Category Archives: Current Issues

Immunization Exemptions and Pediatric Care

As a family nurse practitioner working in a pediatric outpatient clinic, assistant teaching professor Lacey Eden (BS ’02, MS ’09) educates parents about the general health of their child. Eden frequently addresses parents’ questions and concerns regarding immunizations for their child due to the requirement that parents provide either proof of completion or a certificate of exemption before their child can be enrolled in school.

Because of her experiences talking with parents about immunizations, Eden decided to research the rising immunization exemption rates in Utah. She is currently working on a standardized education module for immunization exemptions and also a mobile app called Best for Baby.

Education Model for Immunization Exemption Rates

Immunization exemption rates, particularly those granted for philosophical reasons, have risen drastically in Utah over the last few years. The rise in exemptions may have played a role in several recent outbreaks of vaccine-preventable diseases (measles and pertussis) in Utah, which prompted Eden to research the education provided for parents who wish to obtain an exemption. Currently she is investigating the specific education requirements for philosophical immunization exemptions in all states across the country and how effective this education is at combating the rise in exemption rates.

In her research, Eden found that all 50 states allow medical exemptions for immunizations, 48 states allow religious exemptions, and 18 states allow philosophical exemptions. Utah is one of the 18 states that allows all three types of exemptions. While 18 states allow philosophical exemptions, only 14 states require education before granting exemptions. The type of education parents receive varies from state to state and from county to county throughout Utah.

Eden has discussed her study with several prominent leaders of various associations and departments, including the health director and the immunization manager at the Utah State Health Department and the chair of the Utah Department of Human Services, in efforts to implement a standardized education module for Utahns to complete in order to gain a philosophical immunization exemption. She has also been invited to participate on an immunization exemption task force with several key participants in the state and with fellow College of Nursing faculty—Dr. Beth Luthy (MS ’05), Gaye Ray (AS ’81), Dr. Janelle Macintosh, and Dr. Renea Beckstrand (AS ’81, BS ’83, MS ’87). This task force is charged with creating a standardized education module that can teach parents the signs and symptoms of diseases, what to do if their child contracts a disease, and what to do in the case of an outbreak. The module will also answer frequently asked questions about immunizations and provide information about obtaining low-cost immunizations.

The Association of Immunization Managers and the Centers for Disease Control and Prevention have contributed to this project by aiding in the data-collection process and reviewing the research questions on educational requirements in reducing immunization exemptions.

Best for Baby App

In 2013, the Advisory Committee on Immunization Practices (ACIP) published its recommendation that pregnant women should get a Tdap vaccination between 27 and 36 weeks of pregnancy. Infants do not receive this vaccine until two months of age, but in the womb they do inherit temporary protective antibodies from their mothers, so it is essential for mothers to receive the vaccine and pass antibodies to their children in utero.

Despite being recommended by the ACIP, very few women receive the Tdap vaccine during their third trimester, so Eden, who serves as chair of the Utah County Immunization Coalition, decided to educate soon-to-be parents through a free mobile-device app called Best for Baby (now available on iTunes).

Though geared toward increasing Tdap immunization rates, the app does much more than just teach about vaccines. The program sends expectant parents weekly push notifications that provide updates on their baby’s development and when they need to see their OB/GYN. Additionally, updates tell parents what tests to expect at their next appointment, what those tests look for, and why they are performed. The app continues to give parents monthly push notifications for two years after the birth of the child. These updates include when the child should see a care provider, what developmental milestones he or she should reach during the month, and what immunizations that child should receive.

Enhancement in Education, Part One: The Manikins Among Us

This story is part of an ongoing series about the BYU College of Nursing’s Mary Jane Rawlinson Geertsen Nursing Learning Center and the College’s constant efforts to update it.

Eight new patients in the Mary Jane Rawlinson Geertsen Nursing Learning Center (NLC) just got the doctor’s orders: eight years of bed rest and weekly IVs. It may seem like an intense recommendation, but given that the patients are newly acquired manikins designed to help increase nursing proficiency, the tall order makes sense.

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The BYU College of Nursing recently obtained eight mid-fidelity nursing manikins, four of which are the Nursing Anne type, pictured above.

