Clinical Knowledge & Communication
The Food and Drug Administration (FDA) has moved to limit the sales of electronic cigarettes (e-cigarettes) to youth.[1] The new laws sequester electronic nicotine delivery systems in stores, requiring retailers to keep these products in areas inaccessible to teenagers. Effectively, this bans e-cigarette sales in convenience stores and gas stations, but not in specialty stores.
Continue reading “High-school vaping is up by 78%, and the FDA is taking action”
What is bullying?
Bullying is an intentional harmful behavior that hurts or humiliates a child physically or emotionally due to an imbalance of power. It can happen in school, in the community or online. This behavior is either repeated or can be a one-time incident.
National Center for Education Statistics (NCES) reports that in 2016, more than one out of every five (20.8%) students reported being bullied. Bullying threatens a child’s well-being and the ill effects are experienced by individuals, families, schools, colleges and society. The bullied child may feel intimidated, powerless, and humiliated by the aggressive acts of other children.
Research suggests that shy or anxious children are more prone to being bullied. It has been observed that very young children, who are passive and don’t protest or cry if others snatch a toy, become a natural prey for bullying.
Types of bullying
There are many different ways to bully. Some common ways include hitting, name-calling, extorting money, intimidation and spreading bad rumors. Bullies purposefully hurt someone, physically or mentally, who is less powerful than they are.
Here are the four common types of bullying and surefire remedies to deal with them:
Verbal Bullying
Definition: Verbal bullying refers to continuous name-calling, threatening, and making disrespectful comments about someone’s attributes (appearance, disability, ethnicity, religion, sexual orientation, etc.).
Example: When a child says to another child, “You’re really fat and so is your dad.”
Symptoms:
Check if your child:
Steps to resolve:
Physical Bullying
Definition: Physical bullying refers to repeated pushing, kicking, hitting, tripping, blocking and touching in unwanted and inappropriate ways.
Example: A child gets his shirt pulled down on the playground.
Symptoms:
Check if your child:
Steps to resolve:
Relational Bullying
Definition: Relational bullying refers to purposefully preventing someone from joining or being part of a group, whether it’s at a game, sport, lunch table or social activity.
Example: A group of boys in a band keep talking about a weekend trip and sharing pictures, treating the one uninvited child as if he was invisible.
Symptoms:
Check if your child:
As compared to boys, girls are more prone to experience social exclusion, nonverbal or emotional intimidation. The impact of pain they experience can be just as intense or even greater than physical bullying.
Steps to resolve:
Cyber bullying
Definition: Cyber bullying refers to criticizing someone by spreading lies, mean words and false rumors through e-mails, text messages and social media posts. Racist and sexist messages tend to create a hostile atmosphere.
Example: When someone tweets or posts, “John is a total loser, nobody should hang around with him.”
Symptoms:
Check if your child:
Steps to resolve:
Source: https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2017015
When was the last time you heard a “diabeetus” joke? The answer is likely all too recent. Type 2 Diabetes is an extremely stigmatized condition — the majority of Type 2 diabetes patients report feeling stigma.[1] The public perceives Type 2 diabetes as a self-inflicted disease, worthy of derision. Unfortunately, some healthcare professionals also feel this way.
Every year, over 150,000 people in the United States of America die of lung cancer, making lung cancer by far the leading cause of cancer death.[1] One reason why lung cancer is so deadly is that it often eludes detection until too late to save the patient. 80% of lung cancer patients are only diagnosed once their cancer has reached stage III or stage IV, by which point surgery is off the table.[2]
In the third edition of Skyscape’s Fellows Advisory Network nursing newsletter, we explored how faculty members can take care of themselves by growing what you know, learning what you don’t know, and being comfortable saying no.
These same words – “Know, Don’t Know, and No” – can help us care for our students as we help them become strong, confident, capable, and safe nursing professionals.
Know
First, we have to know our students. Can you look around and know the names of the students who sit in your classroom? Can you honestly say that you know a bit about each one of them – how they study, how they perform on tests, how comfortable they are in the clinical setting, how much they have going on in their personal life? Clearly, knowing our students is a cumulative experience – we learn more about them during each class session, and over each semester as they progress. However, even in the earlier of courses, it is important to make a connection. Knowing a student’s name is the first step towards professional personalization. Being mindful of their didactic and clinical performance can help you effectively intervene when necessary if a student is struggling, provide kudos to a student who is excelling, or gently (or firmly) nudge a student in the direction of growth if they are floundering. Knowing a bit of personal information about a student – within the boundaries of professionalism – can also help the student build trust in your teaching and your intention for their success. This can be demonstrated by simply talking to students about what their goals are after graduation, asking what brought them to your college or university, or allowing them to express what made them choose to major in nursing. Evidence shows that we, as human, are wired for connection; taking the time to know your students not only shows you care; it reminds them that we are here to help them achieve their goals, which builds trust in the educational process and the professional relationship between faculty and student.
