9-7-2015 10-45-10 AMNurse burnout is a huge problem in this country, and is projected to become even more so in the future. Despite the fact that enrollment in bachelor’s, master’s and doctoral nursing programs is up, there is still projected to be a shortage of registered nurses (RNs) by the year 2030. There are many factors that drive the shortage, including the high burnout rate. Contributing factors to the burnout rate include staffing problems, sicker patients, and working long hours.

The term “burnout” was coined by American psychologist Herbert Freudenberger in the 1970s. According to an article from the American Nurses Association (ANA), he used it to describe the consequences of severe stress and high ideals experienced by people working in the “helping” professions.

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It is difficult to tell how many people may actually be affected by burnout, because this term is no longer exclusive to those in healthcare. However, no matter the career path, the symptoms of burnout seem to be the same.

Symptoms

Constant fatigue. You should not go to bed tired and still wake up tired in the morning. When you find yourself without the energy to do common everyday things like exercise, spend time with family or friends, or read a good book, this physical exhaustion could be an early symptom of burnout.

Feelings of being overworked and under appreciated. If you are feeling this way, it may be time to re-evaluate and figure out why you are feeling this way. If you are working too many hours, it may be time to cut back. If you are taking on too much, you may need to figure out how you can cut back. Feeling frustrated and resentful about your job is not good for you, your co-workers, or your patients. If you feel this way, you may need to step back and see how or if being a nurse still fits in with your plans and goals for life, and it’s ok if it doesn’t.

Lack of enthusiasm about work. When you are “just going through the motions,” can be another sign of impending burnout. If you are at home dreading going to work, or are at work and can only think about going home, this can adversely affect patient care since it is vital that you are able to concentrate on what needs to be done for your patient(s) moment by moment. It can also spill over into other areas of life.

Compassion fatigue. This is when you become detached from patients, feel cynical about your work, or feel that you are a failure as a nurse. It is often after years of emotional stress, physical stress, and the experiences on the job.

Contributing Factors

Lack of social support. Many people don’t understand the demanding nature of being a nurse. They aren’t aware of what happens on a daily basis, or the strain that it puts on a person to be able to deal with multiple complex patient care scenarios. Often times, family members expect the nurse to leave his or her work at work, and not to talk about it at home. Many hospitals have an employee assistance program in place, but many nurses don’t use it. Some out of fear that their discussions will be shared with their supervisors. Others don’t use it because of the stigma of “going to see a counselor.”

Inability to control schedules or assignments. Many places set a nurse’s schedule for them, and they have no say in it. Some set schedules force nurses to work 3 days in a row, giving little time to recuperate in between work days. Not everyone can handle this type of scheduling, yet there is little that can be done about it.

Chaotic environment. On any given day in a hospital, things are extremely chaotic. Ask any person who has ever been a patient! If they feel overwhelmed by what is happening in this environment, imagine being responsible for 4 or more complex patients and managing their care! In addition, hospitals are being paid on satisfaction rates by patients’ perceptions. Trying to keep up with everything every one wants exactly when they want it can be extremely daunting.

Work-life imbalance. Sometimes you have issues going on at home that affect your performance at work, and vice versa. When this happens, you aren’t able to give your full attention to one arena or another, and the other suffers.

Staffing issues. This is one of the biggest contributing factors, if not the biggest. Despite enrollment being up, the shortage of nurses persists. Sometimes this is due to budgeting, which often backfires because then patient safety becomes an issue. Other times it is due to the fact hat you can’t keep staff in a department. No matter the reason, it is vital that staffing problems be addressed. Continually running on a “skeleton crew” adversely affects not only nurses, but patients as well. Fixing this one issue has the potential to offset most of the others.

What To Do About It

There are many things that you can do personally to take care of yourself and decrease the stress and likelihood of burnout.

Stretching. Sometimes, just stretching out your muscles helps relieve the tension in them. This can improve strength, flexibility, and posture. You can even teach simple stretches to your patients, giving good self-care at the same time.

Meditation or Prayer. Taking a short break to be able to clear your mind helps tremendously. Even if it is just five minutes. Quiet your mind and spirit. Focus on your breathing and being still, and teach your patient(s) to do the same.

Emotional Freedom Technique (EFT). This is simply a sequence of tapping on different meridian points on the body that can help clear out stuck electrical energy, negative emotions, and stress chemicals. For more information on EFT, you can visit www.thetappingsolution.com if you are interested in learning the basic techniques. If you would be interested in a more in-depth program and coaching, you can visit www.donmilton.net.

Breathing Exercises. Just practice taking long, slow, deep breaths in through your nose and out through your mouth. I’ve often done this with people, patients included. Teaching your patient to become more aware of their breathing is a great way for you to get in touch with your own, and you both benefit.

Nurses, I would be interested in knowing if this has been helpful for you. Let’s beat back burnout together! You can contact me at rachel.athensnow@gmail.com.
By: Rachel Clark, RN, BSN

8-23-2015 1-13-33 PMWell, it’s that time of year again: time for kids to go back to school after a fun-filled summer. I know that many schools around Limestone and Madison County have already opened their doors to students, and that for most the learning has already started in full swing. I remember as a kid being excited on the last day of school, and at the end of the summer dreading the first one back. But as I’ve gotten a little older, I’ve found that I miss those days much more than I’d like to admit.

