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Princeton, MNPermit No. 14

Volume 38 • Issue 2 June, July, August 2011

Circulation to 76,000 Registered Nurses, Licensed Practical Nurses and Student Nurses in Alabama Alabama State Nurses Association • 360 North Hull Street • Montgomery, AL 36104

The Official Publication of the Alabama State Nurses Association

Inside Alabama Nurse

2011 Convention ASNA & ALONE

Registration

0

Prevention Might Just Be The Cure - Conference

Schedule and Registration

Page 13

Inside this IssueAlabama Board of Nursing Vacancies . . . . . . . . . . . .2

ASNA Board of Directors . . . . . . . . . . . . . . . . . . . . .2

CE Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-17

Convention Registration (Pull out Section) . . . . . 9-11

ED’s Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Environmental Corner . . . . . . . . . . . . . . . . . . . . . . . 18

Legal Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

LPN Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Membership News . . . . . . . . . . . . . . . . . . . . . . . . . .7

President’s Message . . . . . . . . . . . . . . . . . . . . . . . .3

Research Corner . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Save These Dates . . . . . . . . . . . . . . . . . . . . . . . . . .1

SAVE THESE DATES

ASNA/ALONE/AANS CONVENTION 2011

Auburn University Hotel & Dixon Conference Center, Auburn, AL

October 20 Through October 22, 2011CONVENTION REGISTRATION IN PULL

OUT SECTION

NOW ON ASNA WEBPAGE

www.alabamanurses.orgMembership Applications

ASNA Scholarship Information

MEMBERS ONLY SECTION ASNA WEB PAGE

www.alabamanurses.orgLook for important convention issuesVisit ASNA’s website for:

• Bylawchanges-maycontactASNAifyou need more information.

• ASNABallot• ProposedResolutions

ATTENTION LPN’s2011 IS LPN’s RENEWAL YEAR

ABN DEADLINE ISNOVEMBER 30th

The ABN will have on-line capability, including payment by credit card. You may also pay by

personal check.

Attend the ASNA Convention to meet your CE needs!

It’sthattimeagain,andtheASNABoardofDirectors/AlaONL/AANS invites YOU to attend the 98th AnnualASNA Convention. We continue to offer the bestcontinuing education, networking and participationopportunities for a fair price and in a convenient format to meet your needs.

Thursday, October 20, 2011 is the Mable Lamb Continuing Education Day from 8:15 a.m.– 4:50 p.m.There is something for everyone and you may registerseparately for this event. Opening Ceremonies begin at5:00 p.m. with Patricia Pearce, MPH, PhD, FNP-BC,FAANP, as the keynote speaker. A President’s receptionwillbeheldfrom6:30p.m.until7:00p.m.WearehavinganAwardsBanquetThursdayNight from7:00p.m. until10:00p.m.Plan to come for the educationor come earlyfortheConventionandstaytomeetandgreetothernurses.Itwillbealotoffunandagreatnetworkingopportunityforallwhoattend!

Friday,October21,2011beginswithExercise,Zumba, withMarilynRhodes,EdD,RN,MSN,CNM,at7:00a.m.A Continental Breakfast from 7:30 a.m. until 9:00 a.m.Exhibits will be open from 8:00 a.m. to 12:30 p.m. andyou’llwanttovisitthemall.Weofferanotheropportunityforcontacthourswhenyouview thePosterPresentationsavailable from8:00 a.m.–12:30p.m.OptionalContinuingNursing Education Sessions from 9:00 a.m.–11:00 a.m.Plenary Session from 12:30 p.m.–1:30 p.m. The HouseofDelegates from 1:30 p.m. until 5:00 p.m. This is youropportunitytohaveyourvoiceheard.We’llbediscussingANA changes, Resolutions, and other matters ofimportancetoASNA.5:30p.m.+SupperfollowedbyplayNunsence.

Saturday, October 22, 2011 will begin with Exercise-GuidedwalkingtourofareawithFrankCanada,BA,RNat 6:30 a.m. Continental Breakfast from 7:00 a.m.–8:00a.m.Pollsopenfrom7:30a.m.–8:15a.m.PlenarySession

from8:15a.m.–9:15 a.m.TheASNAHouseofDelegateswill then convene at 9:15 a.m.–12:15 p.m. Lunch andthe closing plenary sessionwill be from12:30 p.m. until2:00p.m.Wehopeyouwilljoinusandtakeadvantageofthe CE offerings, to network with old friends and makenew ones, and to give yourself the gift of professionalinvolvement. Several fun activities will be interspersed throughoutthemeeting.

Markyourcalendarnow!ComebeapartofAlabamanursesmakingadifference.Findouthowgooditcanfeelto represent your district and your profession as we address the critical nursing issues facingus today.Please use the Convention 2011 special pull-out section for all yourregistrationneeds.

WelookforwardtoseeingYOUthere!

We’ll See YOU There!

ASNA’s Response to the Tornadoes

Our thoughts and prayers go out to all citizens andespeciallytonursesandtheirfamilieswhohavesustainedlossduringthetornadoes.ASNAhascollectedsomesmallmonetarydonationsandsomeessentialitemstodate.Themoniesarebeingplacedinourtaxdeductablefoundation(Alabama Nurses Foundation, 360 N. Hull Street, Montgomery, Al 36104). Please consider giving to thismostworthy cause.ASNA is helpingmembers first thenmoving our efforts to the communities affected. Pleasegive;itcouldbeanyoneofusneedingthishelptomorrow!

Dr.JoyceVarner,PresidentASNA

• The Alabama Nurse June, July, August 2011

ASNA Board of Directors

President . . . . . . . . . . . . . . . . . . JoyceMcCullersVarner, DNP,GNP-BC,GNCSPresidentElect . . .ArleneMorris,EdD,MSN,RN,CNEVicePresident . . . . . . . . . . . . JackieWilliams,MSN,RNSecretary . . . . . . . . . . . . . . . . . . MardellDavis,PhD,RNTreasurer . . . . . MarilynRhodes,EdD,RN,MSN,CNMDistrict1 . . . . . . . . . . . . . . . .LauraChapman,MSN,RNDistrict2 . . . . . . . . . . RubyMorrison,DSN,RN,CMACDistrict3 . . . . . . . . . . MarilynJohnson,BSN,RN,MPHDistrict4 . . . . . . . . . Henrietta“Henri”Brown,DNP,RNDistrict5 . . . . . . . . . . . . . . . . MaggieAntoine,MEd,RNCommission on ProfessionalIssues . . . . . . . JeanIvey,DSN,RN,CRNPSpecial Interest Group:AdvancePracticeCouncil: . KarenDavidson,DSN,CRNP

ASNA STAFF

ExecutiveDirector,JosephF.Decker,II,MADirectorLeadershipServices,CharleneRoberson,

MEd,RN,BCASNAAttorney,DonEddins,JD

AdministrativeCoordinator,BettyChamblissProgramsCoordinator,AprilBishop

334-262-8321Phone

VISION STATEMENTOur Vision

ASNA is the professional voice of all registered nurses in Alabama.

OUR VALUES

• Modelingprofessionalnursingpracticestoothernurses

• AdheringtotheCode of Ethics for Nurses• Becomingmorerecognizablyinfluentialasan

association• Unifyingnurses• Advocatingfornurses• Promotingculturaldiversity• Promotinghealthparity• Advancingprofessionalcompetence• Promotingtheethicalcareandthehumandignityof

every person• Maintainingintegrityinallnursingcareers

OUR MISSION

ASNA is committed to promoting excellence in nursing.

ADVERTISING

For advertising rates and information, please contactArthur L. Davis Publishing Agency, Inc., 517Washington Street, PO Box 216, Cedar Falls, Iowa50613, (800) 626-4081, [email protected]. ASNA andthe Arthur L. Davis Publishing Agency, Inc. reservethe right to rejectanyadvertisement.Responsibility forerrorsinadvertisingislimitedtocorrectionsinthenextissue or refund of price of advertisement.

Acceptance of advertising does not imply endorsementor approval by the Alabama State Nurses Associationof products advertised, the advertisers, or the claimsmade. Rejection of an advertisement does not imply aproductoffered foradvertising iswithoutmerit,or thatthemanufacturerlacksintegrity,orthatthisassociationdisapproves of the product or its use. ASNA and theArthur L. Davis Publishing Agency, Inc. shall not beheldliableforanyconsequencesresultingfrompurchaseor useof an advertiser’s product.Articles appearing inthispublicationexpresstheopinionsoftheauthors;theydo not necessarily reflect views of the staff, board, ormembershipofASNAor thoseof thenational or localassociations.

The Alabama Nurse ispublishedquarterlyeveryMarch,June, September andDecember for theAlabama StateNursesAssociation,360NorthHullStreet,Montgomery,AL36104

© Copyright by the Alabama State Nurses Association.Alabama State Nurses Association is a constituent member of the American Nurses Association.

PUBLICATION TheAlabamaNursePublicationSchedulefor2011

Issue Material Due to ASNA OfficeDec/Jan/Feb2012 November1,2011

Guidelines for Article DevelopmentTheASNAwelcomesarticlesforpublication.ThereisnopaymentforarticlespublishedinThe Alabama Nurse.1. ArticlesshouldbeMicrosoftWordusinga12point

font.2. Articlelengthshouldnotexceedfive(5)pages8x113. Allreferenceshouldbecitedattheendofthearticle.4. Articlesshouldbesubmittedelectronically.

Submissionsshouldbesentto:[email protected]

orEditor,The Alabama Nurse

Alabama State Nurses Association360NorthHullStreetMontgomery,AL36104

Condolences to:Dr.SheliaMarable’sfatherpassedawayApril28.

Betty Grammer’s Mother-in-Law passed awayApril21.

BettyChambliss’brotherpassedawayMay27th.

Alabama Board of NursingVacancies

Therewillbe2 RN positions open and 1 LPN position open as ofJanuary1,2012.Thetermof

MonicaCauley,NursingEducation;CatherineDearman,NursingEducation;andSharonPugh,

AFLPNwillexpireDecember31,2011.RNapplicationsonlyareavailablefromtheASNAoffice.

CallBetty!

Awards Nominations Made Incredibly

EasyThe Awards nomination process just got easier. You

can now nominate some deserving person/organizationforASNAawardsbygoingtotheASNAwebsiteatwww.alabamanurses.org. On the home page click on “ASNAAwards Criteria/Nomination Forms”. All the awards andthe criteria are listed. You can go under the awards andenter the information right on line or you can downloadthe form, fill it in and send it back to ASNA by email,mail or fax.For aperson,youcandownloadand fill outthe Biographical Form or you can send in a CurriculumVitae (CV) if you like. You can download a letter ofsupport form, fill it out and send it back to April at ASNA or you can send in a letter by mail, email or fax. Awards forthisyearmustbesentinbyJuly23,2011.Therearealotofveryspecialpeopleout thereweneedtohonorandrecognizefortheirefforts.Pleasetakethetimetodothis.WechallengeeachoftheDistrictstosendinanominationfor each of the awards. Come on–Make the AwardsCommittee’sjobharder;itwouldthrillus.

