Category Archives: Current Issues

Who Comforts Nurses?

Note: See our Facebook page (https://www.facebook.com/BYUNursing/) for this article’s accompanying video

Who comforts nurses?

It’s a question that may feel odd to ask, given that nurses care for and comfort others. People sometimes forget that nurses are human too.

So who is the designated person for nurses to turn to when their workload seems to be overwhelming them?

“Unfortunately sometimes nobody,” explains assistant teaching professor Stacie Hunsaker. Hunsaker studies two phenomenon that occur frequently in the nursing profession—burnout and empathy fatigue.

Burnout, she explains, is “exhaustion from the demands of work” and can happen in any job. Empathy fatigue is a condition that is a bit more specific to healthcare and has reaching consequences.

“That is when a healthcare provider feels too tired to care,” Hunsaker explains. “Maybe they’ve had a lot of emotional patients, a lot of emotional cases, a lot of things that cause almost PTSD. They didn’t experience the event that caused the stress, but by caring for others and having that empathy for them, it hurts them. People often build up a hard shell to prevent more hurt, so they stop caring.”

When a nurse experiences empathy fatigue, it can deeply affect the way he or she treats patients.

“Most of us decide to enter nursing because we love people and we care for people, and if you build up a wall, you can’t make that connection with a patient,” Hunsaker says. “It really can negatively impact the patient’s care. A lot of research has shown that it can negatively impact even a patient’s recovery.”

How common is empathy fatigue? According to Hunsaker, it’s fairly prevalent.

“There are a lot of studies and a lot of research that it’s most often recognized and probably the biggest problem in those areas that have more exposure to death or dying or psychologically exhausting patients,” she says. These areas include intensive care units, emergency departments, and oncology.

Luckily, research has also shown ways to combat empathy fatigue. Some are basic, such as getting enough sleep, exercising, and eating well. Hunsaker recommends that new nurses avoid picking up too many overtime shifts and take sufficient time to focus on themselves and their relationships with others outside of work. Positivity is also an important tool.

“The number one thing that’s easy to do that I would suggest for nurses is every night before you go to bed write down three good things that happened to you,” she says.

Additionally, nurses need to find someone who they can turn to for help. Research has shown that those who comfort in turn need someone to comfort them.

“I teach and try to tell my students and new nurses to talk to somebody that you know gets it or understands,” Hunsaker says.

One of these sources can be Heavenly Father.

“I can’t imagine practicing nursing without prayer and without praying before a shift, without praying before a difficult case or after,” Hunsaker says.

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Redefining Disability Awareness

According to the US Census Bureau, nearly 56.7 million people in the US struggle with some form of disability. That means that for every five people you meet on the street, at least one of them could be dealing with some unique physical, mental, or emotional challenge. But as a member of the College of Nursing media team has discovered, there’s more to that person than meets the eye.

Jonathan Schroeder is the newest member of the College of Nursing media team. He’s also part of a new social advocacy project working to change how people see and talk about disabilities.

“Sometimes, no matter how hard we try not to, we see people with disabilities differently,” Schroeder says. “When we think of Joe, the first thing we think of isn’t a brilliant student with a sense of humor; we think of the guy in a wheel chair. We don’t remember Suzy as a stunning artist; the first thing we think of is the girl who suffers from serious anxiety or depression. We forget that these people are so much more than the challenges they face.”

Schroeder and three of his friends started More Than What I Have (More Than), a project that is working to change how society sees disabilities.

“The goal of More Than is to recognize people for who they really are; not just the disability or challenge they might have,” says Kimball Vaughn, one of the project leads.

More Than showcases individuals with a wide range of disabilities; from well-known disabilities like Muscular Dystrophy and Cerebral Palsy to more obscure ones like Crohn’s Disease or Raynaud’s Syndrome.

“Not all disabilities are visible,” project videographer Dan Hainesworth explains. “There are a lot of people who struggle with disabilities/conditions like anxiety or depression. We need to be just as aware of their needs as we would be with someone in a wheelchair.”

But rather than just highlight the disability itself, More Than is trying to emphasize all the amazing things that people with disabilities do.

“We’ve found a lot of really cool stories,” Schroeder shares. “For example, there’s a guy on the BYU Cheer Squad that has MS and a girl with severe depression who is an amazing make-up artist. We’re hoping that once we get enough stories out there, that people will start to see those who struggle with disabilities as more than just ‘a disabled person.’”