The manikins, four “males” named Kelly and four “females” named Anne, are created specifically for nursing programs. They replace eight older models, which were donated to BYU-Idaho, and come with many features that allow students to train in a variety of situations.

“You can set them to run scenarios,” says Kristen Whipple, NLC assistant supervisor. “It changes every day to a different lab. It’s something on Monday, and then it’s a different lab on Tuesday.”

The Anne and Kelly manikins are considered low to mid-fidelity, which means that they can represent a human to a reasonable extent. When purchased with digital equipment, including a device known as a SimPad, they create a more lifelike patient.

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NLC supervisor Colleen Tingey and student employee Brian Wing work to unload the new manikins, which have weights comparable to normal people.

“They serve a great purpose just as they are. If you add the SimPad to them, then you can hear heart sounds, lung sounds, belly sounds, GI tract sounds,” Whipple says. “The manikins give us a great opportunity to let you hear what the not-normal sounds like.”

BYU nursing students work with manikins, including four high-fidelity ones, throughout their time in the nursing school. During their first three semesters, students use Anne and Kelly to run through the basics of inserting an IV, dressing wounds, and communicating with a patient. Often students will pair up, with one treating the manikin and the other vocalizing potential responses from the patient.

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Appendages to the nursing manikins wait to be unwrapped.

Each one represents a significant investment in student education; according to Colleen Tingey, NLC supervisor, one Anne or Kelly and the accompanying equipment costs around $11,000 and lasts eight years. The high-fidelity manikins cost around $65,000 each and last only five.  Accordingly, the college makes use of high- and low-fidelity in order to maximize the investment for the students.

“It’s having the different ones that make the real success of the program,” Whipple says. “You really need both to do it well. The big ones seem like they’re better, but they’re good for certain things and [the mid-fidelity manikins] are better for some things.”

Whipple and Tingey, both nurses themselves, appreciate just how much manikins have changed how students are taught.

“I like the fact that it integrates more than just learning the skill. You’re practicing the communication and you’re bringing things together,” Whipple says. “I did go to nursing school, and I think, ‘Wow, I wish that I’d learned it this way.’”

Convergence: How One Disease Brought Four Lives Together

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Representatives from the awareness group Meningitis Angels accompanied by four BYU faculty members, with Beth Luthy and Lacey Eden on the far left, and Janelle Mcintosh and Renea Beckstrand on the far right.

Meningitis. It ebbs and flows in terms of public visibility, and for some people the disease is either unknown or not a concern. For others, however, it is constantly on their minds as they work to combat the risk of another outbreak.

Friday, September 16 will see the awareness group Meningitis Angels at BYU presenting information about the disease. Those in attendance will include Johnny Dantona and Leslie Meigs, two meningitis survivors, as well as Frankie Milley, the group’s founder and national executive director. Also present will be Lacey Eden, an assistant teaching professor whose passion is promoting vaccinations.

Here are their stories.

 

“I see those kids that are so helpless.”good-8

“I don’t know anything about it.”

That’s the phrase that assistant teaching professor Lacey Eden believes a lot of college students think when asked about meningitis, the infectious disease capable of wreaking havoc on a college campus.

“There’s not many people that know a whole lot about Meningitis B,” Eden says. That, she explains, becomes especially problematic on college campuses, where various factors including proximity of students, poor diets, little sleep, and lack of immunization requirements increase the possibility of an outbreak.

Besides teaching at the Nursing College, Eden also educates the general public about preventing infectious diseases through vaccinations. In fact, her involvement in that cause is what brought the Meningitis Angels, who work in the same cause, to her in the first place.

“It all started with House Bill 221 last year, which was a bill to require education before parents could get their immunization exemptions,” Eden says. The bill, which did not pass, would have required that parents learn more about immunizations before they could refuse vaccinations for their children. Eden and fellow teacher Beth Luthy worked tirelessly to promote it, meeting with the bill’s sponsor, Utah Representative Carol Moss, to help her write it and also giving interviews to the media.

This all made her a viable partner for the Angels’ upcoming Utah awareness campaign. As a vaccination advocate, she has accomplished much, including creating an app that helps mothers know when to immunize their babies and also heading a special interest group on immunizations for the National Association of Pediatric Nurse Practitioners. As a teacher, she knows how to work with students and faculty.