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It’s important to focus on ways to keep your child healthy this school year, not just at the beginning. Below you will find some tips to help you do that, and keep your little ones (or not so little ones) on top of their game all year long.

Nutrition
I start with nutrition because it is the building block of all the rest. We’ve all heard that a healthy breakfast can help students concentrate better, and studies show that this is actually true. If your child doesn’t eat breakfast, they may not get another chance to eat for several hours, and their academic performance may suffer because of this.

Cooking Light says that a healthy breakfast “contains a mix complex carbohydrates and protein.” They also suggest “pairing whole grains such as oatmeal, whole-wheat toast, or whole-grain cereal with a protein source such as milk, yogurt, peanut butter, eggs, or cheese. Add a side of fruit for a boost of vitamins and minerals.”

Also, pay attention to the meal calendars your child’s school sends home or posts online. This may help you plan which days you want your child to eat in the cafeteria or which days you want to pack them a lunch. I would suggest packing a lunch most days rather than buying something from the cafeteria so that you can save money and pack something nutritious for your child.

Here are 8 tips from one mom’s online blog (www.brightonyourhealth.com) that she incorporates when packing healthy lunches for her kids:

1. Variety and color-changing it up ensures that your child gets different sources of vitamins and minerals from the food they eat. Color makes the meal more appealing. If there is something your child simply will not eat, try hiding it in smoothies.
2. Whole grains-increased fiber as opposed to white breads and rices
3. Fresh fruits/vegetables-the US government recommends that fully half your plate at each meal should be comprised of fresh, raw fruits and vegetables.
4. Food safety-your child’s lunchbox will be unrefrigerated for several hours, so it is important to keep things cold that need to be kept cold. A good insulated lunch bag or blue ice may help.
5. Taste-involve your children in the selection of their lunch. Choose foods that they like to eat and that taste good to them. If they won’t eat the lunch you pack, it is a waste of time and money.
6. Water-water is the best choice for kids. If your child dislikes plain water, then try adding lemon or other fruits/juices to it to make it more appealing.
7. Fun desserts or snacks balanced with healthy options-at least one day a week, give them a treat that isn’t quite as healthy as some other choices. It’s a balancing act. Give them something to look forward to.
8. The less processed the better-though these options may be convenient for you and desirable for you kids, they aren’t as nutritious as things you make at home from scratch.

Backpack Safety
It is important to choose the right backpack for your child to prevent injury and problems later on in life. Here are a few guidelines from the American Academy of Pediatrics (aap.org):
1. Wide, padded shoulder straps and a padded back
2. Pack light-use all of the backpack’s compartments, and pack heaviest items closest to the center of the back. BACKPACKS SHOULD NEVER WEIGH MORE THAN 10-20% OF THE CHILD’S BODY WEIGHT.
3. Always use both shoulder straps, slinging over one shoulder can cause muscle strain and injury.
4. Consider a rolling backpack if the school allows them. There are downsides to a rolling backpack though, including being carried upstairs, not rolling as well in water/snow/ice, and may not fit into some lockers.

Transportation Safety

No matter what venue of transportation your family chooses, it is important to review basic safety rules with them (aap.org).

• Walking: Choose a safe route with a responsible and well-trained adult to accompany your child. Identify other children who might be walking with them. Identify whether or not your child is a good candidate for walking as small children may not be as careful.
• Biking: Your child should always wear a helmet and ride in the same direction as traffic. Use appropriate hand signals and obey traffic lights and stop signs.
• Car: Always wear a seatbelt and use child safety seats as indicated for your child’s height and weight. Children under 13 years old should ride in the back seat. If your teenager is driving, always use a seat belt, restrict the amount of other teens in the vehicle, and don’t allow eating, drinking, or cell phone usage of any kind while behind the wheel.
• Bus: Always enter and exit the bus safely. Wait for the bus on the curb, not in the street. Ensure that your child is where she can see the driver, allowing the driver to also see him or her. The child should not stand up or walk while the bus is in motion. If the bus has seat belts, encourage your child to use them when available.
By: Rachel Clark, RN, BSN

8-7-2015 3-12-19 PMAs is my usual habit, I have picked a topic based upon national health observances that are getting media attention each month. August just so happens to be National Breastfeeding Month. August 1st-7th is World Breastfeeding Week, which has been celebrated for 22 years, and is recognized in over 175 countries around the globe. The mission of the World Alliance for Breastfeeding Action is to “focus and facilitate actions to protect, promote and support breastfeeding.”

According to a call to action supported by the Surgeon General of the U.S., breastfeeding is “one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself.” This breastfeeding campaign, which is sponsored by the U.S. Department of Health and Human Services, has a goal to “empower women to commit to breastfeeding by highlighting new research showing that babies who are exclusively breastfed for six months are less likely to develop ear infections, diarrhea, and respiratory illnesses and may be less likely to develop childhood obesity.”

In many states in the U.S., breastfeeding is no longer the choice of new mothers for meeting the nutritional needs of their newborns. This is especially true in Alabama. The national average of women who have ever breastfed is 76.5%, while Alabama reports only 60.4%. This number is lower in only 4 other states, 2 of which are in the “Deep South” and includes Mississippi (50.5%) and Arkansas (57.7%). In addition, the number of Alabama mothers still breastfeeding exclusively at 3 and 6 months is low at 23.5% and 11.9% respectively.