June, July, August 2011 The Alabama Nurse •

The President’s Message

Offering Self by Joyce McCullers Varner,

DNP, GNP-BC, GNCS

As I sit here looking outmyoffice window at my beautiful backyardwithsomanyflowersI feel tears well up thinking ofthepeopleinAlabamawhohavelostsomuchtothetornadoesofApril 27, 2011. I am thinking,as I have for the last week, ofhow fortunate so many of usare and howmy heart goes outto those not so fortunate andmy mind goes back to nursingschool at Wallace Community College in Selma duringmy first semester. Mrs. Paula Saliba was talking to ourclass aboutoffering self andwhat thatmeans as anurse.Sheexplained thatasanurseweofferourhandsoncareperforming technical tasks and then we offer “self” bygiving our care and compassion. Tome, this meant thatas a nurse Imust knowhow to performdaily tasks suchas dispensing medication, deciphering orders, bathing,turning, starting IVs, and all the things we do daily. Iinterpreted the offering self part to mean the backs wepat, the hugs we give, the care we show to families ofour patients, the hundred and one things we do that arenottechnicalatall,butareheartfeltandsometimesmeanmuch more than starting an IV. The touch of a hand, awink, the thumbsupwhen a patient is able to get out ofbedwithoutassistance,thephonecalltoadaughterinthemiddleofthenighttoassureherthathermotherorfatheror child is resting well and is okay, the true giving of“self”thatmakesourprofessionremaintoday,asithasforahundredyears,themosttrustedprofession.Thisiswhatseparates us fromother professions:weoffer “self”.Andthisofferingofselfbringsusuntoldrichesintheformof

thanks and appreciation and a feeling of satisfaction thatwe trulymade a difference in the life of another person.Thisiswhatnursingisallabout,afterall.

With the thousands of tragedies ranging from loss oflifetolossofhome,pets,friends,personalbelongingsandthe acquisition of haunting memories during this time,nurses are at the forefront of the battle.Not just to offertechnical care but to offer self to those people who lostso much and have such need. Nurses are always on thefront lines of disasters and this one is no exception.Wehaveheardsomanystoriesfromnurseswhoweredirectlyaffected and those who immediately responded to thosewho needed them while putting their own needs aside.Wehavehadnurses calling frommany stateswanting toknowwhere tocome tohelpandhow toget involved. Inallnaturaldisasters,nursesmakethesecallsgoingbeyondstate borders to offer self in any way needed. It makes me so proud ofmy profession andmy colleagues to see thishere in our state.Alabamanurses responded inwaves tothe needs of people in Mississippi and Louisiana afterHurricane Katrina and we are doing this now for ourown residents. We have many members who need helpand many members who are helping but we need more.In thecomingmonths,after the firstandsecondwaveofassistanceisgonetherewillbemuchworktobedoneforlong term care recovery. As members of ASNA we areworkingtoplanhowwecanhelpinthelongtermeffortsas well as the first and second wave of assistance. Weknow that long term commitment is needed and we aregoing to honor our part in this recovery by working toidentifyneedsfromallthedistrictsaffectedandhelpingtomeetthoseneeds.Wewillbeidentifyingspecificneedsonourwebsite and through email blasts tomembers so youmay choose howyou can be involved andwe can assurethatwewillbeinvolvedforthelonghaul!Thisisourstate,ourpeople,andthisiswhatweareherefor.So,ifyouareamemberitistimetoactandifyouarenotamemberthenit is time to joinwithus inour fight tohealandcare forourresidentswhoneedus.Wearenursesandthisiswhatwe do.


The E.D.’s Notes

Joseph Decker

Legal Cornerby Joseph F. Decker, II

Executive Director

All other events and issuescurrently in our view pale in comparison to the terriblestorms that struck Alabama onWednesday, 27 April. The lossof life and widespread damageis truly astounding. Please keepall of the folks affected by thisimmensedisasterinyourthoughtsand prayers going forward.In addition, please consider volunteering and/or making acharitable donation to the manyagencies who are now heavilyengagedintheareasaroundthestateforcleanup,repairandrenewal.Many,many of our fellowAlabama citizens needourhelp,andweallneedtostepupnow.Afterall,theseareour neighbors, friends and family;we should all be first inline to offer aid and assistance.

Our annual ASNA “Nurses at the Capitol Rally” held on Wednesday, 6 April from 10:00AM–12:00 noonon the steps of the Alabama State House was another bigsuccess. This event is always a lot of fun, and goes a longway towards publicizing the profession of nursing in ourstateanddemonstratingtheimpactnursescanhaveonbothhealthcare delivery and public policy. As you may recall,wehadoriginally scheduled the rally for the9thofMarch,butacertainforecastofnotonlyrainandthunderstormsbutperhapsevensevereweatherforcedustocancelandresetfor6April.(Bytheway,theweatheronthe9thofMarchwas,infact,awful!)Thathiccupnotwithstanding,wesuccessfullyresetandhadagreatcrowdofnearly500inattendance.TheBrookwoodHighSchoolBandunder thedirectionofCraigHenson provided outstanding music and entertainment andinjectedlotsofenergyintotheassembly. Gov. (Dr.) Robert Bentley was our lead speaker and, as is his custom, hadwonderful things to say aboutnurses inAlabama.Weverymuchappreciatehimtakingthetimefromhisbusyscheduletobewithus.Inaddition,Rep. Greg Wren(R)Montgomery,Rep. April Weaver (R)Alabaster andSen. Tom Whatley (R) Auburn addressed the crowd and were enthusiasticallygreeted.We also had an impromptuword of support fromRep. Craig Ford of theHouseDemocratic Caucus.We aregrateful to all of them for taking the time to talk with usduring a very busy legislative day in Montgomery. Otheroutstanding speakers in the program included Dr. Joyce Varner, ASNA President; Richard Brown, APRN, J. D.,NPAAPresident;Dr. Diana Dowdy,CNM;and,subbingforDr. Ruby Morrison, ALNursing Coalition President whowas ill,Dr.Morrison’sdaughterMelissa Hatter,RNandagraduate student studying to become a nursemidwife. Theentire event was emceed by our own Deborah Andrews, Chief Nursing Executive at Cooper Green Mercy Hospitalin Birmingham. We also had enthusiastic participation

from student nursing groups from Auburn Montgomery, Snead State Community College and Northwest Shoals Community College.Finally,wehadexcellentpresscoverageagain this year fromNBC/WSFA-TVandCBS/WAKA-TVinMontgomeryandABCChannel32inDothan.

ASNA’s annual FACES continuing education event heldon26AprilattheEastmontBaptistChurchinMontgomerywas again a huge success, with attendance just under 700.Thisyearwehad10tracksfromwhichtochoose:Cardiology;Clinical1,2and3;Psych/MentalHealth;Obesity;Diabetes;Pediatrics; AANS/Student (NCLEX, etc.); and a grab bagof “mini” or stand alone miscellaneous topics. The AMplenary session was presented by Deborah Kilgo, RN onImmunizationinAlabama(sponsoredbyPfizer)andthePMsessionbyDr.LynnHillhouseonTheConceptofResilienceinNursing(sponsoredbyArthurDavisPublishing).Withover40 topics and as many different speakers–all outstanding,of course–just about every interest was covered. We alsoenjoyedposterpresentations,with34availableonamyriadofsubjects.Andofcoursewehad theusual superbhospitalityfromtheentirestaffatEastmontBaptist;anddidImentionthe terrific lunchservedofgreensalad,bakedpotato, steakand wonderful desserts (peanut butter chocolate pie andstrawberrypieamongthem!).Toallthatattended:thankyousomuch.Andtothosethatmissedout:checkthisspaceandtheASNAwebsitefornextyear’sFACESevent(tobeheldinAprilatthesamelocation).Youwon’twanttomissit!

AfewwordsaboutASNAlegislativeeffortsthisyear.Asof thiswriting theLegislature iscomplete through the23rdlegislativeday.Therearenowonly7daysleftinthecurrentsession, and the Legislature will break for two weeks forpublic hearings across the state on the upcoming districtreapportionment effort.Theywill reconveneon the24thofMay.OurNursing Scholarship bill (HB372, Rep. Weaver/SB209, Sen. Whatley)hasmadesomeprogress,andisnowthroughCommitteeinbothhouses.(FYI,Rep.AprilWeaver,an RN andASNAmember, has been a true champion fornurses during this session and is vigorously pursuing ouragenda.Sen.WhatleyismakingsimilareffortsintheSenate.Weowe themboth a big round of applause.)We anticipatea vote in the full House onWednesday, 25Maywhich, ifsuccessful,wouldstillgiveusanopportunitytogetthroughtheSenatebefore the2011 sessionadjourns.TheEducationTrustFundbudget still has $150K for nursing scholarships,andwehopetoholdontothat.Thereareanumberofotherbillsinwhichwehaveaninterestandaretracking.Youcangotoourwebsite(www.alabamanurses.org)forourperiodicLegislativeUpdates.

Finally,we are now in the run-up to our annualASNAConventionandHouseofDelegatestobeheld20-22Octoberat the Auburn University Hotel and Dixon ConferenceCenterinAuburn.Thisisaterrificfacilityandwewillhaveagreat lineupof speakers,eventsandentertainment.Pleasesee complete information about the agenda and registrationelsewhere in this newsletter and on our ASNA website. Ipromiseyoudon’twanttomissit;seeyouinAuburn!

by Don Eddins, BS, MS, JD

Often when I speak withnursinggroups,Iamaskedaboutwhatregisterednursesshoulddoto stay out of trouble with theAlabamaBoardofNursing.Myresponse if threefold: Commonsense. Common sense. Common sense.

So many licensure issues could be avoided had theregistered nurse just used goodcommon sense. Simply apply thoselessonsyoulearnedinnursingschoolandinvariouscontinuingeducationclassesandyoucanavoidthedreadedletterfromtheBON.

In Alabama, the Legislature has conveyed upon theBoard of Nursing the authority to license professionalnursing.

Licensurebasically iscontrolledbytheNursePracticeAct, which is found at § 34-24-1 through 34-24-63,Code of Alabama 1975. The portion of the law relatingto suspension and revocation may be found at § 34-21-25, Alabama Code, and of course on the basis of thatstatutory authority theBONhas approved regulations foradministrationoftheNursePracticeAct.Thoseregulationsare at 610-x-1 through 610-x-13,AlabamaAdministrativeCode.PertinentlawscanbefoundontheBoardofNursingwebsite.

TheNursePracticeActplacesapremiumonintegrity.For instance, a license can be denied, suspended orrevokedforfraudordeceit,aswellasforcrimesinvolvingmoral turpitude or “gross immorality.” Conviction of afelonymay lead to a denial or revocation, although suchconviction does not automatically disqualify a person forlicensure.

Aperson judged incompetent due touseof alcoholorillegal drugs can have her license suspended or revoked,althoughtheBoardhasanexcellentrehabilitativeprogramthat allows someone to resume practice when they seekhelp.

Disciplinary conduct is defined broadly in the NursePracticeAct.ThatisonereasonIstresscommonsenseinworkplace activities.