In April, the Angels asked for Eden’s help. She agreed; her first assignment was to meet with student body presidents from various Utah colleges to discuss meningitis and how to prevent it. The student body presidents, in turn, would return to their colleges and spread the information.

“So the whole idea behind the Meningitis B Awareness campaign is to educate college students about Meningitis B,” Eden says. “They took it back to the student body officers and talked about how they could do their awareness campaign on campus.”

Getting the correct information out there for students is a key focus for Eden.

“Even if we can educate a very small percentage of those people, hopefully those people will then educate their friends, and then their friends will educate their friends, and hopefully we can see people being more aware of this,” she says.

Another eventual goal of hers is helping develop college vaccination requirements, including at BYU. Utah is one of few states that does not have university vaccination laws.

“I think we should, especially because when you consider the severity of meningitis and how quickly it can be debilitating and even cause death, the fact that there is an immunization to prevent that. Even though it’s a small chance that you could get it, the repercussions are totally worth the requirement to get vaccinated,” Eden says.

One of her biggest motivations is her belief that immunizations are a social responsibility. If one person doesn’t get vaccinated, she explains, they could be putting individuals in their community at risk, especially those with weaker immunization systems.

“I think for me it’s those individuals who are immunocompromised and unable to get immunized, so they depend on everyone else to be immunized to protect them,” Eden says. “As my experience in the pediatric office, I see those kids that are so helpless, and those who can get severely ill from things like that, and to me it’s all about that. Protecting the weakest in our community is really a reflection of how we are as a whole.”

She also understands the wide array of opinions that are spread online, many of which are not backed by substantial medical evidence. Her hope is that this event will help students understand the facts behind the disease, and also that in the future students will rely on dependable sources for information about it.

“I feel like college students are very savvy with social media, and they can very easily get messages on social media about immunizations that are false,” Eden says. “I would just encourage them that while they’re doing their research that they look for credible, reliable research and sources that have a scientific basis and proof about vaccines and their safety.”

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“If you give up, you’re not going to get anywhere.”good-6

Johnny Dantona, 21, of North Carolina is definitely the athletic type. He enjoys baseball and basketball, and every Monday tries to make it to the bowling lane with family or friends.

“It’s a little difficult the way I have to stand and everything, but I do what I like to do,” Dantona says. It’s a little difficult for him because when he was three, he contracted meningitis and lost both legs.

Meningitis is a disease that inflames the area around the back and brain. It comes in many forms, including bacterial meningitis, which can kill a person in less than a day. Other times it leaves its victims with intensive medical issues. Dantona was no exception.

“I don’t remember much because I was so young, but I know that I was fine one minute during the day and then by midnight I was on life support in the hospital. I was in there for six months,” he says. “I ended up losing my fingers, both my legs, and the disease actually hit my whole left side of my body so my left side is weaker than my right.” That includes the left side of his brain, which slowed down his learning ability.

The years following the infection have had their challenges. Learning problems, medical costs, and the effort to obtain special prosthetics that insurance won’t cover have all been obstacles, but Dantona is not a quitter.

“If you give up, you’re not going to get anywhere. For me, this pushes me to do what I want to do, what I think is right,” he says. He walks the talk; Dantona was an ROTC member in high school and for training ran a mile on the track without his prosthetics. Despite the pain, he still goes out to try and walk as much as he can.

His family was eventually contacted by Frankie Milley and he soon joined the Meningitis Angels. Dantona is a national teen leader within the organization. His passion is helping raise awareness of the vaccination for college students.

“If it helps them, it makes me feel better knowing that they’re not going to go through the same stuff that I went through, or worse,” he says. “That’s what keeps me going.”

Despite the trials he has faced, he appreciates that his experience can have a positive impact on his fellowmen.

“With the college students though, even if they don’t understand what [meningitis] is, they see the side effects of what the disease does, so then most of them will go out and probably look it up and people will learn more about it if they want to,” he says. “I think them seeing us and how we look and how we get around is what helps them out a lot more, too.

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“What’s frustrating is that it’s all preventable.”good-5

Leslie Meigs, 26, doesn’t strike people as someone who came within inches of death from meningitis. However, her story reveals a long and painful journey spanning nearly 20 years.