The group recently launched a #MoreThanWhatIHave challenge to help celebrate BYU’s Disability Awareness Week (October 23 – October 27). Participants are invited to create a simple 10-15 second video and post it on social media with the hashtag #MoreThanWhatIHave.

“The video challenge is a really easy way for anybody to show support for those with disabilities,” Vaughn explains. “All you need to do is pull out your cellphone and talk about a challenge you struggle with. It could be stress, stage fright, ADHD, sleeping troubles – whatever you feel like sharing. Then tell us how you define yourself. Share how you are ‘More Than What You Have.’”

“We’re really excited about this challenge,” Schroeder adds. “We hope that once people start to see themselves as “more than their challenges” that it’ll be easier to do the same for people with disabilities.”

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The Importance of Apologies

Marie Prothero received the college’s 2016 Alumni Achievement Award in recognition for her contribution to the nursing profession. This article contains excerpts from her BYU Homecoming address, delivered October 13, 2016.

“I believe that for us to move healthcare forward into achieving quality healthcare and outcomes, [we must] have transparency,” says Marie Mellor Prothero (MS ’96), MSN, RN, FACHE. A nurse administrator, Prothero is the executive director of quality for St. Mark’s Hospital in Salt Lake City. She oversees quality assurance for her organization that includes electronic reporting, patient concerns, and physician compliance. She also strives to improve process flow and safety efforts.

Prothero is currently working on a PhD in nursing from the University of Utah; her dissertation is focused on transparency in healthcare and the role of an apology following a medical error.

The attributes of an apology include expressing regret and sorrow, admitting fault with a statement that an error occurred, listening with dignity and respect, correcting the mistake and ensuring it will not happen again, and offering restitution to the victim.

Her studies highlight several antecedents, such as why we apologize and the corollaries of not apologizing when there is a medical mistake or accident.

“We must realize [that the] consequences of not apologizing affects our emotional, spiritual, and physical well-being,” says Prothero. “And if left unresolved, [mistakes] can create feelings of bitterness and even increase litigation and settlement costs.”

To give an effective apology, one must express regret and sorrow; you cannot fully apologize without remorse. “A conversation casually informing a patient of the error is inadequate,” says Prothero, “and so is a statement that seems forced and insults others’ intelligence.” Appropriately apologizing takes the right setting and practice.

Prothero’s research serves as a starting point for additional inquiry to explore the nature and types of apologies. It will help other nurse leaders identify what comes after the apology and if the patient-provider relationship can be repaired.

“There must be ongoing communication as additional details are learned—with the patient and family members, as well as with unit staff and hospital administrators,” she says. “Once we identify system changes, we need to involve others in the process to ensure needs are met and proper training occurs.”

Further, Prothero’s studies clarify the role of nursing in disclosure, apology, and the creation of a culture of safety in which everyone feels valued and able to speak up. “We must continue the important work of quality assurance, process improvement, and system improvement,” she says. “Never forget that every patient matters.”

She also emphasizes that nurses have the opportunity to be leaders with a broad impact in their organization.

“Leadership is interdisciplinary and [is] a team approach,” she says. “You must know your strengths and weaknesses and understand what you bring to the team. Then surround yourself with people who are different from you and learn from each other for success.”

Prothero has been a leader her whole career. Before St. Mark’s, she was the CEO of Utah Valley Specialty Hospital in Provo for seven years, a CEO of Ernest Health for four years, and an operations officer with Intermountain Healthcare for 22 years.

“Never stop learning and developing your nursing and leadership skills,” she concludes. “Success comes from ensuring the success of your peers. Take time to remove roadblocks, recognize achievement, and encourage others. By being a positive influence, you can see the best in your team.”

 

A Trip They’ll Never Forget: Nursing Students Visit The Holy Land

With clinicals, Public and Global Health trips, and immense loads of homework, BYU College of Nursing students keep themselves busy. The idea of doing a non-nursing study abroad trip may seem out of the question for some, but eight nursing students lived the dream when they studied at the BYU Jerusalem Center this past summer.

Ironically, the students did not coordinate between themselves to go. It was mostly spontaneous decision-making by each student.

“It was just one day in class I was like, ‘You know, I think I really want to go to Jerusalem,’” Hailey Coburn, a fourth-semester student, says.

“None of us planned to go together, but we always found each other,” fourth-semester Jessica Butterfield says. Some, such as third-semester student Maggie Gunn, had friends or family who had attended before and highly recommended the experience.

Upon arrival to Jerusalem, the students realized that they were not in Provo anymore.