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So why is breastfeeding so important? Is it really any better for your baby than pre-packaged formula at the grocery store? With so much information readily available at our fingertips and the click of a few buttons on the Internet, it can get overwhelming to find good sources. There is always “new research” coming out on every topic under the sun, and breastfeeding is no exception. So let’s take a look at what some of the leading scientific researchers in the U.S. have to say.

Health Benefits of Breastfeeding1
• Breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections and pneumonia.
• Breastfed babies are less likely to develop asthma.
• Children who are breastfed for six months are less likely to become obese.
• Breastfeeding also reduces the risk of sudden infant death syndrome (SIDS).
• Mothers who breastfeed have a decreased risk of breast and ovarian cancers.

Economic Benefits of Breastfeeding2
• Families who follow optimal breastfeeding practices can save between $1,200 and $1,500 on infant formula in the first year alone.
• A study published last year in the journal Pediatrics estimated that if 90% of U.S. families followed guidelines to breastfeed exclusively for six months, the U.S. would annually save $13 billion from reduced medical and other costs.
• For both employers and employees, better infant health means fewer health insurance claims, less employee time off to care for sick children, and higher productivity.
• Mutual of Omaha found that health care costs for newborns are three times lower for babies whose mothers participate in the company’s employee maternity and lactation program.

Why isn’t breastfeeding more common, then? Below are some key barriers, as discussed by the U.S. Surgeon General3:
• Lack of Knowledge: While breastfeeding is considered a natural skill, some mothers may need education and guidance. Providing accurate information can help prepare mothers for breastfeeding.
• Lactation Problems: Sometimes babies have a tough time getting good at breastfeeding and an experienced lactation specialist can provide assistance. Most of these are avoidable if identified and treated early, and need not pose a threat to continued breastfeeding.
• Poor Family and Social Support: Fathers, grandmothers, and other family members strongly influence mothers’ decisions about starting, continuing, and accommodating breastfeeding.
• Social Norms: Many people see breastfeeding as an alternative rather than the routine way to feed infants.
• Embarrassment: The popular culture’s view of breasts as only having a sexual purpose compels some women to avoid breastfeeding. Improving support for women to breastfeed can help them better accommodate the demands of everyday life while protecting their infants’ health and can be accomplished at no risk to their own modesty.
• Employment and Child Care: Employed mothers typically find that (1) returning to work and (2) lack of maternity leave are significant barriers to breastfeeding.
• Health Services: Health care systems and health care providers can improve mothers’ breastfeeding experiences by pursuing and obtaining the training and educational opportunities they need in order to fully support their patients.

There are many ways to help new mothers increase their knowledge and skill in regards to breastfeeding. An excellent book written on the subject is “Ina May’s Guide to Breastfeeding,” written by world-renowned midwife, Ina May Gaskin of The Farm in Summertown, Tennessee. There are certified lactation consultants and breastfeeding support groups in many areas, including North Alabama. To find a La Leche (which is Spanish for “the milk”) League group, visit http://www.lllalmsla.org/lll-groups/alabama-groups/. Another great resource for breastfeeding support is an International Board Certified Lactation Consultant. Visit www.ilca.org to find a provider in your area.

Protect your newborn by committing to breastfeeding him or her for at least 6-12 months, or longer if you can!

1http://www.surgeongeneral.gov/library/calls/breastfeeding/factsheet.html
2http://www.surgeongeneral.gov/library/calls/breastfeeding/factsheet.html
3http://www.surgeongeneral.gov/library/calls/breastfeeding/executivesummary.pdf
By: Rachel Clark, RN, BSN

7-17-2015 1-48-39 PMMany of us (as many as 90% of adults before age 40) have felt that annoying tingling sensation on or around our lip. If you’ve had more than one of these episodes, you already know what is coming next: the unsightly, painful blister that breaks and oozes before crusting over and eventually sloughing off. They typically take 7-10 days to completely heal and are contagious until that time.

Cold sores, also commonly called fever blisters, are the result of a virus. The most common strain is herpes simplex type one, but they can also be caused by the herpes simplex virus type two. The most common sites for them to appear include the outside of the lips, nose, cheeks or fingers. Though viruses have no permanent cures available, many people develop antibodies after the first infection and never develop another cold sore. However, for as many as 40% of those infected, cold sores are a recurrent problem.

For most people, cold sores are not a serious problem. However, for those who are immunocompromised (such as cancer patients, chemotherapy recipients, transplant recipients, and AIDS patients), cold sores can be severe and even life-threatening. Unless you have one of the above conditions, there are many options available to help with the symptoms of cold sores.

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Cold sores are generally transmitted by direct contact such as kissing, sharing cups or eating utensils, towels, razors, or sexual contact through sexual contact. Common triggers for an outbreak include menstruation, pregnancy, stress, fevers, colds, flu, allergies, sunburns or any other illness that potentially taxes the body.

There are four stages of cold sores: before an active outbreak (prevention), first sign of impending outbreak, active outbreak, and recovery. Treatment depends upon figuring out which stage you are in. Below, you will find some strategies for dealing with each stage.

