Today is World Sickle Cell Day—a day designed to spread awareness and understanding of sickle cell disease–an often painful inherited blood disorder.
The Sickle Cell Disease Association of America (SCDAA) is marking the 10th year of this recognition. There is no cure for sickle cell disease right now, although some patients have had success with various treatments including hydroxyurea treatment and bone marrow treatment.
According to SCDAA, complications from sickle cell disease (SCD) happen when a normal blood flow is reduced or prevented from flowing normally throughout the body. With SCD, some normally round red blood cells become crescent shaped (sickle shaped) and because of that change, can no longer flow through small blood vessels. These misshapen cells can actually cause a blockage, thereby reducing a normal blood flow that tissues need to stay healthy and to keep the body functioning properly. A common result is that reduced blood flow damages tissues and can lead to debilitating pain.
Blood cells with sickle cells don’t live as long in the body (about 16 days vs. 120 days for normal cells according to the SCDAA), so that rapid turnover can lead to the myriad complications that come with a sickle cell diagnosis including anemia and jaundice. Because SCD affects nearly every organ in the body, systemic complications can involve major systems including the lungs and kidneys. And the damage can also leave the body less able to fight off and control infections.
Current treatments are often a reaction to the complications, although some, like a preventative antibiotic and vaccinations in children, can help prevent complications from beginning. Patients may find various combinations of blood transfusions, pain management, antibiotics, breathing treatments, proper vaccinations, and other medications.
As with other chronic conditions, people with SCD have to take extra care with their own health. Because people are born with sickle cell disease, the disorder is a lifelong condition and can be especially challenging for children to cope with. Generally, a hematologist will manage the condition and any treatments. According to the Centers for Disease Control and Prevention, staying well-hydrated is especially important as is good nutrition and rest. Anyone with sickle cell disease can stay active to help overall health, but just be especially aware of fatigue and fluctuations in body temperature—moderation is the best approach.
According to the CDC, sickle cell disease affects about 100,000 people in the United States with a greater diagnosis rate in minority populations. Sickle cell disease happens in approximately 1 out of every 365 Black or African-American births and 1 out of every 16,300 Hispanic-American births.
More common is being diagnosed as a carrier of the sickle cell trait (SCT) which is not sickle cell disease. A carrier of SCT has one copy of the defective gene that can cause sickle cell disease (you need two copies to have the disease).
For those with SCD, finding a provider who is familiar with the disease and with cutting-edge treatment is important. Research information, through organizations such as the Foundation for Sickle Cell Disease Research is essential. But the emotional struggle of coping with a complex, chronic, and invisible disease that can have such disruption in someone’s life is big. Getting the emotional and social support of a caring community is going to make a difference in developing coping skills and getting through rough times.
If you know someone who is impacted by sickle cell disease in any way, today makes it easier to spread the word, provide education, and let them know they aren’t alone.
June is recognized as Alzheimer’s and Brain Awareness month and during this month nurses act as excellent resources for their patients.
Whether your primary patient population is young or old, education about taking care of this essential organ is important. And while Alzheimer’s disease causes the biggest impact on those 65 and older, early onset Alzheimer’s devastates families as well.
Alzheimer’s and dementia, although not the same, are related. Both conditions affect the brain because they are related to damage of the brain’s cells, but neither is actually a normal result of growing older.
Although Alzheimer’s has no cure, many experts believe that protecting brain health can help delay it or possibly avoid it. There’s no magic, however, as so many varied factors can weigh into whether or not someone develops particular brain diseases.
Because there are still so many unanswered questions, anything that can help brain health is worthwhile for people who have concerns about these conditions. Many times, anything that protects health in general, especially heart health, is good for the brain. Talking to patients about the importance of taking care of themselves in general, from food choices to protecting against preventable head injury, can lead into conversations and education about how to do that in everyday activities.
According to the Alzheimer’s Association, 60 to 80 percent of dementia cases are caused by Alzheimer’s disease, a specific brain disease. Dementia, on the other hand, is characterized by general symptoms of decline in thinking, including the memory issues that many people begin to worry about as they age, but it doesn’t always mean someone has Alzheimer’s.
What can impact someone’s chances of developing Alzheimer’s? Advancing age is a risk factor as more cases of dementia, including Alzheimer’s, show up in older people. But a family history can indicate a genetic risk for developing the disease. People who are Black or Latinx also have greater risk of Alzheimer’s disease, so education about heart health and controlling high blood pressure, high cholesterol, and getting heart-pumping activity can go a long way to helping keep hearts and brains healthy.