First, know your local procedures.Youwon’t get intotrouble by deliberate adherence to the medical facility’sprocedures, but short cuts can be problematic. If theprocedure requires that a nurse call the physician in themiddle of the night before administering a medication,thenwakehimup.Don’tplaceyourlicenseinjeopardyoutofconveniencetohim.

Be careful what you chart. If you are to administermedications at a particular time, be certain your chartverifies that the meds were dispensed. But don’t notateon the chart something that would lead a practitioner toascertain that the patient needed follow-up (“Patient waslethargic and unresponsive.”) unless the follow-up wasdone. And by all means follow up.

I’ve represented one or more nurses for pre-charting.Suppose anursewas to administer amedat10a.m. and2p.m.andoutofconveniencewhenshemadethe10a.m.entry, went ahead and noted the 2 p.m. medication wasadministered.And then the nurse gets called home for apersonalemergencyatnoon.

She already has stated that the 2 p.m.medication hasbeen administered. That amounts to deceit. And whataboutthenursewhofillsinforherwhenshereadsthatthe2p.m.medsalreadyhavebeengiven?Whatisshetodo?As a practicalmatter, shewill go to her supervisorwhowillreporttheoffendingnursetotheBON.

ThereisnothingmoreprecioustoanRN’scareerthanthat hard-earned license, sonurses shouldn’t do anythingtojeopardizethatlicense.UsecommonsensetostayoutoftroublewiththeBoardofNursing.

Join ASNA Today!Application on

page 7 or

www.alabamanurses.org


Research Corner

by Brian Buchmann, BSN, RN, MBA, andGayle Stinnett, MSN, CCRN

IntroductionWith an estimated 2 million patients each year

acquiring infections while hospitalized, reducing health care associated infections is a patient safety issue that should be addressed by all hospitals. One way to address this issue is to implement best practice methods that will decrease urinary tract infections (UTIs). Huntsville Hospital, Huntsville, Alabama, took this challenge and adapted best practice strategies to reduce UTIs for better patient outcomes.

ObjectivesUpon completion, clinical professionals will be able to:

• Reviewcriteriatodeterminewhencatheterizationisnecessary.

• Review risk factors associated with health care-associated urinary tract infections.

• List components of successful hospital programsused to prevent UTIs.

• Implement effective strategies for preventingcatheter-associatedUTIs.

The urinary tract is the most common site for healthcare-associated infections in United States hospitals.UTI accounts for 32 percent of all health care-associatedinfections.(1) Eighty percent of these infections areattributabletotheuseofanindwellingcatheter.(2)

Catheter-associated urinary tract infections (CAUTIs)annual costs are estimated around $390-$450 millionfor inpatient hospital services.(3) Seventeen percent of health care-associatedbacteremias aredue to aUTI. It isestimatedover560,000healthcare-associatedUTIsoccurannually. It isbelieved thata largenumberof these typesof infectionscouldbeavoidedwith the implementationofspecificpreventionstrategies.(4)

A UTI is caused by the invasion of disease-causingorganisms,whichproceedtomultiplyandproducevarioussymptoms in their host. Many of the organisms havebecome resistant to commonlyprescribedantibiotics.ThemostcommonorganismassociatedwithUTIsinhospitalsis Escherichia coli (E. coli).

Some risk factors for health care-associated UTIsincludethefollowing:

• Catheteruse• Lengthoftimecatheterized• Breaksintheclosedsystem• Improperinsertiontechnique• Unnecessaryantimicrobialuse• Femaleanatomy• DiabetesMellitus• Patientsundergoingurinaryprocedures• Impropercathetercare• Fecalincontinence• Renalinsufficiency

There are many strategies health care institutionshave implemented to help reduce CAUTIs. SomerecommendationsforpreventingCAUTIsinclude:

• Catheterizeonlyifabsolutelyrequired(seeexampleofappropriateindicationsbelow)

• Develop a protocolwith criteria to determine needforcatheterization

• Sterile technique on insertion (absolutely nocontamination)

• Nobreachintheclosedsystem• Propercathetercare• RemovecatheterASAP• Nursedrivenautomaticdiscontinuationprotocol• Usesecurementdevice• Donotpretestballoon• Educatenursingstaffonbestpracticemeasures

In 2009, the Center for Disease Control (CDC) listedthe following examples of appropriate and inappropriateindicationsforindwellingurethralcatheteruse.

A. Examples of Appropriate Indications for Indwelling Urethral Catheter Use(5)

1. Patienthasacuteurinary retentionorbladderoutletobstruction

2. Needforaccuratemeasurementsofurinaryoutputincritically ill patients

3. Perioperativeuseforselectedsurgicalprocedures: • Patientsundergoingurologicsurgeryor

Reducing Rates of Catheter-Associated Urinary Tract Infection othersurgeryoncontiguousstructuresofthe genitourinarytract • Anticipatedprolongeddurationofsurgery [cathetersinsertedforthisreasonshouldbe removedinPost-AnesthesiaCareUnit(PACU)] • Patientsanticipatedtoreceivelarge-volume infusionsordiureticsduringsurgery • Needforintraoperativemonitoringofurinary output4. To assist in healing of open sacral or perineal

wounds in incontinent patients5. Patient requires prolonged immobilization (e.g.,

potentially unstable thoracic or lumbar spine,multipletraumaticinjuriessuchaspelvicfractures)

6. Toimprovecomfortforendoflifecareifneeded

B. Some examples of inappropriate uses of indwelling urinary catheters include:

• as a substitute for nursing care of the patient orresidentwithincontinence

• as a means of obtaining urine for culture or otherdiagnostictestswhenthepatientcanvoluntarilyvoid

• and for prolonged postoperative duration withoutappropriate indications (e.g., structural repair ofurethraorcontiguousstructures,prolongedeffectofepiduralanaesthesia,etc.)5

C. The CDC also mentioned alternatives to indwelling urethral catheterization in selected patients when appropriate5

1. Consider using external catheters as an alternativeto indwellingurethralcatheters incooperativemalepatients without urinary retention or bladder outletobstruction.

2. Consideralternativestochronicindwellingcatheters,such as intermittent catheterization, in spinal cordinjurypatients.

3. Intermittent catheterization is preferable toindwelling urethral or suprapubic catheters inpatientswithbladderemptyingdysfunction.

4. Considerintermittentcatheterizationinchildrenwithmyelomeningoceleandneurogenicbladdertoreducetheriskofurinarytractdeterioration.

5. Further research is needed on the benefit of usinga urethral stent as an alternative to an indwellingcatheter in selected patients with bladder outletobstruction.

6. Furtherresearchisneededontherisksandbenefitsofsuprapubiccathetersasanalternativetoindwellingurethral catheters in selected patients requiringshort-or long-term catheterization, particularlywithrespecttocomplicationsrelatedtocatheterinsertionorthecathetersite.

Use of Prevention StrategiesEarly in 2008, Huntsville Hospital System, in

Huntsville, Alabama, created a housewide UTI TaskForce todetermineabestpractice strategy fordecreasingUTIs. Several nursing units were used for the study.The information below is from the Internal Medicine/NephrologyUnit (2E-2WMain).Thisunitused thePlan-Do-Check-Act model,foraqualityimprovementprojectondecreasingCAUTIs.Forthepurposeofthisarticle,onlyafewof thekeyactions taken ineachPDCAphasewillbelisted.

1. “Plan”phase: A UTI task force was formed to look at outcomes, literature and recommended best practice. TheNurseManagercreatedabrainstormingsessionwithheremployeestodiscussimplementationofthebestpracticerecommendationsfromthehouse-wideUTITaskForce.

2. “Do” phase: A new Urinary Catheter CriteriaProtocol was developed, staff members wereeducated on the new protocol, staff began placingthe date of urinary catheter insertion on drainagebags, staff ensured correct positioning of urinarycollection bags and tubing, staff removed urinarycathetersby3rddayandimplementingasecurementdevice. Also, a Urinary Catheter AssessmentChecklistwascreated.

3. “Check” phase: The Urinary Catheter AssessmentChecklistwasusedbytheChargeNurseseveryshifttoassessthefollowthroughofthenewProtocolandprevention measures.

4. “Act”phase:Nursescontinuedtousethenewcriteriaandpreventionmeasures.ThisunitworkedwiththeEmergency Department regarding the use of the

catheter criteria and followed up with any missingdocumentation. Data was collected over two years starting January 2008 and endingDecember 2009.The outcome for this Unit implementing the newcriteria and best practice interventions was a 61percentreductioninUrineNIMsrate.

Continual ImprovementDecreasing reimbursement for health care-associated

CAUTIswillpressureallhospitalstoimplementstrategiesto decrease CAUTI rates. Huntsville Hospital continues to look at ways to improve their infection rate throughidentification and use of urinary catheter best practicemeasures. Some of the best practice measures identifiedinclude:

• UTI subcommittee meets routinely to reviewliterature, hospital outcomes and discuss possiblepreventionmeasuresandneededtraining.

• Training developed focusing on the followingmeasures: not pre-inflating the catheter balloonbefore insertion, and reinforcing the practice ofkeeping the catheter tubing above the level of thecollectionbag.

• Working with appropriate companies to improvepackaging of Urinary Catheter Kits that willdecreasechancesofcontamination.

• Have catheter securement device placed in eachUrinaryCatheterKit.

• Revisions toUrinary Catheter P&P to include newmeasures.

• IdentifyunitswithincreasedCAUTIanddotargetedtraining.

• Development of a “Foley Insertion Best PracticeChecklist” created for training and competencycheck-off for targeted units and all new nursesduringorientation.HuntsvilleHospital’sbestpracticeis forallpersons that insertFoleycatheters tohavecompetencycheck-off.

• Training for Patient Care Aides regarding cathetercare including, proper urine specimen collection,correct tubingplacement,urinarycathetercleaning,etc.

• Data collection for CAUTI continues on all units.Theinfectionpreventionistreportstheresultstotheappropriate committees and units.

• DevelopmentofaUrinaryCatheterRemovalCriteriaChecklist(discontinueafter2daysifcriteriamet).

• Communication of best practice strategieswith thelocalnursingschools.

For improvement of quality patient care, continualimprovement and development of new best practice measures and/or reinforcement of current measuresregardingurinarycathetercareshouldbeapriorityforallclinicians.

References1. Centers for Disease Control and Prevention. Guideline for

prevention of catheter-associated urinary tract infection. http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html.

2. Lo EL, Nicolle L, Classen D, Arias K, Podgorny K, Anderson DJ. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008; 29:42-5.

3. Scott, Douglas R. The direct medical costs of healthcare-associated infections in the U.S. hospitals and the benefits of prevention. Division of Healthcare Quality Promotion National Center for Preparedness, Detection, and Control of Infectious Diseases Coordinating Center for Infectious Diseases Center for Disease Control and Prevention. March 2009.

4. Gould CV, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention; 2009. http://www.cdc.gov/hicpac/pdf/CARTI/CAUTIguideline2009final.pdf.

5. CDC Guideline for Prevention and Control of Catheter-Associated Urinary Tract Infections (2009).


REMEMBER: 70% of your dues are tax deductible!