Prevention:
During this stage, it is important to perform good self care. You should get enough sleep, support your body with adequate nutrition, prevent sunburn, and recognize/avoid common triggers that you have noticed personally.

Herbs
There are also various herbal remedies for preventing outbreaks. Two categories of herbs include what are know as adaptogen herbs and immunomodulating herbs. Avoiding stimulating nervines such as coffee and tea could help decrease frequency of outbreaks. Adaptogen herbs strengthen the body’s response to stress, and combined with diet and lifestyle changes maximizes the prevention of cold sores. Immunomodulating herbs make the body less vulnerable. Antiviral herbs, taken both preventatively and during an outbreak, can help minimize from replicating and attaching to cells.
• Adaptogen herbs: ginseng, codonopsis, astragalus, holy basil, ashwagandah, shatavari, eleuthero, rhodiola, schizandra, reishi mushroom, and licorice.
• Immunomodulating herbs: astragalus, reishi, cordyceps, shitake, and tulsi.
Three other very powerful herbs for cold sores include St. Johns Wort, Balloon Flowers, and Lemon Balm.

Dietary
Eating foods rich in lysine and avoiding those high in arginine can also help prevent an outbreak. The virus needs arginine to replicate, and lysine blocks arginine. Foods high in lysine include meat (turkey, beef, chicken), milk, cheese, eggs, and fish. Foods high in arginine include wheat, oatmeal, brown rice, nuts, chocolate, and beer. Many people also take lysine supplements that can be found at most herb stores. Some nutrients/vitamins that can be helpful include Vitamin C (found in rose hips, pine needle leaves, dandelion leaves, citrus fruits and green leafy vegetables), Magnesium (found in leafy greens, but most people need supplements), and Vitamin D (for which sunlight is necessary to absorb).

First signs of an outbreak:
For best results, action should be taken at the first sign of outbreak. These include regular teas or tinctures of immunomodulating herbs, large doses of lysine supplements, topical treatments of vulnerary (healing) herbs to help heal the wound more quickly (such as calendula, aloe, plantain, comfrey, chamomile, and turmeric), topical St. Johns Wort oil or tincture applied liberally and frequently, topical treatments of lemon balm oil or tincture, and essential oils such as tea tree, lemon balm, and Thieves.

During an outbreak:
Get enough rest and eat a diet that supports your body during illness. Also continue taking antiviral herbs such as St. Johns Wort and lemon balm, as well as vulnerary herbs mentioned in the previous paragraph. You can also apply ice to reduce pain and swelling at the site. Many people will make teas and freeze them for that added kick.

Recovery:
Rest and proper nutrition (a diet high in fruits and vegetables) are essential during this time. This period can last anywhere from 7 to 10 days. When the acute stage is over, sores heal and new skin forms. You can also use herbs during this period to assist your body. Relaxing nervines such as cramp bark, valerian, California poppy, milky oats, skull cap, chamomile, passionflower, lavender, St. Johns Wort, lemon balm, and vervain all help relax the nervous system, promoting calm and sleep. Trophorestorative (balancing) herbs such as milky oats, goldenseal, nettle seed, milk thistle, yerba mansa, hawthorn, and St. Johns Wort can help bring balance.

There are also medications such as prescription Valtrex and over the counter Abreva available to help lessen the symptoms of an outbreak. For more information, contact your healthcare provider to discuss which options might be best for you.
By: Rachel Clark, RN, BSN

7-3-2015 4-30-49 PMAccording to data from the American Academy of Pain Medicine, over 100 million Americans and 1.5 billion people worldwide struggle with chronic pain. Chronic pain is defined as pain that persists over weeks, months, or even years, while acute pain is a trigger of the body to alert you to injury, and the need to take care of yourself (www.pain.org). There may be an initial injury that causes acute pain and turns into chronic, or there may not. The most common sites for chronic pain include back, headaches/migraines, and the neck, but can occur anywhere in the body.

Over the last several years, pain management has been a huge focus in the healthcare world. It is so much so that we have begun to deem pain as the “fifth vital sign” in addition to blood pressure, heart rate, respiratory rate/oxygen saturation, and temperature. If you have been treated in a hospital or doctor’s office recently, you have likely heard them ask about your pain level on a 0-10 scale with 0 being no pain, and 10 being the worst pain imaginable.

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There are many ways available to treat both acute and chronic pain, including over the counter medications, prescription drugs, and alternative pain management solutions. Always discuss your pain management goals with your healthcare provider, and come up with a plan that you can both agree on together for you. Below you will find some alternative therapies to research to see if they might fit your unique situation.

1. Be Active. Exercise is the last thing many sufferers want to think about. However, light exercise can improve quality of life in chronic pain sufferers. Stretching, walking, yoga, and aquatics are all good options when beginning an exercise plan. Talk to a personal trainer and/or your healthcare provider to come up with a plan that is tailored to you and your ability level.

2. Eat healthy foods. Many people struggling with chronic pain have difficulty doing simple tasks like grocery shopping, preparing meals, and even walking around their home. Understanding the relationship between food and disease is an important aspect to dealing with many health challenges. Eating a balanced diet high in plants (fruits, vegetables, berries, etc.) can aid in weight loss, improve mood, decrease in other chronic health conditions, and will provide the necessary nutrition and energy required to maintain an active and healthy lifestyle. Consider cutting out highly processed foods and replacing them with fresh produce and lean meats.