When she was eight, the Texas native one day began feeling ill. Everyone assumed that it was the flu.

“Long story short, that night I was life-flighted to Texas Children’s Hospital and put on a ventilator,” she says. “They put me into a drug-induced coma for two months. There was a point where my brain function was almost completely gone, and the hospital had voted to go ahead and stop life support.”

Right when the doctors were about to tell her family the hospital’s decision, her right hand stirred. That saved her life and started her path to recovery. Slowly, she says, her brain function returned. However, the disease left her with a long list of health complications.

“I had to learn how to walk again. I have scarring all over my body,” Meigs says. “I had to go on continual dialysis because my kidneys were covered in scars, and so a lot of my scarring is internal. I have a lot of organ damage, a lot of blood issues.” In fact, years after she contracted the disease she had to receive a new kidney, donated by her father, and now has to take many medications to ensure that everything functions.

Meigs says that life for a survivor is difficult, both physically and mentally.

“So one of the big points I like to make when talking to fellow students or talking to the public in general is that with this disease, you don’t just get it and its gone,” she says. “If you’re lucky enough to survive the disease, you are reminded of it every single day, and you suffer every single day because of it.  It’s something that you have to learn to live with.”

“What’s frustrating is that it’s all preventable,” she says.

Meigs was one of the first victims with whom Milley worked. Milley had her help promote a bill designed to educate Texan citizens about the dangers of meningitis. Now, years later, Meigs works as a national teen leader for the group.

“Being able to communicate with people just how horrifying this disease is and how important it is to protect yourself and in doing so you protect others, it gives a purpose to our experiences to know that we can actually help people from experiencing this same sort of suffering and financial costs,” she says. “[Meningitis is] a long word of a long disease slapped onto the news with every other issue that’s going on, so to be able to put a picture, a face to it is what really makes the difference.”

Meigs is a strong advocate for everyone to receive the vaccination, not just to protect themselves but also others.

“The example I like to give for it being a public health issue is that it’s in the same line as traffic laws. You don’t stop a stop sign just to protect yourself,” she says. “You stop at a stop sign for other people. You don’t vaccinate just to protect yourself. You vaccinate to protect your entire community.”

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“Ryan didn’t have to die.”good-7

Frankie Milley is an exuberant Texas native who loves a good laugh. However, when it comes to talking about her work at Meningitis Angels, behind the smile is pain. Her story is one of loss and coping, as well as dedication to preventing further tragedies.

It all started Father’s Day, 1998. Her only child, Ryan, began to have a fever along with an earache.

“He was eighteen, just reached his pro golf status, just graduated high school, and was getting ready to go to college,” she says. Events quickly took a turn for the worst, in the process changing Milley’s life forever.

“Fourteen hours later he was laying on an emergency room table with blood coming from every orifice of his body, and he died,” she says.

Milley could not believe what had happened. In retrospect, she can now see that her situation paralleled that of many who have lost family to meningitis; there was limited information available at the time about the disease and the vaccine to prevent it. Milley became determined to change that.

“First I grieved, then I got angry, and then I got busy,” she says.

Since that day, she has helped write, by her count, almost 42 laws addressing vaccinations and meningitis.

In 2001 she founded the Meningitis Angels as a group dedicated to spreading facts to families. According to her, it was instrumental in convincing the CDC to put up recommendations about meningitis vaccinations. The group also works to educate policymakers about the issues involving the disease so that they make informed decisions.

Beyond those fields, the group serves as a hub for families who have been affected by the disease.

“Meningitis Angels also does a lot of hands-on work with the kids who are victims. We offer scholarships for college and technical training. We provide special equipment for the kids sometimes when the insurance doesn’t cover it,” she says.

The kids affectionately refer to Milley as “momma bear.”

“We’re a national support group. We’re like a big family,” she says. “We have a good time. We’ve laughed, we’ve cried together.”

That support becomes critical for families facing down meningitis. Milley lists several possible results of each case that extend beyond just the physical, including financial ruin, insurance problems, and fracturing of families.

She gives as an example one child within the organization who lost his arms and legs, thus requiring an attendant all day, every day.

To her, the choice becomes clear.

“If you weigh all the costs of all of that—some of it you can’t even put a price on, it’s life—if you put the price on the economics and the cost of the aftercare of meningitis, not to mention the millions that the first initial arrival to the hospital can take, what’s a vaccine?” she says.