Don’t Know
Have you ever talked with someone who knew everything? This may have been a family member or friend, or it may have been a fellow faculty member or leader. This is the person who, unfortunately, has nothing new to learn because they have “been there and done that”, no matter where it is, or what you’re referring to in the discussion. Nursing students often feel that faculty members know everything, and granted, we do know a lot about nursing. We are responsible for delivering evidence-based information that is current and relevant to today’s practice…not pulling something out of a filing cabinet from the 1990’s when we prepare to teach. Even when we go to class or clinical as prepared as we feel we can possibly be, there are going to be times when a student asks a question that may stump you. There you are, at the front of the classroom or in the presence of all your students on the clinical floor, with no answer. What are you thinking at that moment? Are you afraid the students will think you are incompetent? Are you concerned that your authority as a faculty member will be diminished if you admit that you don’t know something? Are you scrambling to redirect the conversation so that you don’t have to address the student’s question? Let’s reframe this scenario. What would happen if you simply, openly, and honestly stated, “I don’t know”? What a great learning opportunity this is for students… and how empowering it can be for you as a faculty member… because your next statement can be, “let’s look it up together” as you direct everyone to pull out their smartphone or tablet and seek an evidence-based answer. If it is not convenient to have everyone engage in a search at that moment, consider allowing students to look up the answer before the next class or clinical, and come prepared to discuss the answers to the question. This fosters a sense of inquiry and redirects the students to recognize that nurses must use resources every day to carry out their roles. Use the opportunity of “not knowing” to free yourself from having to have an immediate answer. We care for our students by role-modeling within the learning environment to strengthen students’ abilities to seek information from
credible, current, evidence-based resources
, and we capitalize on this opportunity to remind students that nurses work together to achieve goals as a part of everyday professional practice.
No
Finally, we recognize that sometimes we have to say no for the purposes of the greater good of a student, or in observance of keeping the public safe from harm. A student may miss passing a class by a fraction of a point. Another student may be unsuccessful in the clinical environment. Every faculty member has been on the receiving end of a tearful plea from a student to be granted re-entry into a course or clinical. There are various reasons that faculty may have difficulty saying “no”, but the bottom line is that it is important that we learn how to do so kindly, compassionately, and justly. Students who struggle with passing classes are known to struggle on NCLEX. Students who struggle clinically may compromise patient safety. It is critical that we hold to standards for passing so that we assure that students moving through our programs are safe and prepared for the reality of professional practice. Holding to a standard in the presence of a didactic failure can be done by openly discussing the student’s performance on each required course component. Demonstrate where points were available, and contrast that with how the student performed. Remind the student that sometimes more time is needed to process the material, and direct the student (if eligible) to the process for requesting to retake the class. Allow the student an opportunity to grieve. This demonstrates the essence of nursing – providing a nonjudgmental, compassionate approach in a time of need. It may be more challenging to determine what constitutes a clinical failure. It is important for faculty in a program to agree upon, and collectively use, an evidence-based approach to identifying student behaviors in the clinical setting. Addressing behaviors from the philosophy of a just culture can help the faculty member logically work through the student’s behaviors via an algorithm. This removes subjectivity and feelings from the process of determining whether a student made a human error, if there is a systems problem to which the student was subjected, or if the student behaved recklessly. If it is determined that a student’s behavior was reckless, saying “no” to course continuation or re-entry is the best way we can care for the public, while also caring for that student’s ability to be successful in reaching their academic goals. “No”, depending on the circumstance, can mean “not right now” or it can be absolute, based on your program’s policy for course or program re-entry. Either way, your demeanor in delivering difficult news can demonstrate caring, as long as you remain calm, nonjudgmental, and objective throughout this difficult process.
We have the great privilege, as well as the great accountability, to walk alongside students on their nursing journey. Our roles in caring for students is threefold:
Reflecting on the theme of Skyscape’s Fellows Advisory Network nursing newsletters Editions 3 and 4, “Know, Don’t Know, and No”, consider how adopting this approach into your teaching philosophy may help you guide your students towards success. Earning a nursing degree is a marathon, not a sprint, and exercising this approach can help you care for students by helping them gain the necessary skills to become exceptional nurses in the long run.