Membership News

New/Renew/Rejoin Members:

District 1Ann Hamrick CulpepperDeborahHooverCarolynJ.ButtellJillEnglettJoannaWoodwardMcAbeeRobertL.Love,Jr.

District 2VickiS.HannahHarrietteWhiteAnna K. AndersonAliceMarch

District 3MauriciaC.TimmonsCynthiaN.MasseyArlinda WormelyMelanieDanielMelindaK.FordCatherineLeePatriciaF.Pearce

District 4DeborahFarleyEskewTammyL.BoykinRachelCunninghamLindaRoussel

District 5TheresaOliver-JonesKellyJ.BowenSabrinaR.LeeSandyRevens

Proposed Car Tags for Alabama Nurses: UPDATE–We are close to 800, only 200 +/- more to go!

The Alabama State Nurses Association has contacted the Alabama Departmentof Revenue, Motor Vehicle Division regarding a car tag for nurses. Two choicesareavailable;adecal tobeplacedonaspecial tag,oraspeciallydesignedtag.Thedifference isof coursenumbers. If at least250peoplewill sign a “Commitment toPurchase”attheirlocalrevenueoffice,wegetthedecal.Ittakesatleast1000togetthewholetag.Adesignsimilartothephotoatleftwillbesubmitted.Please do not sign a “Commitment to Purchase Agreement” until you are notified that the tag has been created.

ASNAwillneedtoknowwhatkindofinterestwehaveinthistagpriortosubmittingtheapplication.Oncethetagbecomesavailable, ifyouhavesigneda“CommitmenttoPurchase”agreementwith your local revenue office,youwillbenotifiedbythatoffice.PleasefillouttheshortformbelowandreturnittoASNAat360N.HullSt.,Montgomery,[email protected]

Name: ______________________________________________________________

Phone: ______________________________________________________________

Email: ______________________________________________________________

Address: ____________________________________________________________

____________________________________________________________________

This form indicates interest to ASNA only, it is not a “Commitment to Purchase”

Serve on an ASNA Committeefor2011-2012

Ifyouarewillingtoserve,pleaseindicateyourchoice(s)onthisformandreturnittotheASNAoffice.

STANDING COMMITTEES SPECIAL COMMITTEES _____ Committee on Governance _____ Committee on Awards _____ Committee on Membership _____ Committee on Convention _____ Committee on Finance _____ Committee on Ethics & * ____ Committee on Continuing Education Human Rights _____ _____ Committee on Legislative

_____ Environmental Health & Safety Task Force

* Appointed by each District Board of Directors

Name __________________________________Credentials__________________

Address ____________________________________________________________

City, State & Zip _____________________________________________________

Home Phone ___________________ Work Phone _________________________

Fax: _______________________________________________________________

e-mail: _____________________________________________________________

District _____________________________________________________________

Meetings may be held at the ASNA office, virtual (online) or by telephone conference.

APPLICATION FOR MEMBERSHIP

Please check One New Application _______ Renewal _____ANA ID# Today’s Date _______

Name–First/Middle/Last: __________________________________________________________

Credentials: ____________________________ RNLicense#: ___________________________

Address: _______________________________________________________________________

______________________________________________________ County: _________________ City State Zip

HomePhone: _______________________________ HomeFax: __________________________

WorkPhone: ____________________(Ext) ______ WorkFax: __________________________

CellPhone: ____________________________ E-mailAddress: __________________________

Employer: ______________________________________________________________________

EmployerAddress: _______________________________________________________________ City State Zip

Recruited By:_________________________ Preferred Contact:___Home ___Work ___Email

CIRCLE YOUR MEMBERSHIP CATEGORY

M–FullMembership–Employedfullorpart-time

R–ReducedMembership–Notemployed~full-timestudentornewgraduatewithinsixmonthsafter graduation from basic nursing education program FIRST MEMBERSHIP YEAR ONLY

S–SpecialMembership–62yearsofageoroverandnotemployed,ortotallydisabled

D–Direct(AlabamaStateOnly)/Non ANA Member

PAYMENT PLAN (CHECK 0NE BOX)

ELECTRONICDUESDEDUCTIONFROMCHECKINGACCOUNTM–$24.91Month R–$12.71Month S–$6.61Month D–$15.08Month

Monthly Bank Draft/Credit Card Authorization (Please initial choice):

Readandsigntheauthorizationbelow.Enclose a check made payable to ASNA/ANA for the first month’s dues (see rates listed above). Thisamountwillbedeductedfromyourchecking/.creditcardaccounteachmonth.

____ThisistoauthorizeANAtowithdraw1/12ofmyannualduesandanyadditionalservices feesfrommycheckingaccounteachmonthonorafterthe15thdayofeachmonth,whichis designatedandmaintainedasshownbytheenclosedcheckforthefirstmonth’spayment.

____ThisistoauthorizeANAtowithdraw1/12ofmyannualduesandanyadditionalservices feesfrommycreditcardaccounteachmonthonorafterthe1stdayofeachmonth,whichis designatedandmaintainedasshownbytheenclosedpaymentforthefirstmonth’spayment.

1. ANA is authorized to change the amountbygiving theundersigned thirty (30)dayswrittennotice.

2. TheundersignedmaycancelthisauthorizationatrenewaltimeuponreceiptbyANAofwritten notification of termination twenty (20) days prior to deduction date asdesignatedabove.PleasenotethatallBankDraftplansincludea$6.00annualservicefee.Donotaddthis$6.00toyourpayment;itisalreadybuiltin.ANAwillchargea$5.00feeforanyreturneddrafts.

Authorized Signature: ____________________________________________ Date: ___________

FULLANNUALPAYMENTM–$293 R–$146.50 S–$73.25 D–$175

PAYMENT METHOD

___CHECKENCLOSED ___ VISA ___ MASTERCARD

Card Number: _______________________________________________ Exp.Date: _________

Authorized Signature: ____________________________________________ Date: ___________

Payments toASNA/ANAare not deductible as charitable contributions forFederal IncomeTaxPurposes.However,theymaybedeductibleunderotherprovisionsoftheInternalRevenueCode;checkwithyouraccountant.

For Office Use Only:DateRec’d _________ Dist # ____ County #____ $Enclosed ________ Method ___________PleasereturnthiscompletedapplicationwithyourpaymenttoASNA 360 North Hull

St., Montgomery, AL 36104 or Fax to 334-262-8578


So You Are an ASNA Delegate

Being a Delegate to a state convention can be anexciting experience but one that also has some inherentresponsibility.Asyoumayknow, theHouseofDelegates(HOD) is the governing and official voting body of theAlabama State Nurses Association (ASNA). The Housemeets annually. Members of the HOD have a crucialrole in providing direction and support of the work ofthe Alabama State Nurses Association. Delegates areelected to theHOD towork for thebettermentofASNAand the nursing profession. Each delegate is expectedto study the issues thoroughly, attend each sessionof theHOD (including theOpenForums), and engage in activelisteninganddebate.Also,delegatesareencouragedtousetheextensiveresourcesandcollectiveknowledgeavailableat eachmeeting to provide direction and support for thework of the organization. Such a commitment benefitsthe individual delegate, the association, and the nursingprofession.

Ifadelegateinunabletoattendthe2011ASNAHouseof Delegates, his/her district nurses association (DNA)should be notified at once. When alternate delegatesare substituted for delegates, it is the responsibility ofthe District President to notify ASNA of the changeimmediately.

Important information for ASNA Delegate RegistrationDelegates are encouraged to register for convention

in advance to expedite the on-site credentialing process. See the registration form in thepull out sectionofthisissueforregistrationfees.Fullregistrationincludes,Thursday Evening Awards Dinner, Saturday and Sundaybreakfast and lunch.Additional tickets can be purchasedfortheseevents.UtilizethespecialpulloutsectionofThe Alabama Nursetoregisterforconvention.PleasenotethecutoffdateforthehoteldiscountisSeptember 29, 2011. ASNA has blocked a certain amount of rooms for thisconvention. Please consider that off-site hotel registrationofdelegatescausesafinancialhardshiptotheorganizationiftheroomblockisnotmet.

To ensure eligibility for the credentialing process,delegates are required to present their current ANA membership card and one picture ID at the DelegateRegistrationdesk.Ifyoudonothaveacurrentmembershipcard please contact April Bishop, Programs Coordinatorforassistance.Eachdelegatewillbeissuedanamebadge,adelegateribbon,andinformationalmaterialsuponproofof identification. The name badge and delegate ribbonmust beworn in order to be admitted to the floor of theHouseofDelegates.

PleasecalltheASNAofficeat1-800-270-2762or334-262-8321ifyouhavequestionsorconcerns.

2011 Convention

Thursday, 20 October 2011Mable Lamb Nursing Continuing Education Day(Pre Convention Nursing Continuing Education)

7:45 AM- Registration4:30 PM

8:15 AM- PlenarySessions11:50 Public Health Nursing Today, JohnHankins, MSN,RN Ethics in Nursing Education or What Drives Your Train?, Dr.SarahLatham Safe Patient Handling, PeggyBone,MSN, RN,CIC

9:00 AM ASNABoardofDirectors

9:00 AM AlaONEBoardofDirectors

12 noon- AlabamaOrganizationofNurseExecutives1:30 PM (AlaONE)Annual Meeting&Lunch Keynote: Lori Knarr, MS, RN, NE-BC, FACHE

1:30- Workshops4:50 PM 1) Clinical a. Administration of Moderate Sedation by Non-Anesthetist RNS, MichaelR.Eslinger,CRNA,APN,MA b. Common Complaint-Different Diagnoses: Chest Pain, SusanDashner, MSN,RN c. Perspectives from the Eye of the Storm, PanelofASNAmembersfromDistricts 1,2&3 2) Pharmacology 3) Educators a. Nurse Educators Tool Bag, Dr.ArleneMorris&additionalfaculty 4) Leadership (sponsored by AlaONE) a. Accountable Care Organizations, NanPriest b. Simulation Training,JudiMiller,MSN, RN c. Future of Nursing,PanelofAlaONL Leaders

Thursday, 20 October 2011Alabama State Nurses Association House of Delegates

5:00 PM- OpeningCeremonies6:30 PM Keynote: Evidence and its Use in Safety and Quality in Nursing Dr.PatriciaPearce

6:30 PM- President’sReception7:00 PM

7:00 PM- AwardsBanquet10 PM

Friday, 22 October 2011

7:00 AM Exercise–Zumba(ledbyDr.MarilynRhodes)

7:30 AM- Registration9:00 AM ContinentalBreakfast

8:00 AM- Posters12:30 PM

8:00 AM- Exhibitors12:30 PM

9:00 AM- OptionalContinuingNursingEducation11:00 AM Sessions 1. General–Electronic Medical Records, MichaelJones,MSN,RN,ANDCurrent Impact of the Gulf Oil Spill, Dr.LindaMcCauley(inv.) 2. Pediatric–Management of Child / Adolescent Eating Disorders, BeverlyHaynes,MSN,RN,& VanessaBarlow,MSN,RN,MBA

11:30 AM- LunchinExhibitArea12:30 PM

12:30 PM- PlenarySession1:30 PM

1:30 PM- ASNAHouseofDelegates5:00 PM

5:30 PM + SupperfollowedbytheplayNunsence

Saturday, 23 October 2011

6:30 AM Exercise–Guided walking tour of area (ledbyFrankCanada,RN)

7:00 AM- Breakfast8:00AM

7:30 AM- Pollsopen8:15 AM

8:15 AM- PlenarySession–Red Cross & Disaster9:15 AM Nursing,CherylSchmidt,MSN,RN(inv.)