3. Get a good night’s sleep. A majority of chronic pain sufferers also report difficulty with sleeping. It is vital to create a healthy environment as the first step to better sleep. Maintaining little to no light, turning off devices such as televisions, computers, and cellular phones at least an hour prior to going to bed, and breathing exercises are all ways to improve your environment. You may also consider purchasing a device that can track how well you are sleeping (unless you have a pacemaker, defibrillator, or implanted neurostimulator).

4. Technology. New technology is emerging every day in every arena, and healthcare is no exception. There are biofeedback machines, transcutaneous nerve stimulators (TENS units) and electromyography units. Before use, talk to your healthcare provider and do not use if you have the implanted devices mentioned above.

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5. Acupuncture and Acupressure. This is an ancient Chinese healing art that has been around for thousands of years. It involves inserting needles or putting pressure on various points of the skin in order to regulate and balance the body’s meridian systems. There are a number of studies that show the effectiveness of this treatment for pain.

6. Aromatherapy, Essential Oils, and Herbal Remedies. These therapies uses the oils found in various plants that are either inhaled or applied to the skin, or in the case of herbs, taken orally. This practice also dates back to ancient practices of the Chines, Romans, Egyptians, Greeks, and Indians. Studies show improvement of pain in cancer patients and many other conditions. Many hospitals have begun using aromatherapy as an intervention in dealing with pain and insomnia. Speak to your practitioner and an experienced herbalist for assistance on choosing the right therapies. Make sure that they will not interact with any of the current medications that you take.

7. Chiropractic care. Though it is now more mainstream, it is still considered a form of complementary medicine. Chiropractors look at the relationship between the structure of the body and its function. Many focus mainly on realignment of the spine, but also other bones and joints to promote self-healing. It has been shown effective in dealing with headaches, back pain, and sports injuries. Make sure you talk with your healthcare provider before beginning a chiropractic regimen, and seek out a chiropractor whose ideas of healing are in line with your own.

8. Massage. Like chiropractic care, this is now considered to be more mainstream than it has been in the past, but still is considered complementary medicine. Rather than manipulating bones/joints, massage manipulates muscles and soft tissues. It has also been shown to be effective in several clinical studies at treating various painful conditions.

9. Relaxation and Meditation. Stress can worsen or even create disease, including pain. When we are stressed, we release a chemical called adrenaline, the same chemical that floods our bodies when we are in a dangerous situation. Over time, this can cause muscle tension, increased blood pressure and heart rate, and wreak all kinds of havoc. Some ways to combat this include prayer, meditation, breathing exercises, tai chi, guided imagery, and meditation.
By: Rachel Clark, RN, BSN

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6-18-2015 4-42-06 PMAfter a long, cold winter and a humid, rainy spring, summer has finally arrived in full force. The days are longer, with the sun being up well before 6AM and not going down until past 8PM in the evenings. When I was a kid, I loved this time of year. It meant no school and playing outside all day.

June is National Safety Month, and below you’ll find some tips to keep you and your kids safe this summer as you enjoy the break from school or work.

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Tick Bites:
One of the major things to be on the lookout for this summer is ticks. They are everywhere, especially if you live in rural areas like Limestone County where fields and forests abound. Ticks carry a variety of illnesses such as Lyme’s Disease and Rocky Mountain Spotted Fever, both of which can have serious lasting effects if not recognized and treated early on.

To keep the ticks away:
• Wear protective clothing such as long pants and long sleeves, tucking pants into socks if you are going to be doing any hiking or playing in wooded areas where ticks are common.
• Use tick or bug repellent. There are many different brands available, and it is important to find the best fit for you and your family. Any repellent containing DEET can be extremely hazardous to your health. Some families choose to make their own insect repellents using essential oils like peppermint, lavender, pennyroyal, geranium, lemongrass, eucalyptus, or lemon oil in a witch hazel base. My personal favorite recipe uses Young Living Essential Oils, though any therapeutic grade oil will work. It calls for 14oz of Witch Hazel, 12 drops of lavender, 15 drops of citronella, and 15 drops of lemongrass.
• Perform tick checks on a daily basis, especially if you have been in wooded or rural areas. Check heads, armpits, and any fold/creases, as these are prime areas for ticks to hide.
• Be aware of signs and symptoms with tick-born illness, and call your healthcare practitioner for any questions or concerns. Some signs and symptoms are so subtle that they can be missed or may mimic other conditions. For more information, check out the Centers for Disease Control website.
• If you get bitten by a tick, use fine tipped tweezers and grab the tick as close to the skin as possible. Pull upward with steady, gentle pressure and DO NOT twist or jerk as you can leave pieces of the insect behind. After removing the tick, clean the area well with rubbing alcohol, iodine, hydrogen peroxide, or chlorhexidine. Wash your hands thoroughly before touching any other part of the body, especially mucus membranes. Dispose of the tick by either flushing it down the toilet or drowning it in alcohol; NEVER crush a tick with your fingers.