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Maggie Gunn in front of the Dome of the Rock

“It was unlike any country I’ve ever been to in my life, and that’s saying a lot because I’ve been to a lot of countries,” says globetrotting fourth-semester student Ashley Dyer, who has visited 23 countries.

“One of my favorite parts was walking through the Old City—you could smell all the spices and they always had their olives or their pickles,” Shannon Beech, fourth-semester, says.

The immense diversity of Jerusalem was a defining feature of the trip for most of the students, who appreciated being able to learn from the different people and cultures of the city.

“It was an absolutely incredible experience to be there and understand the culture a little bit better,” Gunn says.

“One thing that I learned from going there is that even more important than the sites is the people,” Coburn says. “There are some of the nicest people over there.” Students routinely were welcomed by locals and invited to participate in communal dancing and other activities. Each culture brought something new that the students were able to learn about and respect—for example, the students visited churches, a mosque, and a synagogue.

“It was really cool learning about the different cultures because I haven’t really been very familiar with Jewish or Muslim culture before, and I think that’s really going to help me in the future,” Dyer says.

The devotion of the adherents of the various religions in Jerusalem also struck a chord with the nursing students.

“When you think of the Middle East, everyone thinks about tension and violence,” Dyer says. “I mean, there was some violence going on, but it was definitely a lot more peaceful than I expected, and a lot more spiritual, both from my religion and other people’s religions as well. People are so dedicated to their faith and it really inspired me.”

“They all lived for a purpose,” Beech says. “That’s something that really hit home with me.”

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BYU Jerusalem students in traditional clothing

Life in the Jerusalem Center was a mix of hectic and spiritual.

“Something about the Jerusalem center is that everything changes—nothing is consistent,” Butterfield explains. “Usually five days a week we have class and our class schedule is not consistent.”

Students took classes on the Old and New Testaments, Palestinian history, local languages, and the different religions of the region. In between classes, students could relax in the lounge, visit local sights, or get food at the Center cafeteria. Butterfield noted that one of the best parts about the trip was not having to cook a meal for three-and-a-half months.

“Usually Mondays were our field trip days,” second semester student Katie Glaus says. Field trips could be within Jerusalem or farther abroad. During the semester, students visited Galilee, Jordan, and Greece on extended trips.

Adventures abounded during the students’ stay. They floated in the Dead Sea, canoed down the Jordan River, rode camels, visited the ruins of Petra in Jordan, climbed rickety towers in Greece, and explored old tunnels in Jerusalem.

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Jessica Butterfield in front of Petra in Jordan

One of the most important parts of the trip, however, was the bonding that occurred between the students. Several of them were assigned as visiting teachers to each other, and they all came closer as they struggled through the immense workload of the Center. Of course, the conversations would come frequently come back to nursing.

“Since I’m in a lower semester, I would always ask questions about the next semester,” Glaus says. “I would just always go to them for advice with nursing stuff.”

“I feel like there’s a special connection between us now,” Coburn says.

The students were impacted spiritually as well. Each had special experiences that contributed to both their spiritual growth and their nursing abilities.

“One thing that was very special about to the Holy Land was that we were able to go see the sights where Christ healed people,” says Dyer. Visiting these sights taught the students about charity and truly caring for patients the way Jesus Christ did.

“I think being there and also studying the life of the Savior while I was there and what He did for the people just helped me to be more loving and helped me to see the bigger picture,” Glaus says.

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Butterfield in Greece

Back in Provo, the students have to adjust to not hearing the Islamic call to prayer five times a day and not having cheap falafel (common street food in Jerusalem) within walking distance of their classes. However, the impact of the trip continues to be felt, and the students are confident that their nursing careers have been positively influenced by the trip.

“I feel like one of the cool things about this experience is that it’s still affecting me as I come back to normal life,” Butterfield says.

 

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Posing in traditional clothing

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Kosher McDonald’s

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Climbing to Petra

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Dyer in front of the tomb of Lazarus

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Glaus and Dyer in front of Petra

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Floating in the Dead Sea

Photos courtesy of Maggie Gunn, Jessica Butterfield, and Ashley Dyer

Happy Fall (Prevention Awareness Day)!

In 2007, a window washer astonished the world when miraculously he survived a 47-story fall. This past February, thousands of Youtubers viewed the footage of a Utah man surviving a 90-foot fall in the Grand Canyon.

While sensational falls like these attract a lot of media attention, they are just the tip of the iceberg.

