The Sandusky Teaching Moment: Unfortunate Silence

It started with a many suspicions and a random post of the Penn State fan forum.

Perhaps more accurately, it started with molestation and loyalty to the institution over the community.

The ongoing reports out of Penn State for the past two weeks have brought forth discussions and elicited strong emotions from those in every sphere of my life.  At first, I started quoting the standard mandatory reporting regulations for sexual assault and how Child Protective Services, at least in Kentucky, do not accept third-party reporting - it has to come from the victim, the witness, or the individual the victim or abuser discloses to. I thought Joe Paterno's retirement at the end of the season announcement was bold and bordering on arrogant, and was exceedingly irritated that many news reports focused on his firing and the unfortunate silence that led to the end of a great coach's career. I did not graduate from a university with a BCS championship-claiber football program, so I have a hard time relating to the initial student protests of his ousting in light of the allegations.

More details concerning the access Jerry Sandusky had to the facilities after his employment immediately brought forth the thought "this is beyond cover up - there are probably others paying in kind to have access to these boys or to keep quiet." With records missing from Sandusky's charity Second Mile, non-communication with the university lawyer following McQueary's report to Paterno, District Judge and Second Mile contributor Leslie Dutchot letting Sandusky go home without bail, Sandusky's interview with Bob Costas where he admitted to showering with the boys appropriately, and police reports on victims going back to 1998, the rabbit hole gets deeper and deeper.

Teaching Moments
In the real world, these kinds of stories are opportunities for all of us to open the dialogue on healthy relationships. Since this story broke, I have asked many of my patients with young children if they have had these conversation and if this story has affected the family in any way. Most report a heightened sense of awareness and want to introduce or re-empasise body rights and choice. This article provides several useful tips: How to Talk to Your Child About Molestation For the teen or tween: Talking to Teens about Paterno, Penn State, and the High Price of Bystanding.

Every state is different, however mandatory reporting for teachers, healthcare professionals, and law enforcement are generally standard. Some states extend the duty to report to all residents, but this is not typically well known. To look up the statues that apply to you, visit State Laws on Reporting and Responding to Child Abuse and Neglect.

The "coach" position is a gray area, as evidenced by Penn States's policy that you report to your superior before reporting to the police or emergency teams. While it is in the rhelm of possibility that a federal mandatory reporting act could pass as a result of this tragedy, the Center for Ethical Youth Coaching posted an excellent guide for action when a coach, or anyone, witnesses child abuse: Procedures for Handling Abuse

May communities have domestic violence and sexual assault shelters that provide community outreach.  The Center for Women and Families is one of our city's greatest gifts and they provide information on spotting, preventing, and healing from these traumas: Educational Brochure Library

Of course, no OneDNP post would be complete without a nursing mention. When stories of abuse break like this, many victims relive their own traumas and can experience setbacks, especially when in the midst of therapy. It is important when providing care that nurses are aware of the effects of vicarious trauma and transference issues. To learn more about preventative healing and self-care, visit Reveal, Release, Reconnect

Remember that silence kills mind and body. The arguments many nurses make to avoid reporting peers for issues such as substance abuse  - ruining a peer's career, not wanting one's name connected with the report, fear of retaliation or disbelief, looking bad on the profession, practice, or organization - are the same reasons the powers at Penn State rationalized their silence. And no, it's not different.

Highlights from APNA 25: Psych Nurses Have More Fun

This was my second year attending the American Psychiatric Nurses Association annual conference, and the experience again renewed my enthusiasm for live CEU events. There were plenty of excellent speakers, exhibition (sales) booths, and poster presentations, but that is not what makes this a must-do yearly event. It is the camaraderie within the profession and the fact psych-nurses know the importance of having a good time. Here are a few of my personal highlights.

   

Venue: Disneyland Hotel

An excellent location to blend education and fun. Although the place was under construction and wi-fi was a bit spotty, the staff managed to make it magical. We had an awesome renovated room in adventure tower with a view of the evening fireworks. Since we were not run ragged with sessions and the conference ended early on Saturday, there was plenty of time to explore downtown Disney and the parks without the need for car rental or long monorail/bus rides. There were excellent places to eat (Napa Rose for high-brow, Trader Sam's for sips and apps), wonderful spa (ask for Carlos), and a fine collection on shops with live music until 10 or later every night. There were plenty of pens and pads along with a good selection of breakfast and boxed lunch choices. And Pluto, of course!



    

Inspiration: Jean Watson

Her presentation Caring Science and Psychiatric Nursing: Relationship and Emergence of Human Spirit included a singing bowl meditation and an honest discussion on how PMH nurses can use authenticity, interconnectedness, and belonging as instruments of healing.  While speaking on esoteric topics is commonplace in my CAM conferences, I was delighted her powerful delivery made it into an area that does not like to stray far from evidenced-based practice. "Being" is not a concept easily researched through science!  Jean was referred to often throughout the rest of the conference - I gave her a nod in my presentation on the role social networking plays in world connectedness - and she had a huge line of folks waiting to shake her hand following her talk. I studied her middle-range theory of human caring in my MSN program, but there is nothing like a personal illustration by the creator to bring life to a concept that seems more simple and obvious on paper than it does in clinical practice. Watson Caring Science Institute


Mentorship: Pat Cunningham
My advisor won this year' award for excellence in practice and we whooped it up when they presented her award. What is amazing about Pat from a student perspective is her ability to individually listen to each of us, evoke the best practice and thought out of ourselves, and to use that blunt humor so characteristic of the best psych nurses. I imagine her patients feel the same way!