Although no one can cure Alzheimer’s yet, research is ongoing into medications and treatments that offer much hope for a cure. In the meantime, if patients ask what they can do, there’s plenty you can tell them. They can get involved in advocacy on the local, state, and national level. That could mean advocating for residents of a long-term care facility in their hometown or getting involved on a national scale to pass legislation that impacts the research and the people affected by Alzheimer’s and brain health in general. There are many clinical trials run through the Alzheimer’s Association, the Mayo Clinic, and the National Institute on Aging, among others that need people who might offer clues into the disease, whether they have a brain disease or not.
Patients can also learn what they can do to help their own brain health. Small things like ensuring rugs are not trip hazards, clearing walkways of snow and ice, wearing a seatbelt always, and being aware of sports with high concussion risk such as football or soccer can help prevent the injury that can lead to cell damage.
During June, have conversations with your patients to help get them started on a path that boosts their brain health.
Men’s Health Month is recognized every June, but it’s not a month exclusively for men. Men’s Health Month is an opportunity for men to learn more about their own health and how to protect it, but it’s also a time when women who have men in their lives—partners, husbands, brothers, fathers, friends, sons, mentors—can help support their healthy efforts.
Men have different health challenges from women. According to the Centers for Disease Control and Prevention (CDC) the leading causes of death among all men and of all ages are as follows:
- Heart disease
- Unintentional injury
- Chronic lower respiratory disease
By age group, the patterns are clear. Men aged 1-44 die most often from unintentional injuries. From ages, 45 to 84, cancer takes over as the leading killer of all men. For men aged 85 and older, heart disease is the top threat.
While heart disease, cancer, and unintentional injury cause untold suffering, there are steps men can take throughout their lives to help improve their health and lessen their chances of dying early.
Heart disease is a top killer worldwide and is often a silent disease, sometimes striking without other overt symptoms. It can lead to heart attacks, stroke, and heart failure.
Some common health problems are significant contributors to heart disease. The American Heart Association points to heart disease risks such as high blood pressure, high cholesterol, smoking, sedentary lifestyle, genetics, and obesity as contributing to the condition. Cancer is often caused by similar or the same triggers. According to the American Cancer Society, some cancer risk can be mitigated with healthier lifestyle choices and habits. Smoking, obesity, diet, activity level, and screening and vaccinations can help prevent some cancers.
As the third leading cause of death for men, unintentional injury seems like one that is out of the control of most people. But there are ways to incorporate safety measures into day-to-day life that will help men stay safer.
The Office of Disease Prevention and Health Promotion says the complexities around what causes an unintentional injury can have roots deep in social issues. But individuals can take steps to keep themselves physically safe in many instances. Alcohol and drug use can play a major role in events that lead to an unintentional injury, as can safety and anti-violence measures in the home and neighborhood environment.
Some easy fixes are never swimming alone, always wearing a seatbelt, making sure there are no loose rugs or other fall or trip hazards at home, careful home improvement activities, nurturing relationships, and not texting or being distracted while driving. Other factors are much harder to remedy easily including equitable access to reliable healthcare and emergency services, as well as perceptions and attitudes toward violence.
As men strive to live healthier lives and take control over the factors that can impact their short- and long-term health, beginning with what they are able to control is the first step.
Travel nurses are in great demand right now, as they are helping to relieve frontline workers during COVID-19. While health care facilities are doing everything they can to make environments safe, there are still specific risks that travel nurses are dealing with during this pandemic.
Georgia Reiner, Senior Risk Specialist, Nurses Service Organization (NSO), gave us the latest information about what’s happening with travel nurses, what the risks are, and what they can do to protect themselves.
Are hospitals throughout the country calling on travel nurses to relieve frontline workers? Is the main purpose to alleviate burnout of the frontline workers?
Travel nurses are in high-demand across the United States as hospitals work to treat surges of coronavirus (COVID-19) patients. This crisis arrived at a time when nurse staffing was already a concern due to a multitude of factors, including the growing health care demands of an aging population and nurses aging out of the workforce. Therefore, the demand for travel nurses seems to be primarily driven by a need to build up hospital capacity to handle the influx of COVID-19 patients.
Data from different staffing platforms show that throughout the pandemic, travel nurses are in highest demand in areas most impacted by the coronavirus, like New York and Washington State, and certain nursing specialties like ICU/Critical Care, ER/Trauma, and Med/Surg.
Certainly, as the pandemic continues, the sense of burnout among health care workers will intensify, and travel nurses will likely play an important role in helping to alleviate burnout.