Beat the Heat:
In states like Alabama where the heat index is high, it is extremely important to be aware of how heat can wreak havoc in your body if it isn’t accustomed to high temperatures.

Remember to:
• Keep yourself hydrated. Drink more water in the summer months. Stay away from sodas, caffeine, and sugary drinks as these increase the risk of dehydration. Offer fluids BEFORE someone complains of thirst because they are already dehydrated at that point.
• NEVER leave anyone unattended in a vehicle during the summer. The heat inside a vehicle is much greater than outside and can cause severe or fatal consequences. Children, animals, and the elderly are at the highest risk for negative outcomes associated with heat.
• Cover skin and/or use sunscreen to prevent sun damage that can lead to skin cancer. Some sun is necessary for the body to be able to absorb Vitamin D and can help fight off symptoms of mild depression. Make sure to get sun on bare skin in the early morning or late evening when the suns rays aren’t at their peak. If you choose to use sunscreen, there are options for making your own that is a safer alternative to commercial ones that can be harmful.

Water Safety:
Water sports are a big hit, especially in this area where pools, rivers, and streams abound. Adult supervision is mandatory for your enjoyment of water activities.

Keep in mind:
• No one, including adults, is drown proof.
• Always wear life jackets when on a boat, jet ski, or any other watercraft.
• NO DISTRACTIONS! Looking away for even a moment can have disastrous effects.
• Practice touch supervision, meaning that a supervising adult who can swim is within arms reach at all times when children are in or near water.
• Children can drown in many different places including bathtubs, buckets, swimming pools, baby pools, streams, creeks, lakes, and rivers. It doesn’t take much water.

Fireworks Safety:
The 4th of July is right around the corner. Many children enjoy fireworks displays and want to play with sparklers, firecrackers, and other fireworks.

Make sure you:
• Supervise children with any fireworks at all times. Even sparklers can reach temperatures in excess of 1000 degrees.
• Attend displays put on by professionals who are experienced and have access to emergency medical equipment and personnel.
• If you or a child experiences burns, seek immediate emergency medical treatment. The chemicals in fireworks can linger and burn longer and hotter than a normal burn.

Enjoy a safe, fun summer.
By: Rachel Clark, RN, BSN

6-6-2015 11-58-41 AMSeveral weeks ago, I saw a Facebook post about how secrets can be dangerous things. Webster’s Dictionary defines a secret as something we keep hidden from the knowledge of others. Teaching children about secrets is an important part of keeping them safe from the long-term effects that can be caused by abuse.

According to a sexual abuse prevention workshop called “Parenting Safe Children,” secrecy is a key element to childhood sexual abuse. A Denver mom wrote a blog post about her experience with teaching her son an alternative to secret keeping. In her home, she teaches her children about surprises instead. She recounts the story of a friend who gave her son a cookie and said “shhh…it’s a secret.” To the mom’s utter delight, the son told the woman that in his home, they don’t do “secrets,” but instead they do “surprises.”

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The mom explains “Surprises are something we keep quiet about temporarily; then you share the surprise and people are happy. But secrets are meant to be kept quiet forever and they are often protecting something that would make people unhappy.” Surprises are things like a birthday party or a gift. Secrets like sexual abuse leave long-lasting scars on everyone involved.

Often times, sexual predators will test children by asking them to keep smaller secrets (like cookies or other treats), building up to bigger and bigger secrets about what is happening to them. By teaching her children different terminology, she is bypassing this common method of trapping children in the abuse cycle. This little boy was bold enough to say that he doesn’t keep secrets. He is no longer a vulnerable target because of the wisdom of his mother in teaching him about body safety.

It is vital to start early teaching children about their bodies and which parts are ok to touch and which parts aren’t. If these important lessons are instilled in them early on, they are less likely to experience abuse, and the devastating effects it can lead to in the future such as anxiety, depression, and suicidal ideation/attempts.

Body Safety Rules include the following (adapted from Parenting Safe Children Workshop developed by Sandy Wertele, Ph.D. and Feather Berkower, MSW):

1. No one is allowed to touch your private parts
2. You should not touch someone else’s private parts
3. No one is allowed to take pictures of your private parts
4. If someone tries to touch your private parts, say “NO!”
5. When playing friends, play with your clothes on
6. You are allowed to have privacy when bathing, dressing and using the toilet
7. You have permission to say “No” and get away if someone tries to touch your private parts or breaks any of your body safety rules
8. We don’t keep secrets in our family. If someone tells you to keep a secret, tell an adult.

Also, educate children that doctors and nurses sometimes have to examine these private parts of their bodies and that is ok, because Mommy or Daddy is with them. Begin to teach your children these rules now to eliminate them as targets later. If you don’t yet have children, adopt the practice now of not keeping “secrets” so that it will be easier to instill in them these principles when you do.
By: Rachel Clark, RN, BSN

5-15-2015 3-39-02 PMThe American Trauma Society (ATS) and the Society of Trauma Nurses recognize the month of May as National Trauma Awareness Month. This year’s slogan is “3D Trauma Prevention,” focusing on 3 major contributors to motor vehicle accidents (MVA): Drugs/Drinking, Distraction, and Drowsiness.

