff nurse in 1982. He has deep roots in the area, having earned his bachelor’s from North Carolina Central University and his master’s and doctoral degrees from UNC-Greensboro.

An internationally recognized expert on burn care and fire safety, Grant was presented with a Nurse of the Year Award in 2002 by former President George W. Bush for his work treating burn victims from the World Trade Center site of the 9/11 terrorist attack.

Grant won the election by an overwhelming majority of votes from his colleagues after having served as vice president of the ANA and being an active member for decades. The organization has served nurses for 122 years, and now represents more than four million registered nurses nationwide.

Grant intends for his appointment to help unravel stereotypes about men in nursing. He plans to use his term to address some of the most pressing issues in the field, such as a looming nursing shortage that more inclusionary educational recruiting practices could alleviate.

We interviewed Dr. Ernest Grant to learn more about his historic election as ANA president and what the future holds for the association under his leadership.

ANA President Ernest Grant

ANA President Ernest Grant
Photo credit: Max Englund/UNC Health Care

What are your top priorities as far as encouraging more diversity in nursing?

Increasing gender and ethnic diversity in nursing is one of my top priorities. A nursing shortage is expected as the general population is aging, and experienced baby boomer nurses are retiring.  (Projections are that 500,000 seasoned RN’s will retire by 2022, and 1.1 million new nurses will be required to replace them.) There are ways we can avoid this [predicated shortage], which include recruiting more men into nursing and increasing diversity across the profession.

How will you encourage greater diversity in the nursing profession?

There should be more people of different backgrounds entering the profession so that it reflects society. One way to achieve this is through better access to scholarships and other educational and community resources. People of all ages, genders, and ethnic backgrounds must know what’s available—that there are federal loans geared to nurses, for instance.

A nursing assistant may not be aware that taking courses at a community college is possible or that an employer may offer tuition assistance. But the stumbling block is not always money; it could be having young children or home responsibilities. Online training or resources in the community that pay for child care would be the solution then.

What would encourage more men to pursue the nursing profession?

Men are joining the profession. Seeing someone who resembles them in the health care system has helped empower them to become nurses. Promoting images of men in nursing needs to begin early, starting at the grade school level and letting boys see men who are nurses. “Here’s somebody who I can identify with,” they will think. Then at the high school level, it gets reemphasized by a guidance counselor or health occupation program. In those programs, they can get certified as a nursing associate, and obtain more exposure to nursing.

Currently, 9 to 13 percent of nurses are men, but when I started it was much less. (Probably it was only 3 to 4 percent.) Several things are contributing to the increased interest, including increased representation in advertising and the media. Another is men who served as medics in the military but then unfortunately don’t [immediately] qualify for any nursing jobs. There are some accelerated nursing courses nationwide for former medics. In my state, they can choose nursing school, PA school, or medical school—all are good options for our military folks.

How did you get interested in nursing and decide to make it your career?

I grew up in a very poor community, as the youngest of seven, and my father died young. It took a village. Everyone knew everybody and people made sure you studied and didn’t misbehave. They said they knew I was going to successful.

When I got into nursing—I started as an LPN—I intended to go on to medical school. I got exposed to men in nursing and was fortunate enough to have multiple mentors to go to for advice. These are still my mentors. Thanks to Dr. Gene Tranbarger and others, who paved the pathway for me. When I started my studies in the mid-70’s and early 80’s, there were many stereotypes about men in nursing, but you don’t hear them as much anymore.

People know: Men are just as capable of providing care as women. You can be masculine and still care. I’m 6’6” and very large, so a lot of people may think “this guy is going to hurt me” but I’m really a gentle giant. They would soon realize that and ask for me as their nurse.

How has being a racial minority impacted your career as a nurse?

It has impacted my career, especially in the early years. (I grew up during time when segregation was ending.) Once in a while, you may meet someone who doesn’t want you to care for them because of your sex or color or both. Now it doesn’t happen as often. You have to prove yourself to be just as competent of a nurse as your white counterpart.

Have there been other minority nurse presidents in ANA’s history?

Yes, ANA has had two African American presidents, Barbara Nichols (served 1978-1982) and Beverly Malone (served 1996-2000).

I would like to be judged by my capabilities, not by my race or gender. My leadership skills are what got me here. I’ve worked very hard to win the respect of my colleagues. Men ran before for ANA president but faced a lot of obstacles. I’m looking forward to this challenge and endeavor.