9:15 AM- ASNAHouseofDelegates12:15 PM

12:30 PM- LunchfollowedbyAlabama Board of2:00 PM Nursing Update, N.GenellLee,MSN,RN,JD

Alabama State Nurses AssociationAlabama Organization Nurse ExecutivesAlabama Association Nursing Students

Annual Convention Agenda


2011 Convention2011 Convention

ExhibitorsAlabama-NorthwestFLAssociationAuxiliaryofthe Gideons InternationalAlabamaOrganCenterALLKIDS-AlabamaDepartmentofPublicHealthAuburnMontgomerySchoolofNursingHurstReviewServiceJackson HospitalMiddleTennesseeSchoolofAnesthesiaPublicHealthFoundationRinehart&AssociatesTroyUniversitySchoolofNursingUAHCollegeofNursingUniversityofAlabama-CapstoneCollegeofNursing

ASNA & ALONE RegistrationName & Credentials _______________________________________________________________________________________

Address _________________________________________________________________________________________________ City State Zip

Dayphone( ______ ) ___________________________Fax( ______ ) ____________________________

E-mail _________________________________________________________________________________________________

Credit Card #: _____________________________________ Exp.Date: ______________CVV # _________________________

Registration: The Mable Lamb Educational Day registration includes lunch and continuing nursing educational sessionsonly. All may attend the ASNA Convention Keynote Address; but only those registered to attend Convention will receive continuing nursing education credit and may attend the banquet. Single day Convention registration includes meal functions and continuing nursing education fees. Individuals registering the day of theConventionwill be issued food ticketsONLYifavailable.Additionalguestticketsmaybepurchasedforfoodfunctionsonly.

Payment:Amountofregistrationisdeterminedbypostmarkifmailedordatereceivedincaseofphone,fax,oronline.PaymentorPurchaseOrdersmustaccompanyregistrationinordertobeprocessed.All registrations received after October 14, 2011 will be considered “at door” and processed on site.

Before September 1, 2011 willbeconsideredearlyregistration.

After September 1, 2011willbeconsideredregularregistration.

Confirmations: Only e-mail confirmations will be sent (approximately two weeks after receipt of registration form). NoconfirmationwillbesentafterOctober,14,2011.

Cancellations:AwrittenrequestmustbereceivedpriortoOctober1,2011.Arefundminusa$20processingfeewillbegiven.NorefundwillbegivenafterOctober1,2011.Wereservetherighttocanceltheactivityifnecessary.Inthatcaseafullrefundwillbegiven.

Continuing Nursing Education: The Alabama State Nurses Association is accredited as a provider of continuing nursing education by the American NursesCredentialingCenter’sCommissiononAccreditation

AlabamaBoardofNursing(ValidthroughMarch30,2013).

1.0contacthoursareawardedforeachsessionattended,includingPosters.Amaximumof7.0(ANCC)/8.4(ABN)contacthoursmaybeearned.Anadditional7.0(ANCC)/8.4(ABN)contacthoursmaybeearnedbyattendingthePreConventionsessions.

Returned Check Fee:$30returnedcheckfeeforanyreturnedchecks.

How to Register for ConventionRegister online at www.alabamanurses.org. or send registration form and paymentto (check made payable to ASNA)ASNA, 360 North Hull Street,Montgomery, AL36104-3644or ifpayingbycreditcardFax to334-262-8321(donotmail if faxingorregisteringonline).Forhotelreservations,contacttheAuburnUniversityHotel&DixonConferenceCenterat1-800-228-2976.Roomratesare$109.00foraSingle/Double.PleaseinformthehotelthatyouarepartofASNAwhenmaking reservationsbySeptember29,2011TOBEINCLUDEDINTHEROOMBLOCK.Reservationsmadeafterthatdatewillbebasedon a space and rate availability.

241 College Street, Auburn, AL 36830

Fees1.) Mabel Lamb Continuing Education Day Workshops, Thursday, October 20, 2011 (includes Lunch only).

Circle one of the following choices for afternoon sessions:

Track I Clinical

Track ll Pharmacology ______ ASNAmember$79 ______ Non-member$99

Track III Education Development

Track IV Management (Sponsored by ALONE)

NOTE: Add $10 to above fees if received after October 1, 2011

2.) Convention, Thursday night, October 20, 2011; and Friday & Saturday, October 21-22, 2011 (includes tickets to all meal functions listed in this application)Select one of the following choices:

ASNA Delegates Only (must register for entire convention)*

ReceivedonorbeforeSeptember1,2011 ____ $239

ReceivedafterSeptember1,2011 ____ $259

Non-Delegates–Full convention *

ReceivedonorbeforeSeptember1,2011 ____ ASNAMember$295 _____NonMember$320

ReceivedafterSeptember1,2011 ____ ASNAMember$310 _____NonMember$335

Daily Registration *

ReceivedonorbeforeSeptember1,2011 ____ ASNAMember$199/day _____NonMember$220/day

ReceivedafterSeptember1,2011 ____ ASNAMember$210/day _____NonMember$235/day

Additional Meal/Function Tickets (for guests or those meals not included in your registration

Thursday,October20,2011–Luncheon _____ $35

Thursday,October20,2011–President’sReception _____ $10

Thursday,October20,2011–AwardsBanquet

Select One()MahiMahior()BeefTenderloin _____ $55

Friday,October21,2011–Breakfast/Breaks/Lunch _____ $70

Friday,October22,2011–Supper/Play _____ $50

Saturday,October22,2011–Breakfast _____ $25

Saturday,October22,2011–Luncheon _____ $30

Total Enclosed: $ ____________

*ASNASpecialDuesmembers(65+/RetiredorCompletelyDisabled)receiveanadditional10%discountonregistration.RegistrationpostmarkedorreceivedafterOctober14,2011willbeconsidered“at-door”.

INDICATE BANQUET CHOICEThursday, October 20, 2011 _________BeefTenderloin_________MahiMahi


2011 ConventionNominations and Election of Officers

AlabamaStateNursesAssociation’s (ASNA)nominationandelectionofOfficers shallbeconducted inaccordancewithRobert’s Rules of Order, 10th EditionduringtheofficialmeetingoftheASNAHouseofDelegates(HOD).

1. NOMINATIONS A. Nominations Committee a.NominationsfromtheNominationsCommitteeshallbeaccomplishedaccordingtoASNABylaws. B. NominationsfromtheflooroftheHODshallbeaccomplishedaccordingtoRobert’s Rules of Order, 10th Edition.

2. ELECTIONOFOFFICERS A.Electionswillbebysecretballot. B. OnlycredentialeddelegateswillbeallowedtovoteattheASNAConvention.SeeASNAwebsite (alabamanurses.org)undermembersonlysectionforconventioninformation.

Preliminary Ballot for ASNA ConventionCandidates for 2011-2013

Vice President: Jackie Williams, MSN, RN

Write-in-candidate: _________________________________

Secretary: Lygia Holcomb, DSN, CRNP


Commission on Professional Issues (Vote for 4) Deborah Andrews, RN, MSHSA Will Brewer Shannon L. Morrison Glenda Smith, PhD, RNC, NNP, PNP-BC


ANA Delegates (Vote for 8) Brian Buchmann, BSN, RN, MBA Laura Chapman, MSN, RN Lygia Holcomb, DSN, CRNP Rebecca Huie, BSN, RN Marilyn Johnson, RN, BSN, MPH Rosemarie Juergensen, MSN, CNS, CES Debbie Litton, RN, MSN, MBS, CNA Shannon L. Morrison Glenda Smith, PhD, RNC, NNP, PNP-BC Jill Stokley, MSN, RNC, CD, MA Helen Wilson, MSN, RN Alternate to the Alternate–Charlene Roberson


Nominating Committee (Vote for 3) Brian Buchmann, BSN, RN, MBA Rebecca Huie, BSN, RN Rosemarie Juergensen, MSN, CNS, CES Kim Smith, RN, BSN, MA, MSN


A Special Thank You to our Exhibitors and Sponsors at

Elizabeth A. Morris Clinical Education Sessions (FACES)

SPONSORS:ArthurL.DavisPublishingAgency,Inc.PfizerCostco

EXHIBITORS:AlabamaHealthLibraryAssociationAlabama-NWFloridaAssociationAuxiliaryofGideonsInt.AlabamaOrganCenterALL KidsAmedisysHomeHealthCostcoJackson HospitalJSUCollegeofNursing&HealthSciencesMiddleTennesseeSchoolofAnesthesiaMETIProvidenceHospitalRinehart&AssociatesTroy UniversityUAHCollegeofNursingWalden University


“Missed Opportunity’’

by Gregory Howard, LPN

A term frequently used in aPrimary care setting, but is notlimitedtothissetting.Thistermdenotes needed information or treatment not done at a recent visit to one’s provider. A rule of thumb is to get everythingpossible done while the clientis present. Some of the thingsthat can be missed are: changeof address, telephone/cell phonenumber changes, Insuranceinformation, lab test, injections,etc.

Sowhat do you do if something is omitted? Call theclientimmediatelyandgettheinformationoverthephoneorscheduleavisittogetonlythethingsyouarenotabletodobyphone.Thisact satisfies theomission/corrects itinatimelyfashion.

This situationcanhappen inotherhealthcaresettingssuchas:MentalHealthandRehab,Medicine,but it takesonadifferentshapeinareassuchasthesebecauseofthenature of the clinics. But the fact of the omission is thesameand the solutionwouldbe the same.Call the clienton thephoneandget theneeded informationorscheduleanimmediatevisittogetwhatisneeded.

Guess what? “Missed Opportunity” can apply to ourpersonallives.Thewaywecancombatthistonotputoffuntil tomorrow what we can do today. We don’t alwaysexpressourtruefeelingtothepeoplewhomeanthemosttous.Weoftenignorethe“elephantintheroom,’’forfearof exposure.Butwho else canwebe transparentwith, ifit’s not the peoplewe care for/the personwe call friend.Nowthereisadifferencebetweenfriendandacquaintance,ahugedifferencesobecareful.

“Whatwedoforourselvesdiewithus.Whatwedoforothersisimmortal.”

LPN Corner


CE Corner

Prevention Might Just Be The Cure

Saturday, August 20, 2011LoebConferenceCenter~OldAlabamaTown~301ColumbusSt.~Montgomery,AL

8:00AM Registration

8:30-9:30AM UpdateofEnvironmentalIssues&BillsinAlabama&Washington,DC

9:30-10:30AM WhyAreChemicalsaHealthProblem?

10:30-10:45AM Break

10:45-11:45AM TheWaterStory

11:45AM-12:45PM LunchProvided&ExerciseEncouraged

12:45-1:45PM ImprovingSustainabilityinHealthcare.