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Meningitis Angels Spread the Word about Not Spreading the Disease

On Friday, September 16, Brigham Young University will host the Meningitis Angels, a nonprofit meningitis awareness group.

Several reasons to visit campus are to educate students that this disease is deadly and debilitating and that there are vaccines to prevent it, and that there are two separate vaccines they need to prevent it.

“The thing that people need to understand is that meningitis is not something where you’re going to go to the hospital, come home and be over it. It’s a lifelong disease,” says Frankie Milley, founder and national executive director of Meningitis Angels.

 

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Frankie Milley

As a mother who lost her college-age son to the illness, she has firsthand experience with how devastating it can be. Ryan, a healthy 18-year-old athlete, contracted it and was dead in less than a day.

After his passing, Milley formed the Meningitis Angels organization to help other families who had faced the disease and also to educate the public and policymakers on its effects. One of their main purposes has been to increase the amount of information available to families.

Meningitis, defined by the Mayo Clinic as an “inflammation of the membranes (meninges) surrounding your brain and spinal cord” comes in several forms, one of the most dangerous being bacterial meningitis, which claimed Ryan. The consequences can be devastating, with some dying in less than 24-hours.

Despite not being as prevalent as other diseases, the fact that some forms of meningitis spread rapidly in close quarters means that schools can be hubs for the disease, especially when there are students who are not immunized. The last few years have seen several types of meningitis outbreaks in Colorado, California, Tennessee, Oklahoma, Oregon, and other locations; some of these have been on college campuses.

This week, the Angels are working at Utah colleges to help students know the facts, especially with the need to obtain two different vaccinations to be fully protected—Meningococcal C4 and Meningococcal B.

“One child is too many, especially if it’s your child,” Milley says. “Ryan did not have to die. He could have been vaccinated and I would have my precious son with me today.”

 

 

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Johnny Dantona

Accompanying her are Leslie Meigs, 26, and Johnny Dantona, 21. Both contracted meningitis at a young age and survived, but not without significant health impacts. Meigs has extensive internal scarring and organ damage and had to receive a kidney transplant several years after the infection. Dantona lost both legs and sustained brain damage. Both are now members of the Angels organization and work to help fellow students get vaccinated.

 

“You don’t want to wait until it’s too late to where you have to understand the value of life and the value of living a healthy life,” Meigs says. She stressed that each person can protect not only themselves but others in their community by getting immunized.

Assistant teaching professor Lacey Eden and associate professor Beth Luthy have been instrumental in helping the Angels in their recent campaign. They hope that this week’s event will have a good outcome.

“There’s not many people that know a lot about Meningitis B,” Eden says. “Even if we can educate a very small percentage of those people, hopefully those people will then educate their friends, and then their friends will educate their friends, leading to  increased awareness across campus.”

The Meningitis Angels will be in the Wilkinson Student Center on Friday from 10 am to 12 pm presenting information and answering questions.

 

 

Baby app puts nursing grad on track for a job

Graduation. It’s the day you’ve been waiting for. After all final tests, late night studies and presentations, you stand ready to receive your diploma in cap and gown.

To find the first job after graduation is the goal for aspiring BYU grads. Annie Tyler, a college of nursing graduate from Merced, CA has made her time at BYU count. After graduation she will work at Cook Children’s Medical Center in Fort Worth TX; it is nationally ranked 6th in pediatric specialties by the U.S. News and World Report “Best Hospitals.”

“I feel really prepared and ready to go to work,” Tyler says. “All of our classes and clinical hours we do in the program have helped me so much to feel comfortable being in the hospital.”

Tyler and two other nursing students went above and beyond their studies by developing and writing a new mobile app under the supervision of Assistant Teaching Professor Lacey Eden.

Eden and Tyler look at "Best for Baby" app that promotes medically accurate information about vaccinations for pregnant women.

Professor Eden and nursing student, Annie Tyler look at “Best for Baby” app they developed that promotes medically accurate information about vaccinations for pregnant women.

This program promotes medically accurate information about vaccinations for pregnant women and tracks the immunization schedule of infants up to two years old. Because mothers can choose the best for their baby, they called the app “best for baby.”

