With suicide rates rising and an alarming number of teens and young adults at serious risk for suicide, many health professionals are not fully prepared to recognize a patient’s psychiatric difficulties. A team of researchers at the National Institute of Mental Health (NIMH) recently came up with the ASQ Toolkit, a simple four-question survey for health professionals to help identify and get help for at-risk youth.
NIMH’s Division of Intramural Research Programs created the free Ask Suicide-Screening Questions (ASQ) Toolkit that can be used in various medical settings. According to the NIMH, the toolkit (available in many languages) is easy to use, making it effective in many settings including emergency departments, outpatient clinics, primary care offices, and inpatient medical/surgical units.
Before using the toolkit, organizations must have a plan in place to have a standard set of effective next steps for patients who do test with an outcome that indicates they are at risk. Whether that is a further evaluation with an on-site mental health counselor or another trained professional, the toolkit isn’t meant to be used without a follow-up plan.
No matter what their area of practice or setting, nurses and physicians can quickly assess patients by asking the four questions in the toolkit. If a patient answers yes to any of the questions, it’s a red flag for the medical professionals to consider the patient at risk for suicidal thoughts and behaviors. From there, the toolkit offers guidance on the next steps that will be most helpful for the patient and will also help them access the help they need.
Gaining this extra knowledge is essential skill to have no matter who your general patient population is. According to the World Health Organization, “Suicide accounted for 1.4% of all deaths worldwide, making it the 17th leading cause of death in 2015.” With such astounding facts, it’s imperative that nurses are able to have the tools to support them in identifying youth who might be at-risk. To help that, the toolkit even offers scripts like this nursing script for emergency room settings or this nursing script for inpatient medical/surgical settings.
The toolkit’s importance is highlighted in the rising numbers of youth who die by suicide. But underneath those shocking numbers are the hidden numbers of even greater numbers of people who are suffering with thoughts of suicide or even attempts at suicide. In fact, the American Foundation for Suicide Prevention estimates that for each person who dies from suicide (all ages), 25 more make a suicide attempt. Early intervention by healthcare professionals who can identify the risk and then have the resources to help the patient can be a turning point for the youth.
The ASQ Toolkit is only one resource for nurses to use in helping patients in a mental-health crisis or who are suffering from long-term suicidal ideation. With proper steps in place to help patients who do screen positive, it is also a potentially life-saving tool that healthcare setting and organizations might find worth investigating.
Can a simple B vitamin like folic acid really prevent serious birth defects? The answer is a resounding yes, but taking the vitamin in the easiest days and weeks of pregnancy is key.
When women find out they are pregnant, staying healthy often becomes a top priority. Making sure they are eating nutritious foods, getting enough rest, remaining active, and generally taking care of themselves comes to the forefront. But one of the most critical times for preventing certain birth defects is before a woman even knows she is pregnant.
Sufficient intake of folic acid (folate) can prevent serious birth defects, so January 7 to 13 marks Folic Acid Awareness Week. The observation offers a timely opportunity for nurses to become aware of their own folic acid intake and to open up discussions with their female patients of child-bearing age.
According to the National Birth Defects Prevention Network (NBDPN), sufficient folic acid intake before pregnancy occurs can “prevent up to 70% of some serious birth defects of the brain and spine, called neural tube defects.” Specifically, the vitamin has protective benefits against spina bifida and anencephaly, which begin to develop in the early weeks of pregnancy, often long before a woman even realizes she is pregnant.
Because approximately half of all pregnancies in the United States are unplanned, raising awareness about the protective benefits of sufficient folic acid intake before a pregnancy happens is essential. Luckily, getting the recommended 400 mcg of folic acid is as easy as taking a daily multivitamin or eating fortified pasta, rice, breads, or cereals (at mealtime or as a snack). Often, one small bowl of a fortified cereal can supply the minimum amount for the whole day.
Women who prefer to get enough folic acid from unfortified sources can turn to dark leafy greens, some juices, and many beans. But they need to be aware of the amounts they need to consume to meet the minimum requirement. According to the National Institutes of Health, these non-fortified foods are top sources of folate: beef liver, boiled spinach, black-eyed peas, asparagus, Brussels sprouts, and romaine lettuce.