In fact, the CDC estimates that every second of every day, an older American falls, making falls “the number one cause of injuries and deaths from injury among older Americans.”

That’s why today, the first day of fall, is Fall Prevention Awareness Day, sponsored by the American Council on Aging. The idea is to spread awareness of the dangers posed to seniors by falling and highlight preventative measures.

The CDC explains, “Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.” The CDC also estimates that the problem will increase as more and more Americans turn 65.

“[Falls] are very common in the older population,” says assistant teaching professor Dr. Blaine Winters, an expert on head injuries and gerontology. He believes that most falls go unreported despite the massive dangers they pose. Part of this, he thinks, comes from a lack of understanding about the nature of fall injuries or the health risks that can lead to them.

“Many times we hear ‘Oh, she fell and broke her hip,’ but in reality her hip broke because of osteoporosis which made her fall,” he says. He also points out that many times the consequences of a fall worsen over time, meaning that many Americans do not initially seek treatment and thus increase the chance of more serious health problems like a stroke.

That is why, Winters says, anyone, particularly older adults, who has fallen should promptly visit the emergency room. However, even more important are the preventative measures that even college students can start in order to reduce their future risk of falling.

“Fall prevention begins before you’re at risk for falls,” he says. Health living, including exercise, is critical to maintaining strong and flexible muscles into old age. Having proper lighting and removing tripping hazards in homes are also important.

BYU Earns Bronze Level Campus Recognition from American College of Sports Medicine

Last October as the Pokémon Go craze swept the nation, dozens of BYU students were treated to an unusual sight—a Pikachu tromping around campus. In between taking selfies with students, the mascot vainly tried to use its stubby arms to stabilize a foam board sign hanging from its neck that advertised an upcoming Pokéthon 3K run/walk for the BYU community.

That weekend, 140 people attended the event, chasing Pokémon as they completed the course. Few knew that their participation was a fulfillment of the hopes of a small cadre of BYU professors trying to improve BYU fitness levels, and that it would contribute to BYU being recognized as a Bronze Level Campus by the American College of Sports Medicine (ACSM), a distinction awarded on June 1, 2017.

Nursing professors Dr. Neil Peterson and Craig Nuttall and exercise science professor Dr. James LeCheminant are working together to implement the college campus version of an ACSM program called Exercise is Medicine. The initiative focuses on improving the fitness levels of community members through holding events, education, and evaluating people’s fitness using a measure known as the Physical Activity Vital Sign, which measures how much people exercise per week.

“Exercise is something that frankly is probably one of the most important things in medicine right now, because it can treat most diseases that are out there,” Nuttall says. “You exercise, your diabetes risk goes down. You exercise, your hypertension risk goes down. You exercise, your cancer risk goes down.”

“The scientific evidence of the benefits of physical activity to support and improve health is overwhelming,” LeCheminant says. “Health initiatives in large venues, such as a university setting, have the potential to positively impact many people. Promoting ACSM’s theme of ‘Exercise is Medicine’ puts focus on health which can lead to a higher quality and more productive life.”

The Pokéthon was the pinnacle of the team’s efforts; it also helped qualify BYU to earn the Bronze Level Campus ranking. Other work has included teaching BYU nursing students about the Physical Activity Vital Sign and evaluating work that the university has already done to increase physical activity, such as closing down parts of Campus Drive and improving sidewalk availability.

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Peterson representing BYU at the Exercise is Medicine award ceremony

The organizers of Exercise is Medicine told Peterson, who is the project leader, that they were surprised to see the large role of the BYU College of Nursing in this endeavor, given that most universities were wholly reliant on their exercise science departments to implement the program.

“They were really happy that our leadership team is interdisciplinary,” Peterson says. “Another thing that was impressive that they mentioned to me was that at our Pokéthon fun walk two thirds of our participants were community members, so we weren’t just getting people on campus. It wasn’t just faculty, staff, and students; we had a very sizeable community involvement because we do want to make our campus healthier, but they see the campus as an epicenter for the community.”

The Bronze Level recognition will last two years, but the team plans to find ways to earn possibly a Silver Campus ranking in the next year.

“The university should be very proud of the efforts that they’ve done already to make the campus safer for pedestrians, making it a more walkable campus, and really using the built environment to promote physical activity,” Peterson says. “These different levels of the awards help to give us direction to make sure that we are meeting what some national recommendations are as far as improving physical activity and reducing sedentary behavior on campus and in the surrounding community.”

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.