Authored by:
Influenza, also known as “the flu”, is a contagious respiratory illness. It is caused by influenza viruses that infect the nose, throat and lungs. Flu symptoms can include fever, cough, body ache, headache, sore throat, runny or stuffy nose, chills, tiredness and sometimes vomiting and diarrhea. In some cases, people with flu do not have a fever.
Continue reading “11 Misconceptions about the Influenza Vaccine”
“What could explain my patient’s pain and discolored legs after ankle surgery?”
Continue reading “Medical Librarians: Vital Partners in Healthcare”
At Toyota factories—yes, the car company—every assembly line has a big red button. And every worker has a responsibility to press the button if they feel something is amiss. This button stops the entire assembly line. Stopping the line could mean the difference between building a safe car versus building one that puts people at risk.
The news constantly bombards us with headlines announcing yet another thing that may increase cancer risk. From pesticides to cigarettes, burnt toast to nitrates, the list goes on and on.
Yet one carcinogen is rarely spoken of, and this carcinogen is far more potent than charred food. The carcinogen in question is alcohol. Research suggests that 15% of breast cancer deaths in the United States are attributable to alcohol consumption.1 The exact mechanism of oncogenesis is still unknown,2 but the data speaks for itself. For Breast Cancer Awareness Month, take a moment to learn about one of the deadliest risk factors of all.
Compared to women who do not drink, women who have three alcoholic drinks a week have a 15% higher risk of getting breast cancer. Studies have shown that that for each additional daily drink, a woman’s risk of breast cancer goes up another 10%.3 The risk applies to youth as well. For girls ages 9 to 15, consuming three to five drinks a week triples their risk of developing benign breast lumps. Although these lumps are benign, they are not innocuous. Certain kinds of benign breast lumps increase a young woman’s chance of breast cancer later in life.4 Tellingly, breast cancer rates are extraordinarily low in Utah,5 where alcohol consumption is much lower than the American average.6
There is little research on alcohol and breast cancer recurrence, but the research that does exist paints a grim picture. Even consuming as few as 3-4 drinks a week increases the chances of breast cancer recurrence in women who were diagnosed with early-stage breast cancer.7
So as a practitioner, what is to be done? Conversations with patients are essential. Most healthcare providers wouldn’t hesitate to ask a patient about cigarette smoking, or counsel them on the risks of smoking. The same philosophy should apply to alcohol usage. Ask your patients about alcohol, and remember, no age is too early to begin the conversation. Don’t write off a patient’s alcohol use as harmless “social drinking”— a lot of unhealthy habits can fit under the umbrella of “social drinking.”
For women concerned about their breast cancer risk, make sure they understand exactly what is at stake. Consider the BRCA1 and BRCA2 mutations, which are well known to raise a woman’s risk of breast cancer. Collectively, 5-10% of breast cancer diagnoses are linked to a
BRCA mutation.8 Now compare that to data on alcohol. Remember, 15% of breast cancer deaths are attributable to alcohol. If your patient is curious about her breast cancer risk, alcohol needs to be as much a part of the conversation as BRCA.
Of course, in today’s world, complete abstinence from alcohol may seem like a huge undertaking. But every drink not poured helps. Harm reduction is key here. Data suggests women should limit alcohol use to two drinks a week.9 Make sure your patients are aware of this. Remind patients who drink socially that they can still have a good time and see family and friends without alcohol. Suggest that patients make delicious virgin cocktails, or learn to appreciate the many non-alcoholic beer, wine, and champagne products on the market.
The silver lining on this dark cloud is that unlike many factors that increase a woman’s risk of breast cancer, her alcohol consumption is entirely within her control. Your patient cannot choose whether she has inherited a BRCA mutation, whether she began menstruating before the age of 12, or whether she started menopause after the age of 55. She cannot alter the level of dense connective tissue in her breasts, or prevent herself from aging.10 But she can make choices around her use of alcohol. For a woman worried about breast cancer, this is wonderful news.
Heading back to school following a relaxed summer can be a time of great excitement, and carries with it some anxiety for both parents and children. Parents can help to mitigate this by establishing a regular routine for their school-aged children, in an effort to make the 2018-2019 school year as successful as possible.
Continue reading “Tips for a Successful Back-to-School Season”