1:45-2:45PM 10AmericanStories

2:45-3:45PM PharmaceuticalDisposal

Evaluations&CertificateofAttendance

Goal:ExploretheenvironmentalimpactonthedeliveryofhealthcareinAlabama

You will learn about:1. Impactofpoliticsontheenvironmentalarena2. Healthhazardstonursesandpatientsfromchemicalsintheworkplace3. Diseasescausedbychemicalsintheenvironment4. SafetyofAlabamadrinkingwaterorwhereisitunsafetodrinkAlabama

water5. Chemicalcontaminationatitsworst(Notevenafetusissafe)6. 10 worst sites in Alabama for hazardous material–might be in your

backyard7. Safedisposalofleftovermedications8. Reducing health care costs with the 3 E’s–Economy, Energy, and

Environment

Prevention Might Just Be the Cure

Name: _______________________________________________________ABNLic.#: _______________________

Address: _______________________________________________________________________________________

DayPhone:( ____ ) ___________________ Email: ___________________________________________________ PaymentMethod: _____ ASNAMember$59 _____NonMember$79 After Aug. 12, 2011 add $15

Card #: _______________________________________________ _____ Check–MakePayabletoASNA

Signature: __________________________________________ ExpirationDate: ________ Security Code: _______

Confirmations by Email Only ~ Licenses Will Be Scanned at the Workshop

Mailregistrationformto:ASNA,360N.HullSt.,Montgomery,AL36104ORFaxto334-262-8578/Registeronlineatwww.alabamanurses.org

ConfirmationbyEmailOnly

Contact Hours:6ANCC7.2ABN

Cost:$59member $79nonmember

Accreditation:The Alabama State NursesAssociation is accredited as a provider of continuing nursingeducation by the American NursesCredentialing Center’s Commissionon Accreditation.AlabamaBoardofNursingProviderNumber ABNP0002 (valid until March 30, 2013). Refunds: If cancellation is received in writing prior to Aug. 12, 2011 arefund (minus a $20.00 processingfee) will be given. After Aug.,12, 2011 no refund will be given.We reserve the right to cancel theprogram if necessary.A full refundwill be made in this event. A $30returncheckfeewillbechargedforallreturnedchecks/payments.

Visit us on the web anytime...

anywhere...

www.alabamanurses.org


A $30 fee will be assessed for all returned checks or dishonored check/payments

The trust that society gives to us as healthcareprofessionalsincludesanobligationtoensurehighqualitycare, reliability, and pursuit of excellence in all of our interactions with patients and families. There are andalways have been certain expectations regarding death.Americanstendtoexpectthatthelastfewmonthsoftheirlife will be miserable and pain-filled rather than being“lucky” enough to die suddenly or experience a gracefulclose to lifewith respectful, appropriate care, and familycloseness. As a society, we feel it is almost indecent to mention death until it is imminent. Until the last threegenerations, most people died suddenly from infection,accident, or diseases that went undiagnosed until welladvanced. Only since the discovery of penicillin couldmost people expect to live to old age. As a society, wehave built a healthcare system around the epidemiologyof a time long gone rather than around the needs of thechronically ill majority today. Today we need supportivehousing, home care, continuity, and family support.Withthebabyboomers itwillbenecessary toshift focus fromcure to care as no society, not even ours, will be able to affordhealthcarebuilt around theold ideasofnumerousresuscitations,hospitalizations,futilecare,andablindeyeto cost.

Our Current State of Care• 1/2 of conscious hospitalized patients have serious

paininthedaysbeforedeath• 1/3 of Medicare recipients are in nursing homes

duringthelastyearoflife• Less than 1/2 of nursing home residents with pain

getadequatetreatment• In Medicare, 9 out of every 10 deaths have heart

disease, chronic lung disease, stroke, dementia, orcancerinthelastyearoflife

• Only1outof10diesuddenly• Most have a long disability of 2-5 years prior to

death and with the military veterans of the lastfew decades we will see these years of disabilityextendedgreatly

• Serious chronic disease at end of life has becomea common cause of financial bankruptcy and thesourceofmostfamilycaregivingburden

Needs for Quality Care at End of Life• A care system that is reliable with enduring

competence from onset of serious illness throughdeath

• Home care, hospice services, healthcareprofessionals who are compassionate and caring,hospitals,pharmacies,andnursinghomestoworkasonesystemduringaperson’sfinaljourney

6 Promises that Healthcare Professionals Need to Make (and Keep)

1. Adequateandcompetentmedicalcare2. Effectivesymptomcontrol3. Continuityacrosstimeandprograms4. Planningaheadtoavoidemergencies5. Considerationforpatient’sfamily6. Assistancetolivewelluntiltheend(Americansfor

Better Care of the Dying (1999) http://www.abcd/caring.org/tools/actionguides.htm)

Core Principles for End of Life CareMore than 10 years ago, representatives of various

medical specialty societies met in order to share theirorganizationsexistingorproposedpoliciesonqualityendoflifecareanddraftedasetofcoreprinciplesconcerningthiscare.FourteensocietiesandtheJointCommissionontheAccreditationofHealthcareOrganizationsadoptedthepoliciesinwholeorwithmodifications.

American Medical Association (AMA) Core PrinciplesSince people in the last phase of life seek peace and

dignity, they should be able to expect the following 8elementsfromphysicians:

1. Opportunitytodiscussandplanforendoflifecare2. Trustworthy assurance that physical and mental

sufferingwill be carefully attended to and comfortmeasures intently secured

3. Trustworthy assurance that preferences forwithholding or withdrawing life sustaininginterventionwillbehonored

4. Trustworthy assurance that there will be noabandonmentbyphysicians

5. Trustworthyassurancethatdignitywillbeapriority6. Trustworthy assurance that burden to family and

otherswillbeminimized7. Attentiontothepersonalgoalsofthedyingperson8. Trustworthyassurancethatcareproviderswillassist

thebereaved throughearly stagesofmourning andadjustment

Achieving Quality Care at End-of-Life

Instructions:Authored by: Dr. Joyce Varner, Associate Professor,

AdultHealth,USACollegeofNursing.([email protected])Authordisclosesnoconflictofinterest

Objectives: At the completion of this course theparticipantshouldbeableto:

1. Definequalityofcareatend-of-life.2. Identifyelementsofqualityend-of-lifecare.3. Discussquality indicatorsofqualitycareatend-of-

life.

Directions: Read the monograph Achieving Quality Care at End-of-Life.CompletethePostTestandevaluationand return both completed forms toASNA (360N.HullStreet,Montgomery,Alabama36104or(F)334-262-8578).AContinuingNursingEducationcertificateofcompletionwillbesenttoyouuponsuccessfulcompletionofthepost-testandevaluationsheet.Youmustscoreat least80%onthepost-testtopass.Shouldyouscorebelow80%,youwillbenotifiedandofferedtheopportunitytoretakethepost-testforanadditionalcostof$5.00.

Board of Nursing Transcript: ASNA will enter thecourseonyourAlabamaBoardofNursingtranscript(you will be unable to successfully enter the course on your transcript) within twoweeksofsuccessfulcompletionoftheactivity.

Contact hours & Accreditation: This 1.0 contact hour course (60 minutes equal 1.0

contact hour) activity is provided by the Alabama StateNursesAssociation.TheAlabamaStateNursesAssociationis an accredited provider of continuing nursing educationbytheAmericanNursesCredentialingCenterCommissiononAccreditation(ANCC).

This 1.2 contact hour course (50 minutes equal 1.0contact hour) activity is provided by the Alabama StateNurses Association, which is approved by the AlabamaBoard of Nursing, provider number ABNP002 (validthrough30March2013).

Theactivityisvaliduntil8May2011

Intended Audience: Nurses

Fees: ASNAMember:$7.50 Non-member:$10ShippingandHandling:$4.00

CE Corner

Achieving Quality Care at End of Life

Achieving Quality Care continued on page 15


American Academy of Hospice and Palliative Medicine (AAHPM)

Theprincipalgoalsofthisorganizationinclude:1. Establishment of those living with terminal illness

excellenceofcare thatnotonly treats theirmedicalneeds but also includes their family and friends intheircare

2. Attendingtoqualityof life issues thatarefacedatlife’scompletionbythepatientsandtheirlovedones

3. Thedissemination of information to thosewho arecaringforpatientslivingwithterminalillness

4. Participates in public education in mattersconcerningendoflifeissues

5. Maintains a central repository for up to dateinformationconcerningthemultifacetedcareoftheperson at end of life

6. InsummarizingitsroleincaringforpatientsatendoflifetheAAHPMstates

“It is the belief or theAAHPM that the dying personandtheircareunithavetherighttodeterminetheamountandthetypeofmedicalcarethatwillenhancethequalityof their lives during the terminal phase of life. Thephysicians in ourAcademyhave the ability and desire toteach, function on the interdisciplinary team, and pursueethicalissuesthataffectthecareofthedying.”

American Geriatrics SocietyModificationofprinciplestoinclude:

1. Respectthedignityofbothpatientandcaregivers2. Be sensitive to and respectful of the patient’s and

family’swishes3. Use the most appropriate measures that are

consistentwithpatientchoices4. Make alleviation of pain and other physical

symptomsahighpriority5. Recognize that good care for the dying person

requires quality medical care, but also entailsservices that are family and community based toaddresspsychological,social,andspiritual/religiousissues

6. Helpassurecontinuityofcare7. Advocate access to therapies which are reasonably

expected to improve the patient’s quality of lifeandprovide that patientswhochoose alternativeornontraditional treatments not be abandoned

8. Advocateaccesstopalliativecareandhospicecare9. Respect the patient’s right to refuse treatment, as

expressedbythepatientoranauthorizedsurrogate10.Respect the physician’s professional judgment and

recommendations, with consideration for bothpatient and family preferences

11.Recognize thatalthoughmedicalcarehasacriticalrole to play in supporting patients and families attheendoflife,dyingisfundamentallyaprofoundlypersonalexperienceandpartofthelifecycle

12.Encourage health care professionals to help ensurethat their care environment is capable of providingquality care and ensure accountability forperformance

13.The AGS considers attention to physical andcognitive function to be a vital part of palliativecare; the patient should be assisted in achieving ahighdegreeofindependenceforaslongaspossible-unless efforts to do so would cause the patient tosuffer.Also, to promote education on these specialgeriatricissuesfortraineesatalllevelsofallhealthcare professions.

American Association of Colleges of Nursing (AACN) Recommendations for End of Life Care

The nurse should take into consideration the culturalaspectsandoptimizecaringsoas to facilitateadignifiedandpeacefulclosureoflifefortheclientandfamily.