According to the NBDPN, babies born to Hispanic women have the highest rates of these birth defects and that, in general, Hispanic women consume less folic acid overall and are less aware of the protective benefits of the vitamin during pregnancy.
For nurses, using Folic Acid Awareness Week to open up a conversation and give patients some easy-to-follow information for preventing these birth defects is worthwhile.
As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.
As the opioid epidemic continues to grow throughout the nation, it’s not surprising that this kind of addiction, as well as others, can also affect nurses. If you’re a nurse in New Jersey and have a problem with addiction, however, there’s a treatment program specifically designed to help you.
Established in 2003, the New Jersey State Nurses Association (NJSNA) Recovery and Monitoring Program (RAMP) has helped more than 2,000 impaired nurses since its inception, says Terri Ivory, RN, MSN, Director of NJSNA. “RAMP is the only program for registered nurses and licensed practical nurses of its kind contracted through the Board of Nursing,” explains Ivory. “RAMP is important because it supports impaired nurses and protects their licenses so they will be able to work again with monitoring once they have completed evaluation and treatment. What makes the program special is that nurses are taking care of nurses who understand the challenge of being a nurse.”
Ivory agreed to answer questions about the program. Following is an edited version of our interview.
Tell us about RAMP.
The goals of the program are to provide safety to the public though early detection and monitoring, reduce the time between identification and treatment, and provide a process for the nurse to recover that is non-punitive and non-public.
Entering the RAMP program, which is voluntary, protects the nurses’ licenses. While in the recovery phase, the nurses’ licenses may become inactive, but not revoked, which protects the licenses. The licenses can be re-activated once the process is completed and the return to work is issued.
How does it work? Is it a rehab/detox? Do you provide counseling?
RAMP is a recovery and monitoring program, which means it makes referrals for treatment, detox, and counseling. It is not rehab and detox nor does it do counseling.
The RAMP process includes evaluation, toxicology screenings, referral for treatment, weekly peer support group meetings, monthly reports, check-ins, monitoring, and a return to work process. There are peer support groups that RAMP participants must take part in during their time in the program.
Are all nurses accepted into the program? Do they need to apply? Does their employer get notified?
All RNs and LPNs practicing in New Jersey are eligible for the program and can be self-referred or referred by their employer or the public (such as family, attorney, friend). After a nurse self-identifies or is referred to RAMP, the first thing that happens is an evaluation process, which includes a psychological evaluation and random toxicology testing that can take up to 90 days. Nurses must check in with RAMP every day during the evaluation phase. During this time, the nurses do not need to disclose to their employers that they are in the program.
After evaluation, the nurse will get recommendations—whether to stay in the program or discharge—based on the results of the evaluation. If it is recommended a nurse stay in the program, the nurse must disclose the program participation to her/his employer.
Participation in the program may last up to five years.
RAMP notifies the New Jersey Board of Nursing (NJBON) as soon as the referral comes in, and the NJBON works with RAMP throughout the process. Dialogue with NJBON happens every two weeks or more often as needed. If nurses do not comply with recommendations, they are discharged from the program and reported to the BON.
It is within the nurses’ scope of practice to report fellow nurses.
Do the nurses pay for the program or is it covered by insurance?
Insurance does not pay for the program itself, which includes lab fees, evaluation fees, peer group fees, and therapist fees. All fees must be paid up front.
Hard medical costs, such as a lab fee or therapist, might be covered by medical insurance.
If they complete the program, how do they get back to working as a nurse? What tends to happen?
During their time in the program, a return-to-work program is implemented. Sometimes there are restrictions on work hours (no overtime), medication administration, and on specialty or place of employment. Nurses are monitored while they are working and monthly reports are sent to RAMP. Monitoring can be done for up to 5 years. Upon return to work, the only person that knows about the nurses’ participation in RAMP is the potential supervisor and human resources.
What have your outcomes been?
The overall success rate of the program is 60%. There are a total of 607 nurses in the program as of October 31, 2017: 493 nurses being monitored, 27 in intake stage with 23 monitoring out-of-state with 36 peer support groups, and five mental health groups. Two hundred thirty participants have been discharged as of October 31, 2017.