According to the ATS website, there were 32,000 fatalities and 2.3 million injuries from MVAs in 2013 alone. Of those, 31% were linked to an alcohol-impaired driver and another 18% were linked to a distracted driver.

Most of us are aware of the risks of getting behind the wheel after drinking or using drugs. Below are a few statistics from the ATS and the Centers for Disease Control (CDC) regarding drinking/drugs and driving:

• Drugs other than alcohol are involved in about 18% of MVA driver deaths, and are often used in combination with alcohol.
• Someone is injured every 2 minutes due to a drunk driving crash.
• On average, 2 of 3 people will be involved in a drunk driving crash in their lifetime.
• In 2009, 18% of fatally injured drivers tested positive for at least one illicit, prescription, or over-the-counter drug.
• Of the 239 child passengers 14 and younger who died in alcohol-impaired driving crashes, over half were in a car with an alcohol-impaired driver.
• Of the motorcyclists killed in 2012, 29% had blood alcohol levels greater than 0.08%.
• In a study done in 2013, 9.9 million people admitted to driving under the influence of illicit drugs in the year prior to being surveyed.
• In 2012, 29.1 million people admitted to driving under the influence of alcohol.
• In 2011, 15% of drivers in fatal crashes were drunk compared to 31% on the weekends.

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Distracted driving is also a big problem. Actions such as the use of electronic devices (cell phones, GPS, radio, etc.), the driver’s state of mind, conversations with passengers, eating/snacking, reading, taking notes, and applying makeup all contribute to MVAs. Many adults and teenagers are aware of the dangers of using an electronic device while driving, but will also admit to their use while behind the wheel. There is no text or social media post that can’t wait until a time when you aren’t behind the wheel of a motor vehicle.

Many drivers are less aware of the effect of their state of mind on their ability to drive safely. Being distracted can involve intense conversations with passengers, being upset or being overly tired. Eating also distracts you. Take a few minutes to pull over and enjoy your meal rather than risk harming yourself or someone else.
Drowsy driving is another problem that drivers face, especially those doing shift work. It is especially dangerous as it slows reaction time, decreases awareness, and impairs judgment just like drugs or alcohol. AAA surveyed police officers and 9 out of 10 drivers they suspected of being drunk turned out to be drowsy instead. Some danger signals include:
• Having trouble keeping your eyes open and focused
• Inability to keep head up
• Daydreaming or wandering, disconnected thoughts
• Frequent yawning or rubbing eyes repeatedly
• Drifting from your lane or tailgating
• Missing signs or driving past your exit
• Drifting off the road/hitting rumble strips
• Inability to remember how far you’ve traveled or what you recently passed

Some suggestions for avoiding driving while drowsy are:
• Don’t drive when you know you are sleepy
• Get enough sleep the night before, especially if going on a long trip. Less than 6 hours of sleep increases risk of falling asleep at the wheel. Don’t plan to work all day and then drive all night as drivers being awake for 20 hours or more have high risk of falling asleep while driving. Travel at times when you are normally awake, rather than driving straight through.
• Travel with a passenger. They can watch for signs of fatigue and take over if necessary.
• Take a power nap. Pull off the road in a safe, well-lit area such as a parking lot or rest area.
• Schedule breaks every 4 hours or 100 miles.

Next time you get behind the wheel, make sure you haven’t been drinking/using drugs, get rid of the distractions, and that you aren’t drowsy.

*Information above adapted from the website and posters presented by the American Trauma Society for National Trauma Awareness Month.
By: Rachel Clark, RN, BSN

5-1-2015 1-17-59 PMTechnology changes the world we live in on a daily basis. There is always a new gadget or gizmo coming out on the market that is supposed to save us time, make our lives easier, or benefit us in some way or another. The marketing is usually well-planned, and it targets people of all ages, not just the GenY and technologically savvy. It is also changing how we do healthcare.

The federal government mandated that all hospitals and physician’s offices across the country have some type of electronic medical record by the beginning of this year. The thinking is that it will help make things more standardized across the board, and will make the charting process more efficient. The goal is to make medical records containing history, allergies, diagnoses, medications, and treatments available to clinicians around the country quickly and easily.

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As a nurse, I work with electronic medical records every day. I have always had computerized charting, ever since I started as a new-graduate nurse. I never learned the art of paper charting, or how to read the infamously atrocious handwriting of doctors. All of my orders have been neatly typed, with little room for errors in interpretation. I have always had the ease of entering into the computer whatever treatments I’ve given to my patients, be that medications, physical assessments, or vital signs.

Most of the time that task has been as simple as selecting the correct treatment from a dropdown menu of choices. Sometimes I’ve had to add in notes in a free text box to explain what isn’t exactly covered by the dropdown selection. I now use a system where I don’t even need to use a mouse. All I have to do is tab, arrow, and enter to select the value I want to enter into the patient’s chart.

Sounds like a wonderful, high-tech solution to a problem, right? It is. And most of the time it is truly a marvelous thing! As a GenY-er, I quickly and easily adapt to the changing face of technology in the healthcare world like the rest of my generation. But not everyone does. And it’s not always all it is cracked up to be either.