AACN Care PrinciplesInplanningandimplementingendoflifecare,thenurse

needstoconsiderthefollowing:1. Affirm life and regards death and dying as an

integralpartoflifecontinuum2. Clientincludespatientandfamily3. Provide measures for relief from pain and other

distressingsymptoms4. Attend to physical, psychological, social, spiritual

and cultural aspects of care5. Offersupporttohelpclientmaintainoptimalquality

of care6. Preparethebestpossiblesupportiveenvironmentfor

clienttoendlifewithdignityandcomfort

7. Offer support to help the bereaved family to copewiththelossofafamilymemberorlovedone

Nursing Responsibilities• Assesses and takes appropriate actions to alleviate

theclient’spainanddiscomfort• Respects the client’s right to know and to obtain

informationabouthis/herillnessandprognosis• Acknowledges that making decision to forgo life

sustaining treatment is a process built on trust andrequirestime,information,honesty,andempathy

• Conveys the client’s choices and wishes to thehealth care team with respect for the right of selfdetermination, and choices are respected andaccommodated as far as possible

• Maintains good relationship and effectivecommunicationwiththeclientinordertounderstandtheirneedsandchoicesintreatmentandcareoptions

• Servesasanadvocateincommunicatingtoandfromthehealthcareteam

• Assists the family to cope with the associatedsuffering,grief,andloss

• Maintainscompetency throughcontinuous learningandupdatingskills

• Understands that dying is inevitable in the lifecontinuum and is an essential element of care providedinvarioussettings

International Council of Nurses (ICN)Affirms that one of the fundamental responsibilities

of the nurse is to ease suffering and achieve the highestqualityoflifeforpatientsandfamilies

1. Provide relief from pain and other distressingsymptoms

2. Neitherhastennorpostponedeath3. Affirmlifeandregarddyingasanormalprocess4. Integrate the psychological and spiritual aspects of

patient care5. Offer a support system to help patients live as

activelyaspossibleuntildeath6. Offer a support system to help the family cope

duringthepatient’sillnessandbereavementperiod

Information Available for Healthcare Providers and Patient/Family

There are many services and sites available to helpboth healthcare providers and the public learn abouteducational offerings, services, and options for care atendof life. Inorder toassurequalityendof lifecare it isbeneficial tobeawareof trainingandeducation. Itwouldberemisstoexcludecontentregardingtheseoptionsinthispresentation.

Toolkit for Nurturing Excellence at End of Life Transition (TNEEL)

TNEEL is an innovative teacher/learner package ofelectronic palliative care education modules that can beutilizedtoprovideonsitelearningfornurseswhodealwithpalliativecareandendoflifeissues.ThisisfundedbytheRobertWood Johnson Foundation and available at http://www.tneel.uic.edu/tneel.asp.TNEELContent:

• Comfortgoalsandpreferences• Assessment and management of pain and other

symptoms• Signsandsymptomsofapproachingdeath• Decisionmakingatendoflife• Communicationsandrelationshipssupportingpatient

andfamilycenteredcareattheendoflifetransition• Grief,loss,andbereavement• Hopeandwellbeing• Complementarycomforttherapies• Spiritualandpsychosocialneeds• Impactofdying• Cultural, ethical, legal, andqualityof lifeconcerns

at end of life

End of Life Nursing Education Consortium (ELNEC)This is an overview of the need to improve end of

life care and the role of nurses in end of life care.Basicprinciples of palliative care are presented in modules withinaqualityoflifeframeworkalongwithgoalsofcare,cost issues,personaldeathawareness,andvariousdiseasetrajectories/acuteillnessencompassingallagegroups.ELNECCoreCurriculum:

• Nursingcareatendoflife• Painmanagement• Symptommanagement• Ethicalissuesinpalliativenursing• Communication• Culturalconsiderationsinendoflifecare• Loss,grief,bereavement

• Achievingqualitypalliativecare• Preparationforandcareatthetimeofdeath

Nurses who wish to apply for this training shouldcontact http://www.aacn.nche.edu/ELNEC. Trainingconsists of a train the trainer approach and allowsnurseswhosuccessfullycompletethiscoursetoprovideeducationregardingendoflifecaretoothers.

Five WishesAdocumentthathelpsapatientexpresshowtheywant

tobetreatediftheyareunabletospeakforthemselves.Itisuniqueinthatitlookstoallofaperson’sneeds:medical,personal, emotional, and spiritual. To obtain free copies contact http://www.agingwithdignity.org.FiveWishesDocumentContent:

1. The person I want to make care decisions for mewhenIcan’t

2. ThekindofmedicaltreatmentIwantordon’twant3. HowcomfortableIwanttobe4. HowIwantpeopletotreatme5. WhatIwantmylovedonestoknow

Advanced DirectivesThreestatewideassociations, theMedical Association

of the State of Alabama, the Alabama State Bar, and theAlabama Hospital Association,withsupportfromtheAlabama Public Health Department and theAlabama Organ Center, have developed an exciting opportunityto deliver an important health care message to allAlabamians.

LIFEPLAN is a statewide campaign to encouragepeopletodiscusshealthcarewisheswiththeirfamiliesanddocumentthemnow,ratherthanduringacrisis.Accessibleat: http://www.alabar.org/public/lifeplan.cfm.

Brochure for information on what should be includedinanadvancedirectiveandhowtoformulatealegalcopyis available at: http://www.alabar.org/brochures/brochure-advance%20health%20care%20planning.pdf.

Legal Advance directive form for download availableat: http://www.alabar.org/members/consumer-guide_forms_8_2008.pdf.

Quality Indicators of Quality End of Life Care

Ethics Committee of the American Geriatric SocietyAreasidentifiedforimprovingcareatendoflifeinclude

physicalandemotionalsymptoms,supportoffunctionandautonomy, advance care planning, aggressiveness of careneardeath,andpatientandfamilysatisfaction

Institute of Medicine Committee on Improving Care at the End of LifeAffirmsthatthesedesignatedareasneedimprovement:

• Overuse of care inconsistent with references andprognosis

• Under-useofcaretotreatsymptoms• Untimelyreferraltohospice• Poortechnicalpalliativecare

These quality indicators aim to assess the provisionofcaretoachievea“gooddeath”whichisdefinedbytheInstitute ofMedicine as “one that is free from avoidabledistressandsufferingforpatients,familiesandcaregivers;in general accord with patient’ and families’ wishes;and reasonably consistent with clinical, cultural andethical standards.” Empirical research further describesthe components of a good death as including teamwork,coordination,earlynursing involvement,andspecificationofakeyworkerasessentialforgoodterminalcare.

Difficulty with Developing Quality Indicators • Identifying the population to whom the indicators

shouldapply• Even in an at risk population such as vulnerable

elders, patients with a very low probability ofsurvivalaredifficulttoidentifywithaccuracy

• It is best, in light of these difficulties, to focus onpatient preferences for care through advance careplanninganddecisionsaboutaggressivenessofcareand palliation

Assessing Care of Vulnerable Elders (ACOVE) Project• In2000,RANDHealthresearchersreleasedthefirst

set of quality measures specifically developed forthe vulnerable elderly—thosemost likely to die orbecomeseverelydisabledinthenexttwoyears

• The ACOVE indicators reflect the most

Achieving Quality Care continued from page 14



comprehensive examination ever conducted of thequalityofmedicalcareprovidedtovulnerableolderAmericans

Indicators 1 and 2: Surrogate Decision Makers andAdvance Directives

Atadmitorwithin48hoursofadmit thechart shouldinclude information regarding surrogate decision makersandadvancedirectives.Alleldersshouldhaveanadvancedirective in their chart indicating the surrogate decisionmaker,documentationofadiscussionaboutwhowouldbea surrogate decisionmaker, or indication that there is nosurrogatedecisionmaker.

Indicators3and4:DocumentationofCarePreferencesIf a vulnerable elder carries a diagnosis of severe

dementia, isadmittedtoahospitalandsurvives48hours,thenthemedicalrecordshoulddocumentthatthepatient’sprior preferences for care have been considered or thatthese preferences could not be elicited or are unknownbecausepatient’svaluesandpreferences shouldguide lifesustainingcare.

Indicator 5: Eliciting Patient Preferences ConcerningFutureHealthStatus

Ifavulnerableelder indicates thathe/shewould ratherdie than live permanently comatose, ventilated, or tubefed, then the chart should document a discussion of lifesustaining treatment preferences along with an advancedirective. If he/she indicates that this is not to be desiredthenthisshouldalsobeindicated.

Indicator6:AdvanceDirectiveContinuityIf a vulnerable elder has an advance directive in the

outpatient, inpatient, or nursing home medical record orthe patient reports the existence of an advance directive,and the patient receives care in a second venue, then theadvancedirectiveshouldbepresent in themedical recordat the second venue. Documentation should acknowledgeits existence, its contents, and the reason it is not in themedicalrecordbecauseadvancedirectivescanguidecare

only if their existence is recognized and their content isknown.

Indicator7:PatientPreferencesforMechanicalVentilationIf a vulnerable elder required mechanical ventilation

during a hospitalization (except for short term and postoperative mechanical ventilation), then within 48 hoursof the initiation of mechanical ventilation the medicalrecord should document the goals of care and thepatientspreference formechanicalventilationorwhy thisinformation isunavailablebecausemechanicalventilationshould be performed only when it is consistent with apatient’sgoalsandbecauseearlyconsiderationofprognosisand preferenceswill guide care to be consistentwith thepatient’s values.

Indicator 8: Patient Participation in Life Sustaining CareDecisions

If a vulnerable elder with decision making capacityhas orders written to withhold or withdraw a particulartreatment then the medical record should document thepatient participation in the decision or why the patientdid not participate in the decision because patients withdecisionmaking capacity whowish to participate shouldhavetheirvaluesguideimportantdecisions.

Indicator 9: Care Consistency with Documented CarePreferences

Ifavulnerableelderhasspecific treatmentpreferencesdocumented in a medical record, then these treatmentpreferences should be followed because medical careshouldaimtobeconsistentwithapatient’spreferences.

Indicator10:ManagementofVentilatorWithdrawalIf a non-comatose vulnerable elder is not expected

to survive and a mechanical ventilator is withdrawn orintubation iswithheld, then the patient should receive (orhave orders available for) an opiate or benzodiazepineor barbiturate infusion to reduce dyspnea, and the chartshoulddocumentwhetherthepatienthasdyspnea,becausedyspnea can be controlled in the setting of comfort carewhenmechanicalventilationiswithdrawnorwithheld.

Achieving Quality Care continued from page 15


Indicators11,12,13,and14:CareoftheDyingPatient11-If avulnerableelderwhohaddyspneain the last7

daysoflifediedanunexpecteddeath,thenthechartshoulddocument how the dyspnea was treated and follow-upshouldbedocumentedaboutthedyspneabecausedyspneacanbeeffectivelytreatedwithoxygenandpharmacologicalagents.

12-If a vulnerable elder who was conscious duringthe last 3daysof lifedied anunexpecteddeath, then themedical record should contain documentation about thepainor lackofpainduringthe last3daysof lifebecausepain is common at end of life and can be effectively treated.

13-If a vulnerable elder who was conscious duringthe last 3daysof lifedied anunexpecteddeath, then themedical record should contain documentation aboutspirituality or how the patient was dealingwith death orreligiousfeelingsbecausespiritualissuesplayaprominentroleattheendoflifeandcanbeaddressedbyavarietyofinterventions.