The most important thing for nurses to know is not to be afraid to report, either self-reporting or peer reporting. This helps close loop and gets the nurse the help they need. The main goal of the program is to have nurses to practice safely, protect the public, and protect the nurse.
RAMP has a 24-hour hotline for questions: 800-662-0108.
When you are dealing with diabetic seniors, it is especially important to identify changes in their health as early as possible, when treatment may be more effective. Recent studies have shown that the risk of developing Type 2 diabetes worsens with age, and if symptoms aren’t monitored property it can lead to more serious complications.
Scheduling regular doctor visits is the best preventative care, but in addition to this, seniors can also play an active role in tracking important health stats on their handheld devices by downloading these helpful smartphone apps.
“According to the latest research, 54% of seniors who participated in one study said using smartphone apps to manage their diabetes was helpful, and 48% were willing to try these apps, but only 7% were actually doing so.”
How to Utilize a Smartphone for Diabetic Management
By taking advantage of apps that offer glucose tracking, nutrition guides, and medication reminders, detecting changes in a senior’s diabetic condition that need to be brought to the attention of physicians and other health care professionals is easier than ever before.
Alarms Can Be Used as Medication Reminders
Every smartphone comes with standard alarm features, including the ability to set multiple alarms and to customize them by the day of the week. While these alarms are typically used as wake-up calls, they can also be used to easily and conveniently remind the elderly to take their medication. This feature is especially helpful because medication schedules can often be complex, making them especially difficult for seniors to remember.
Alarms can also be used as reminders to eat or to monitor blood sugar levels. By programming this data into their alarms, seniors’ phones will have the responsibility of remembering these tasks covered for them.
Maintaining a Healthy Diet
Diet apps can play an important role in helping seniors to manage their diabetes. One helpful app is My Fitness Pal, which can be used to make smart nutrition choices by scanning bar codes on everyday food items, which the app will then analyze, making this the perfect companion to take along to the grocery store.
Another app that should be downloaded is Fooducate, which offers a recipe calculator that allows seniors to check calories when they are preparing meals at home. In addition to this it also has an exercise-tracking feature that can be synced with other fitness apps. Diabetes Logbook is an app that uses easy-to-read, color-coded screens to offer suggestions for healthy eating choices. But the app also provides more.
Tracking Your Glucose
Diabetes Logbook can also be used to track glucose, and there are several other apps that are also available for this task. Glooko can access data from insulin pumps and continuous glucose monitors that can help seniors with their carb, insulin, and medications by analyzing them alongside their blood glucose levels.
The mySugr diabetes logbook was designed to help people with both type 1 and type 2 diabetes by offering fun challenges to complete and motivational feedback while tracking and securely backing up important data. The Glucose Buddy app offers push reminders and fast log entry that will allow seniors to compare their data with the data of other users, and they have over 36 million logs to date.
Users of Glooko alone have shown significant decreases in the risk of hypoglycemia and hyperglycemia, along with an impressive 29% increase in blood sugar testing.
According to the latest research, 54% of seniors who participated in one study said using smartphone apps to manage their diabetes was helpful, and 48% were willing to try these apps, but only 7% were actually doing so.
Rates of diabetes and of smartphone usage in this demographic are on the rise, and these figures demonstrate that the elderly can benefit from being encouraged to use these apps to improve their overall health along with their quality of living.
If you had to choose the place you’d like to be in during the holidays, most likely it wouldn’t be the hospital or a skilled nursing facility/rehab center. But for many patients, that’s exactly where they are.
Nurses are compassionate, so it makes sense that you would try to keep them feeling happy and cheery when they’re with you. We asked nurses for some tips on how to do it best. Here’s a sampling of what they had to say…
“I decorate the Christmas tree and make the patients part of the process by having them make ornaments in their art therapy. By placing the tree in a common area, I hope to give them a feeling of being home.”–Luisa Vega, DNP, PMHNP-BC, AGPCNP-BC, Psychiatric Nurse Practitioner at River Oaks Treatment Center.