“I think it really helped me to see how much nurses can influence people and how powerful they are within the community,” Tyler says. “People really trust us as nurses and it is not just working in the hospital, but it is also reaching out as a whole and helping people live healthier.”

Tyler’s focus was editing and making the app at an understandable level, and felt that it gave her an advantage on good research experience for her new job. Professor Eden also played a big part in her undergraduate experience with mentoring and learning, with a friendship that can last after graduation.

“The biggest take away in all of this is, even as a nursing student I can help future generations improve their health,” Tyler says. “BYU gives you a chance to get experience and gain close relationships to instructors that are fundamental about your career and in life.”

 

 

A proposal better than Disney World

BYU nursing students recently travel to Orlando, FL not for the beach, spring break or even Disney World but to present a proposal at the National Student Nursing Association (NSNA) conference.

Since receiving a $1000 grant, the BYU Student Nursing Association (SNA) have written and presented resolutions (proposed national nursing policies) for the past six years. The issues ranged from diabetes to shaken baby syndrome and each BYU SNA resolution presented has passed.

This semester, Deven Jennings and Vanessa Fisher, BYU SNA board members wrote a resolution on the issue related to veterans. The proposal further highlights the risk of PTSD and suicide against the veteran population, and has a firmer stance on the unresolved issue.

“It’s the first step in what will become a very large cascading snow ball effect,” Jennings says. “Hopefully, NSNA will be able to become more involved in veteran affairs as it recognizes the issue. Together we can help push national government policies.”

With the veteran resolution passing this year, it will be published in the NSNA magazine, sent to various organizations and affiliations around the country such as American Nurses Association and the National League of Nursing. It will have a national effect on nursing.

Deven Jennings presenting a proposal at the National Student nursing conference about veterans mental health.

Nursing student, Deven Jennings presents a proposal at the National Student Nursing conference about mental health for veterans.

BYU SNA advisor, Sondra Heaston hopes that the students understand the voice they have on issues that are important to them.  “My involvement is to mentor them through the process,” says Heaston. “I review their drafts and give comments, then I have the opportunity to sit back and watch them shine at the national conference.”

Thinking back a year ago, Jennings was inspired after taking a veteran class. He cared for WWII veteran Francis Simms, and was upset to learn that after coming home, Francis was never screened for PTSD and struggled with it his whole life. This lead to him writing a scholarly works project, and developed it into a simulation lab for BYU nursing students.

“It all started out with just the smallest little seed of interest and optimism,” says Jennings. “It then became a new simulation for students, and now is presented around the country. It has turned into something much larger than I ever thought.”

Be a Voice for Patient Safety

The problem is becoming more and more serious. In 1999 Americans learned from the study, To Error is Human by the Institute of Medicine that 98,000 patients die every year from preventable errors in hospitals. In 2013, a study in the Journal of Patient Safety found an increasing number between 210,000 and 440,000 patients are dying from preventable errors each year in hospitals.

This striking statistic is causing many to acUnited Safetyt. Each year, to help health care organizations increase safety, The National Safety Patient Foundation promotes an annual education and awareness week campaign. Patient Safety Awareness Week educates healthcare staff and patients about the importance of preventing errors within hospitals.

As a nurse it is important to start early, practicing good safety habits to keep patients safe and healthy. Patient safety research shows that most errors occur during change-of-shift report.  As a result, a standardized change-of-shift report was created to reduce nurse to nurse communication errors. The following is done:

    1. Require two nurse signatures
    2. Adhere evaluations

These two simple tasks can prevent many complications and can help patients get the correct care they need. For nurses it is important to increase communication during these pivotal moments of  in between care and shift changing.

As a patient it is also important to talk to your healthcare professional to make sure you understand your own care.  Make sure your nurse or hospital staff explain to you any medication, treatments or procedures. Ask the following :

  1. Name of your medication
  2. Purpose of your medication
  3. Time for your medication to be taken
  4. How to take your medication
  5. Side effects of the medication

If you feel your nurse or hospital staff have not answered these questions ask them to do so.

Together, patients and healthcare professionals can eliminate the problem of unsafe healthcare. As everyone works together with better communication, everyone can prevent errors in hospitals every day, and not just during Patient Safety Awareness Week.