Sometimes, older nurses have problems with the system, and it is much harder for them to navigate it. If they haven’t familiarized themselves with the basic functions of a computer, they have more trouble than their peers who have done so. I know such nurses; they do their jobs well, and their patients are always well taken care of. They’re old school, and I enjoy working with them quite a lot. They have a great deal of wisdom, and have seen things change drastically over the many years they have been doing what they do. But some of them struggle with the computerized part of their job.

Not only is it a problem for some of the more seasoned nurses who have been doing this for years, it can be a problem for the GenYers. Not in the same sense of course; our problems come when for one reason or another, the system is not functioning as it should, is completely down, or is being updated.

We all know our personal computers, phones, and tablets need to be updated from time to time. It’s annoying when your device informs you it needs to shut down in order to install an update that it thinks you need. Sometimes, until that update is done, you are left scrambling because you’ve become dependent upon that piece of technology.

Magnify that stress by 100. That is what it is like when the computer system of a major hospital or hospital system is down. Suddenly, those nurses like myself who have always had the ease of technology no longer have that comfort to fall back on. We have to chart on paper. We have to decipher the scribbling that is supposed to constitute a physician’s signature or order. We are totally and completely lost. For most of us, it can be one of the worst days in our career. If we have the ability to schedule ourselves for our weekly shifts, most of us will avoid working on days where there is a planned downtime of the system.

Not all of us are that lucky. This was the exact situation I found myself in this past weekend. I also became more grateful for those nurses who have been around for several years, those who knew what it was like before we became completely digitized. All of a sudden, I was a brand new nurse again who had no idea what to do. I couldn’t read my orders, and was constantly asking either the nurses around me or the doctors themselves what was written on the page.

It’s days like Sunday that make me question whether or not this electronic health record system is as efficient and valuable as it is said to be. Nursing is a science, but it is also an art. We are beginning to lose some of that art, especially as it relates to communication with doctors and each other.

Some days, technology makes my job easier, and some days it makes it more complicated. And isn’t that always the case when the law of unintended consequences is in effect?
By: Rachel Clark, RN, BSN

4-17-2015 10-15-39 AMWhat is stress? According to the dictionary, there are several definitions of stress, but our focus will be the following aspect: “ a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances.”

We have all experienced stress at some point in our lives. And not all stress is negative. Stress can motivate us, but it can also do damage to our bodies if we are continually living in a state of tension and strain. In fact, Yale-trained physician, midwife, and herbalist Aviva Romm, states that 60% of all illnesses are linked to a stress component-that’s right folks, 60%!

Each of us has our own symptoms related to stress. They may be the same or different from the symptoms experienced by your family, friends or coworkers. You likely already know yours. There is a list of 50 common signs/symptoms of stress listed on stress.org. A few most common ones I experience personally include racing heart, ringing of the ears, racing thoughts, difficulty concentrating, difficulty sleeping, crying, feeling overwhelmed, feeling the need to “run away,” and communication problems.

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Many symptoms, such as increased heart rate, muscle tension, head pounding, and increase breathing rate, are all components of the “fight-or-flight” response that is instinctive to the human body. Our body was made to react to stress. Small amounts of stress on a regular basis can be a good thing as it can help improve mental clarity, focus and immune response. However most of us are continually exposed to situations that require the body to react this way, and it is damaging over time.

Stress is a big deal. It is linked to heart attack, depression, suicide, drug and alcohol addiction, eating disorders, herpes outbreaks, autoimmune conditions, high blood pressure, stroke, infections, and even accidents such as car accidents and work-related incidents. Over time, stress decreases our body’s ability to handle exposure to even small amounts of chemicals released by stress such as adrenaline, epinephrine, and cortisol.

In order to combat the stress, we must first learn to recognize it in ourselves and admit it. Admitting it is most of the battle. Once you see it for what it is, you can make choices that reduce the stress and improve your ability to handle it.

Below are some ways to reduce stress, without the use of medications.
• Eat well-increase the amount of whole, plant-based foods in your diet to help boost the immune system
• Get enough rest-take a nap if you can, go to bed earlier, allow your body to wake up naturally without the use of an alarm clock
• Exercise-MOVE your body; go for a run, walk, swim, or bike ride.
• Laugh-find a way to make yourself laugh, it lowers cortisol (a stress chemical) and boosts endorphins (chemicals in the brain that make you happy)
• Listen to music-this simple thing can lower blood pressure, anxiety, and depression; create a playlist of your favorites and crank it up!
• Get a massage-relieve muscle tension and soreness related to chronic stress
• Connect with someone-this strengthens the relationship but also helps give you a new perspective
• Write/journal-this is an avenue I use CONSTANTLY to combat stress in my life; it gives me a way to put onto paper what I am feeling and deal with it in ways that are positive and uplifting, and is especially helpful when I use it in combination with prayer
• Breathing exercises-this will also help lower heart rate and blood pressure; sit up straight with one hand on the belly and the other on the head, breathe in deep through your nose and feel the breath starting in the belly and work up to the top of your head, exhale through your mouth while reversing the process. It is helpful for some people to imagine their favorite color filling up the lungs as they breathe in deeply.
• Meditate/pray-it has been suggested that this can alter the way the brain actually works.
• BE GRATEFUL!-start a gratitude journal to remind yourself of all the positives in your life; keep one in several places so it is accessible at all times
By: Rachel Clark, RN, BSN