This is a different situation for travel nurses. One risk is checking licensing in different states. What can travel nurses do to be sure that their license transfers? If it doesn’t, but frontline workers are still needed, are exceptions being made?
Before deciding to accept a job, nurses need to ensure that their licenses will allow them to practice in that state/jurisdiction. Multi-state licenses are available for nurses who meet the requirements, which include elements like background checks and education criteria. Temporary licenses are also an option—these are generally reserved for travel nurses who have accepted a job in another state and are awaiting their permanent license.
During the nationwide public health emergency due to COVID-19, some statutes and regulations regarding licensure portability may be relaxed or waived, so it is important for nurses to be aware of what the requirements are both during and following the emergency period. The National Council of State Boards of Nursing (NCSBN) has compiled information about the nurse licensure compact and emergency action taken by states, which is a great starting place for information.
When travel nurses are thrust into an unknown situation in a hospital/medical center that isn’t familiar to them, and they are working with systems they’re not familiar with, what’s the best way for them to cope? How can they avoid burnout themselves? Please explain.
Working in a new environment is inherently stressful. Getting used to new processes, technologies, hospitals layouts, and new people can be overwhelming under normal circumstances, and can be amplified during a crisis like COVID-19. Travel nurses should make sure to take time for self-care to preserve their mental health. This is a stressful time for everyone, so don’t be afraid to reach out to colleagues with questions and for support. Failing to make an effort to cope with these rapid changes can have a negative impact on personal wellness and patient care.
What about a nurse’s scope of practice? what can nurses do to make sure that they are acting in the scope of practice? What if the facility allows them to do more than their own state? Does their scope of practice relate to the state they’re in or the one they’re licensed in, or both?
As the COVID-19 crisis rapidly evolves, travel nurses may be given patient assignments outside of their typical practice areas and locations. When faced with situations that exceed the scope of practice for the state in which they are practicing, or the skills or knowledge required to care for patients, travel nurses, like all other nurses, should develop and implement proactive strategies to alleviate unsafe patient assignments. Nurses need to advocate for patient safety and for their nursing license by speaking up if an assignment does not fall under their scope of practice.
When the assignment is within a nurse’s scope of practice, but not within their realm of experience or training, saying “no” to the assignment could lead to dismissal. At the same time, if the nurse does not feel they are equipped to handle the assignment, they could potentially put patient safety at risk. In these scenarios, nurses should tell their supervisor that they have very limited experience in that area and should not be left in charge. The nurse should describe the task or assignment they don’t feel equipped to handle, the reason for their feelings, and the training they would need to be more confident and better prepared.
What changes have occurred during COVID-19 regarding travel nurses and the risks they face that you think should be permanent either for the near future or forever?
Currently, there are certain state and federal regulations, declarations, and orders that extend liability immunity in the fight against COVID-19. What’s not clear at this time is the breadth and scope of these regulations and orders.
For example, it is not clear if these orders and declarations extend to all providers in all areas of service or if such immunity will be limited and specific to certain types of health care providers. Since there is lack of clarity in terms of immunity, it is prudent for nurses to not presume they have any immunity.
Further, plaintiff’s counsel can file a lawsuit, immunity or no immunity, if the plaintiff’s counsel believes the client was injured and that injury was the direct result of the nurse or other health care professional providing or failing to provide professional services. In the best-case scenario, the suit brought against the nurse will be deemed baseless and their malpractice insurer will work to get the suit dropped/dismissed.
Is there any other information that is important for our readers to know?
The COVID-19 pandemic is still evolving, and there is much we still do not know about the virus. All nurses should continue to follow the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for updates and guidance to help prevent the spread of the virus and protect themselves and their patients.
As the nation struggles through the health, social, and economic upheaval of the COVID-19 crisis, nurses are at the crux of it all. As nurses cope with the physical and emotional impact of working with so many critically ill patients and in conditions that often threaten their own well being, they are simultaneously juggling worries about their families and loved ones. The toll on the nation’s nurses has been steep and many are feeling the effects of mental health struggles with burnout, exhaustion, anxiety, depression, and post-traumatic stress disorder symptoms.
If you’re experiencing any symptoms of mental health struggles, there are resources available to help. It’s always said that you can’t effectively help others until you take care of your own needs and that is especially relevant for nurses right now. It also poses a dilemma as many nurses barely have time to eat or sleep with the schedules they are keeping and the demands being placed on them. In that kind of situation, it can seem impossible to try to get help for yourself when you have no time to have a thought.