 What do you want MinorityNurse.com readers to know?

Consider joining ANA and your state nurses association if you’re not already a member. As you begin your career, I want to encourage you to be more politically savvy at the legislative level. You need to be more aware of how decisions in the house or senate may hurt your ability to practice to your full license and educational level. Or it may limit your ability to treat patients—if they can’t get to us to access care [due to political efforts to replace or end the ACA]. If we’re not smart enough to advocate for our patients, then we’re doing a disservice to them.

Get out there and attend town hall meetings that your representatives are having, and volunteer to serve on their committees as a health care expert. Who else out there is more of a health care expert than a nurse? I would challenge all nurses to be more politically astute about how decisions at the state and national level affect the nursing profession.

7 Attributes of a Successful DNP Student

7 Attributes of a Successful DNP Student

Enrolling in a Doctor of Nursing Practice (DNP) program can be a daunting task for many students due to the rigorous academic requirements often associated with it. Although DNP school can be intimidating, students who choose to enroll not only embrace the significance of pursuing higher education but also the possibility of advancing their roles as prominent health care leaders in the nursing profession. As a DNP candidate myself, I’ve grown to appreciate the triumph and struggles associated with pursuing a terminal degree. Therefore, I believe students who are considering pursuing their DNP degree must harness these seven attributes to ensure that they are not only readily prepared but also successful in their scholastic endeavors.

1. Clear Vision

Setting a vision and goal for the future is vital for success in the DNP program. Possessing a clear vision is necessary because it helps you organize your individual objectives and helps you maintain accountability throughout the program. If choosing to enroll in DNP school perfectly aligns with your personal and professional goals, having a vision that is well defined will not only help you focus on your objectives but also create a sense of purpose that ultimately becomes your own measurement for success.

2. Ability to Prioritize

Students who know what and how to prioritize tend to be more successful in DNP school because they know how to differentiate tasks as either critical or noncritical. One of the best ways to prioritize in DNP school is by looking over the program and course objectives of each class and determine which tasks need to be completed first. By knowing how to prioritize your tasks wisely you will not only be able to minimize stress but also maximize results more effortlessly and efficiently.

3. Effective Time Management Skills

Possessing excellent time management skills is an important trait prior to beginning DNP school because of the high academic workload associated with pursuing a doctoral degree. Managing your time effectively will allow you to accomplish more tasks in a shorter period of time and help lower your stress and increase your concentration and attention. To ensure that your time is properly managed, it helps to keep a written or electronic record, diary, or calendar to ensure that you know what tasks are required and when they must be completed.

4. Strong Work Ethic

Maintaining a strong work ethic is essential in determining your overall success in DNP school. Students who possess a strong work ethic understand that success can only be achieved by practicing the ideals of discipline and hard work on a regular basis. To maintain a strong work ethic, it is vital to practice positive habits consistently every day so that hard work is almost automatic. Forming respectable habits such as exercising daily, staying punctual, maintaining your obligations, and finishing tasks immediately help establish your credibility and image as a doctorally prepared nurse.

5. Healthy Work-Life Balance

While it is important to study and work hard in DNP school, it is equally important to create a healthy work-life balance and set aside much needed time for yourself and your loved ones. Learning how to care for yourself is extremely important in DNP school as working too much can ultimately cause you to become overwhelmed, overworked, and overstressed. To avoid this, it is best that you take consistent breaks throughout the day to maintain your overall well-being. Learning how to take ample rest breaks is vital to ensure your physical, mental, and emotional health is adequately cared for in DNP school.

6. An Understanding that Excellence is a Lifelong Process

One of the key principles that DNP students must understand is that excellence is a lifelong process. Understanding this concept is vital because sustainable success in DNP school and in life is not something that is built overnight but rather an extended period of time. As leaders in the nursing realm, DNP students must understand that sustainable excellence requires constant monitoring, learning, and improvement with the realization that the journey is just as important as the destination.

7. Perpetual Curiosity

DNP students who remain perpetually curious are more susceptible to success because curiosity not only propels innovation but also self-reflection. Fostering your curiosity in DNP school is essential because it allows you to be fully present in the moment. Curious people are not only happier but also more successful because they are non-blaming, non-shaming, supportive, and focused on exploring options to find the best solution that supports collaboration and innovation.