14-Ifavulnerableelderwithoutknownfamilyornextofkindiedinthehospital,thechartshoulddocumentasearchfornextofkinbecauseitiscriticaltoinformfamilyofthedeath of a loved one in a timely fashion and because thenext of kin may provide information about patient’s desires forafter-deatharrangements.

One of the challenges of using the medical record tomeasurecareprovidedtodyingpatientsisthedifficultyinusingchartdocumentationtoprospectivelyidentifypatientswhowilldie.

Healthcare provider, nurse, socialworker, and pastoralcare documentation should include information regardingthesequalityindicators.

In ConclusionQualityofcareatendoflifemeanssomethingdifferent

toeverypersonasked.Elementsofqualitycareatendoflife include all domains of care. Quality indicators of care provide a means for healthcare professionals and otherprofessions involved in careof thedyingaway to ensurethatthebestpossiblelevelofcareisprovidedwithcaring,compassion,andconcernforthedignityofthepatientandfamilymemberswholovethem.


Post-test

1. Until the last threegenerations,mostpeoplediedsuddenly from:

a. Infection b. Cancer c. Car accidents

2. Inourcurrentstateofcare: a. 1in100diesuddenly b. 2in65dieslowly c. 1in10diesuddenly

3. One of the 7 promises that healthcare providersneed to make and keep is:

a. Carecustomizedtopatientandfamily preference b. Theywillbeavailableduringtheweek c. Someonewilltakeamessageiftheyareoutof theoffice

4. AccordingtotheAACNprinciplesofcare,clientincludes:

a. Spouse and patient b. Patientandfamily c. Patientonly

5. AccordingtotheInternationalCouncilofNurses,one of the fundamental responsibilities of thenurse is to:

a. Respecttheclient’srighttoknowandtoobtain informationabouthis/herillnessandprognosis b. Providegooddocumentationofimmunizations c. Neitherhastennorpostponedeath

6. Oneofthemostimportantfunctionsofanurseinend of life care is to:

a. Conveytheclient’schoicesandwishestothe healthcareteamwithrespectfortheright ofselfdetermination,andensurechoicesare respected and accommodated as far as possible b. Documentfamilywishesfirst c. Makephonecallstopastors

7. TheInstituteofMedicinecommitteeonimprovingcare at end of life affirms that one area needingimprovement is:

a. Thenumberofproviderswhochoosegeriatric care b. Over use of care to treat symptoms c. Untimelyreferraltohospice

8. In the Five Wishes document, patient’s expresshowtheywanttobe:

a. Treatediftheyareunabletospeakfor themselves b. Treated by friends c. Talkedtobythepublic

9. Lifeplanisa: a. Astatewidecampaigntoencouragepeopleto choosecremationoverburial b. Astatewidecampaigntoencouragepeopleto discusshealthcarewisheswiththeirfamilies anddocumentthemnowratherthanduringa crisis c. Astatewidecampaigntoencouragepeopleto justwritedownwhattheywantatendoflife and place it in a safety deposit box for later

10.InAlabama,thereisabrochureonwhatshouldbeincluded in:

a. An advanced directive b. Adocumenttobeusedincaseofahurricane c. A document to be used for fires

Evaluation/Post Test ~ Achieving Quality Care at End of Life

1.0(ANCC)1.2(ABN)contacthours Activity#:4-0.924

Goal:Explorequalityend-of-lifecare.

Name, Credentials: ___________________________________________ _______ Member ($7.50)

Address: ___________________________________________________ _______ NonMember ($10.00)

___________________________________________________________ ABNLicense#: _________________

City State Zip CC Security Code: _____________

Phone: ________________________________________ Email: ______________________________________

_________________________________ / ___________ ______________________________________Credit Card Number Exp. Date Signature

Place answers to post test in designated boxes, and return only this page.

1 2 3 4 5 6 7 8 9 10

ACTIVITY EVALUATION Circle your response using this scale: 3–Yes 2– Somewhat 1–No

Objectives&Goalswereappropriate. 3 2 1

RateyourachievementoftheobjectivesfortheactivityDefinequalityofcareatend-of-life. 3 2 1

Identifyelementsofqualityend-of-lifecare. 3 2 1

Discussqualityindicatorsofqualitycareatend-of-life. 3 2 1

Programfreeofcommercialbias. 3 2 1

Onascaleof1–5/1(low)5(high)knowledgeoftopicbeforehome-study 5 4 3 2 1

Onascaleof1–5/1(low)5(high)knowledgeoftopicafterhome-study 5 4 3 2 1

Howmuchtimedidittakeyoutocompletetheprogram? ______hours ______ minutes.

ADDITIONALCOMMENTS:


Environmental Corner

by Barbara Sattler, RN, DrPH, FAAN

Author Information: Dr. Sattler is Professor, Director oftheEnvironmentalHealthEducationCenterattheUniversityofMarylandSchoolofNursing.ShealsoservesasChairoftheBoardofDirectorsfortheAllianceofNursesforHealthyEnvironments(ANHE).

Overthelastseveralyears,wehaveallbeenhearingandreadingabouttoxicchemicalsthatareinavarietyofproductsthatweuseeveryday.BisphenolA(BPA),flameretardants(PBDEs),andphthalatesarehazardouschemicalsthatcanbefound in our foods, mattresses, baby pacifiers, and personal careproducts,respectively.Therangeofhealthrisksthattheycreate include cancer, infertility, and a host of endocrine-related problems. States around the country are passinglegislation to ban these and other individual and categoriesoftoxicchemicals.Thequestionthatwe,asnurses,shouldbeaskingis“howcomethesetoxicchemicalsareallowedinourproductsinthefirstplace?

Themainreasonthattheyhavebeen“allowed”isbecausewedonothaveanyrulesthatsaytheycan’tbeinourproducts.We are all familiar with the tight government oversightthat guides the development of new pharmaceuticals. DrugcompaniesmustapplytotheFoodandDrugAdministrationassoonastheideaofadrugismerelyatwinkleintheireyes.From the onset, through clinical trials and final approval,thereiscontinuousFDAoversight.Butwhatoversightexistswhenamanufacturerwantstobringanewpaintorcleaner,or for thatmatter a cosmetic or baby lotion tomarket.Theanswer helps to explain why we have so many potentiallytoxic chemicals in the formulas forour everydayproducts.The answer is that there isNO requirement for pre-markettestingoftheingredientsnorthefinalproductbeforeitcomesto market.

So, what’s the result of this “under sight”? We havefragrances in our products that can trigger asthma,carcinogens inourhand creams, and reproductive toxicantsinourinsectsprays.Dothelabelsontheseproductswarnusabouttheserisks?No.Notrequired.

A bit of U.S. chemical history is useful here. At thebeginningofthe20thcentury,womenwereconcernedaboutthe new-fangled packaged foods that were beginning toappearonstoreshelves.Theyasked the federalgovernmentforsomeassurancesabout thesafetyof thesenewproducts.In response to their concerns, the federal government setup a new process by which food product manufacturershad to send their packaged goods to a new federal agencykitchenwheretheproductwouldbecookedaccordingtothedirections on the can, box, or sack. They then would feedthefoodsubstance toagroupofhealthy, twentyish-yearoldmen.Iftheygotsick,theproductcouldnotgotomarket.Iftheydidn’tgetsick,theproductcouldgotomarket.Thisoddoversightforprocessedfoodslastedabout6orsoyears.Thenthey disbanded the process. BUT. As silly as the previousoversightwas,theydidnotreplaceitwithanything.So,thereisnorequirementofpre-markettestingforfoodsubstancesintheU.S.either.

We can continue to try to pass legislation state by state,chemicalbychemicalandwe’llbeatthisforavery,verylongtime.Thereareanestimated80,000registeredchemicalsforwhich there is at least one, peer-reviewed study indicatinga riskof toxicity. Ifwe take themonon-by-one, itwill stillleaveuswithatrailofhealthrisksforthecenturytocome.Alternatively, we can support legislation that calls for pre-market testing and appropriate labeling and a mechanismto remove products and chemical processes that createsignificant, known health risks. Sounds like a no brainerbut it is actually quite an uphill battle. Industry spent over$50million to defeat last year’sCongressional version of acomprehensivechemicalreformbill.We,inhealthcare,don’thavethatkindofwarchestforanationalcampaign.Butwhatdowehave?Wehavealot.

Firstofall,thereareALOTofus–mothers,fathers,nurses,other health professionals–allwhohave a stake in reducingtoxic exposures.One in every one hundredAmericans is aRegisteredNurse!!Weare themost trustedprofessional forconveying information about health and health risks, andwe have incredible organizational structures–the AmericanNurses Association, State Nurses Associations, nursingsubspecialtyorganizations,nursingorganizationsbyrace(i.e.,NationalBlackNursesAssociation,NationalAssociation ofHispanicNurses),andsoon.Wehavenursinghonorsocietiesandsororities.Wemeetandgreettomobilizeourselveswhenprofessional practice issues are at stake and other nursingconcerns.Weeducatepolicymakersandlobbyinstatehousesandonthehill.Wecanharnessthisincrediblepowertohelpmake our immediate environments–our homes, schools,daycarecenters,andworkplaces–healthierandsaferplacesbyengaginginthenewcampaigntoreformchemicalpoliciesinthiscountry.

We’re also a very civically engaged lot. We are activemembersofourfaith-basedorganizations,ourPTAs,aswellasbeingdenmothers(andfathers)andleadersamyriadlocalorganizations.Wehaveanamazingopportunitytotalkwithourfriendsandneighborstohelpthemunderstandthatthisisanissuethattrulyaffectseachandeveryoneofus.

TheCentersforDiseaseControl(CDC)hasbeensamplingurine and blood from a cross-section ofAmericans for thepresence of toxic chemicals. They’ve been finding that weare awash in chemicals that are associated with cancer,birth defects, neurological disorders, learning disabilities,depression, and a broad range of other common anduncommondiseases.Thesechemicalsshouldneverbefoundinthehumanbody.Theyareclearlytrespassing.

AnevenmoredisturbingstudybyEnvironmentalWorkingGroupandsubsequentlycorroboratedbyseveralpeer-reviewstudies indicates that the same range of chemicals foundin adults can alsobe found in theumbilical cordsbloodofnewborns. This final fact is a very loud alarm that shouldbe sounding in every nurses’ head. This is the compellingevidence that our chemical policies are BROKEN and thatcomprehensivechemicalpolicyreformisneeded.Weshouldnotbedeliveringnewbornswhohaveabodyburdenoftoxicsolvents,plasticizers,andpesticides.Asnurses,wefindthiscompletely unacceptable.

Iinviteyoutojoinmeandothernurseswhoareworkingwith the national campaign for safer chemicals (www.saferchemicals.org) by working with the Advocacy andPolicyWorkGroupofthenewAllianceofNursesforHealthyEnvironments(www.EnviRN.org)Inourdailywork,wecareforpeoplewhentheyareattheirmostvulnerable.Weneedtoaddanotherelementtoourprofessionalpractice–aconcurrentengagement in an effort that is truly designed to preventdiseases.

Chemical Policy Reform ~ Nurses Must Say “YES”

inside alabama nurse we’ll see you there!€¦ · 2011 is lpn’s renewal year abn deadline is...

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