But it’s important. As nurses have supported this country through the crisis that is still unfolding, they will continue to see a need for their services. The COVID-19 crisis is not going away for many months, possibly longer, and nurses need all the support they can get to make it through.
If you’re a nurse and you’re noticing signs of depression or anxiety in yourself or your colleagues, acknowledging that support is needed and warranted is the first step. If you’re personally experiencing symptoms, prioritize times when you can fit that kind of support into your schedule, so that you can find the help when you can access it. If you’re a manager, make sure your employees know how to recognize when they could use help and have the resources to access it. Many organizations offer free counseling as part of their health insurance plans, so that’s also an option to investigate.
Here are some resources:
If you’re experiencing thoughts of suicide, feel in danger of hurting yourself, or need immediate help, call the National Suicide Prevention Hotline at 1-800-273-8255.
American Nurses Association offers specific resources for nurses who are experiencing mental health distress of any level.
The National Alliance on Mental Illness (NAMI) can help you understand some of the typical treatments available to help.
Mental Health America offers specific tips for those experiencing COVID-19 stress and for first responders.
National Institute of Mental Health (NIMH) has brochures and fact sheets for education and awareness of many symptoms and how they are best treated.
The World Health Organization has information on how policies are shaping priorities around nursing and mental health.
MentalHealth.gov can help you determine if you’re experiencing symptoms of post-traumatic stress disorder.
The personal risk of ignoring the signs of mental distress is particularly significant for nurses. To have the very people the nation is leaning on continue doing a herculean job without help for their own struggles is unacceptable. There needs to be time and resources for nurses to get the help they need and to unburden themselves of the intense and unrelenting stress they have experienced.
In 2014, Melisa Wilson, DNP, ARNP, ACNP-BC, the Clinical Operations Director and Pulmonary Hypertension Program Coordinator at AdventHealth Orlando, discovered a lump in her breast. Fearing a cancer diagnosis, her husband encouraged her to see her doctor immediately.
Wilson nearly didn’t. After all, she didn’t have a family history of breast cancer. She thought it was a mammary duct drying up as she was pumping breast milk less for their child.
Thankfully, she listened to her husband. An ultrasound led to a biopsy and then a diagnosis.
“I was taken entirely by surprise. The journey was swift from the time we felt the lump to diagnosis—just eight days. I did not expect to hear, ‘I am sorry, Mrs. Wilson, you have breast cancer,’” Wilson recalls.
Wilson’s diagnosis was Stage IIB HER2 positive, and for the next 18 months, her treatments included Herceptin, Perjeta, Carboplatin, Taxotere, and Neulasta. Her inspiration was her son, who had been born at 23-weeks. “He fought for his life, and in turn, it inspired me to fight for mine,” says Wilson. “My faith in God got me though.” She also had tremendous support from her family, work family, friends, and her oncology team, including her NP, MD, and LCSW.
The most challenging part of her journey, Wilson says, was financial. “The bills for oncology treatment came in quickly and were very high. I maintained my full-time job as a nurse practitioner, though, with some accommodations. I would work up to the day of chemo, take six days to recover, and then return to work for another two-week cycle,” she recalls. “It was hard, and the bills would be overwhelming to deal with at times. I remember being at chemotherapy and getting a call asking me to pay several thousand dollars to pay for a test I needed.”
Wilson beat the cancer, and she says that she now can more easily empathize with her patients because of what she’s experienced. “As an NP, I can relate to my patients on so many different levels. My patients have a rare cardiopulmonary disease—pulmonary hypertension. Most have no idea what pulmonary hypertension entails,” she says.
A few years ago, Wilson says, she had a patient who was scared about having a line placed in her chest. This needed to be done for infusion of pulmonary hypertension treatment. The patient experienced a lot of pain due to being on a subcutaneously infused machine. “One day I called her and asked for her to come in for an office visit with me. I explained that I had done as much as I could to manage her pain, and she needed to consider a different route of infusion. She was tearful and upset. She was concerned about her body image,” says Wilson. “I showed her my port, though it was different and showed her my head, which was hairless due to chemo. I told her, ‘I understand what it is like for your body to change in front of your eyes, but these are the things we do to survive.’ We cried together, and she went on to have the line placed.”
Just recently, Wilson says that her mother was diagnosed with breast cancer. Wilson believes that she went through her journey so that she can help others and that cancer taught her how to live and not be as fearful. “My tribulation shaped me, and now I help my Mom. I am happy to be her advocate,” says Wilson. “Being there for her and not feeling helpless is rewarding. I know it gives her comfort.”