“In most cases, Chanukah and Christmas are extra special times of the year for children. And most adults treasure December holiday childhood memories: dressing up in special clothes, lots of cookies, decorating the house, being in awe of shining lights, and, depending on the family, observing religious traditions. For children with chronic conditions or in hospice care, December can be a lonely, difficult, and anxious time. Many parents of my patients are unsure of what to do: I encourage my families to celebrate and encourage friends to join in. My colleagues and I call it ‘party at the bedside.’ Best of all, you can do it any time of the day or night—whenever the patient feels best, is most alert, and tends to be in the least amount of discomfort.”—Kate Dunphy, RN, Pediatric Hospice Nurse Case Manager, MJHS Health System.
“I talk to patients and ask about their family and any traditions they usually keep for that particular holiday. I also share some traditions my family has during the holidays.”–Maria Camacho, BSN, RN, IU Health West Hospital.
“We should be more kind and positive and lend an ear when they express concerns about not being with their families during the holidays. Just making sure we smile when greeting them or passing them in the hall can make a big difference. Being a patient during the holidays is extra hard because they are doing the right thing by being here, but also feeling bad about not being at home with their children, spouses, family, etc. I think incorporating extra fun activities and bringing special treats during holidays is great, and we do that here at River Oaks.”– Diana Nelson, BSN, RN, Staff Nurse at River Oaks Treatment Center.
“I ask patients about their family and traditions, and if family is coming to visit. I also draw a holiday-themed design on their Styrofoam cups and dry erase boards. Sometimes I’ll even print a holiday sign, color it and hang it in their room.”–Monaca Gentry, RN, IU Health West Hospital.
“For Christmas, I buy a box of cards and candy canes for my tech and me to sign and give to our patients. If a patient is diabetic, I make sure to give him/her sugar-free candy canes.”–Dickie Smith, RN, IU Health West Hospital.
“Nurses often work over the holidays, sacrificing time with family and friends to serve patients and their families. The best way to keep patients in good spirits over the holidays is by making sure the patient care team is in good spirits. At IU Health West Hospital, we offer a complimentary meal to working team members and their families on major holidays to show our appreciation.”–Lisa Sparks, chief nursing officer, IU Health West Hospital.
“I try to make my presence known especially during this time of year, because it goes along way when someone is not able to be with their family. I always try to be a good listener and allow them to plan what they will do differently next year with new sober life, while keeping the thought of being in treatment positive.”–Theresa L. Brown, RN, Director of Nursing at Solutions Recovery Treatment Center.
“For the patients with us over the holidays, we plan a Skype visit with the patient’s family if they were out of the area and unable to visit. On the holiday, one or two members of our Alcathon meeting will deliver gifts to the patients and offer their support.”–Corinne Conlin, RN, Director of Nursing at Sunrise House Treatment Center.
“I find joy in making my patients smile and laugh during times when they may feel stuck in the hospital during the holiday season! Once you start laughing, the healing starts.”– Mertis Shearry, BSN, RN, Director of Nursing at Laguna Treatment Hospital.
“Sometimes the best language between a nurse and a patient is the language of the heart. It makes people feel more loved and have a sense of belonging and purpose. And remember, serenity is an inside job.”– Kimberly Knapp, RN, Staff Nurse at Laguna Treatment Hospital.
Angela Mitchell, BSN, NS, CNML, Center Director, St. Paul’s PACE AKALOA, gave these tips:
- Encourage involvement in care as much as possible–loved ones can include neighbors, friends, church members, etc.
- Keep familiar items in the room such as favorite blanket/throw from home, pictures of family, etc.
- Spend at least five minutes at the bedside, engaging in a “moment of caring.” Research shows that time spent sitting at the bedside promotes trust, which ultimately improves nurse satisfaction, patient satisfaction, and patient outcomes.
- Provide a small gift. Even something small shows you are thinking of them and can bring patients joy during the holidays if they are feeling lonely.
- Spread some holiday cheer. Pick an appropriate time of day to gather 3 – 4 team members to perform a bedside Christmas carol (20 – 30 seconds top). This can be done periodically throughout the morning and afternoon shifts.
Caroline Park, LVN, Staff Nurse at Laguna Treatment Hospital, likes to remind her patients that: “The best gift you can give to your loved ones this Christmas is YOU.”