Trend: Integrative Therapies

Last year there were a few posters that addressed CAM use by nurses and I was excited, but this year saw an explosion! Mindfulness training, supplement and nutrition use, and schools of nursing integrating various CAM certifications as part of their psych-np programs are just some of the new blends of therapies to benefit our patients.  I found out one of my current teachers has been using hypnotherapy with some of her pediatric clients and a former psychiatrist colleague has been instrumental in establishing integrative practices in the Long Beach VA's mental-health program. I am excited that the future may hold a number of niches I fit into without having to carve them out on my own. There may be opportunities to expand NP ability to practice certain CAM therapies as part of their scope of practice similarly to how MDs already have, and I would love to be a part of making that happen.

 
   

Coolest Product: Mindability
This product was cool for 2 reasons. First, all the promo literature was on a flash drive that I was able to use to store my presentation when I could not find mine (it resurfaced in my backpack yesterday). Second, the rep gave me a fun wallet card targeted to control emotional reactions. It included some great phrases such as:

• "If I'm reading this, it means I'm more upset than is good for me."
• "However I'm feeling is exaggerated"
• "Whatever I am thinking is distorted." 
• "Whatever I'm thinking about saying or doing, DON'T, until I calm down."

If reality TV stars had these in their pockets, there would be no reality TV stars! In all seriousness, this brought out a new idea for PTSD group I hope to use during clinical soon.

   

International Perspective: Holland
While a group of use were relaxing by the pool area in between sessions, a fellow nurse from Holland decided to sit and chat with us. I found it interesting that while the US is trying to establish mental health parity, in Holland, they have decided those with mental illness will now have to pay over-and-above the standardized government health insurance rate for supplemental coverage if they want psychiatric services. We also had an interesting conversation about different nursing roles and marijuana bars.

Obligatory Gala: California Dreamin'

Hosted on Adventure lawn, the Friday night reception was included in the conference registration rather than having to purchase separately. An excellent buffet and cash bar (boo!) was well staffed, and the all-dentist band made for a wild evening. The dance floor was defiantly too small for this crew as all-ages crowded it and boogied down. Later we went to my room for a wine tasting wind down that resulted in one of my classmates deciding to commit to the ascot. Pittsburgh better watch out in 2012!

  

APNA Presentation & Resource List

Uploaded to slide share and ready to view! Well, except my cool social-media sun did not transfer over well.Please remember to take the survey: Social Networking and Mental Health Providers

Social Networking for Psychiatric-Mental Health Nurses

View more presentations from Jaclyn Engelsher

Resources
ANA's Social Media Toolkit - What every nurse should know

Health Vault - The possibilities for collaboration and consultation are encouraging

VA Directive 6515 (Social Media Policy)

Healthcare Communications & Social Media #hcsm Sunday's at 9pm EST

People Say I'm Crazy John Cadigan, schizophrenia patient, movie maker, twitter junkie

Google Privacy Center  An excellent primer

Facebook Privacy The place to update your settings

Working the System to Make the System Work for Me!

One of our big projects this semester is an economic analysis of a healthcare issue or technology.  Between my APNA presentation and Capstone project, I am a little spent (ha, I made a pun) on social media and wanted to tackle something a bit more juicy: Collaborative practice agreements.

After about 10 hours reading a lot of stuff I already knew:

• The Institute of Medicine's position that APRNs should be full partners and allowed to practice their full scope of practice
• In states without collaborative practice agreements APRNs rank as high or better than MDs when it comes to outcomes 
• State medical boards have banned together to push the idea that nursing is actually medicine and must be regulated by state medical boards
• MDs are still bitching to each other on Sermo and publishing their opinions that so-called mid-level providers are only competent so long as they hand 5-15% of their revenue over in exchange for an on-paper collaborative agreement

I learned some interesting things I did not know regarding the Federal Trade Comission citing that the collaborative practive agreement could be considered monopolistic and a restraint of trade.

Then I decided, I like my blood pressure where it is, and scrapped it. I decided to analyze workforce management solutions for healthcare systems, specifically when it comes to mobile technology. Why? Because there is a Kronos conference in Orlando this November that I have been invited to that will allow me to get first, the latest data, second, the ability to network as part of the research, and third, to write off the entire trip.

Now thats some health economics!

The New & Improved ANA Social Networking Principles!

While I am not narcissistic enough to believe my contributions during the "open to public comment" period had anything to do with the excellent edits, I like to think the synergy of many like-minded nurses worked to improve the specificity and decrease the Ratched. The ANA was also nice enough to provide a Tweet and Learn #anachat for 0.5 CEU credits. Now we own it!

Benefits

• Networking and nurturing relationships 
• Exchange of knowledge and forum for collegial interchange 
• Dissemination and discussion of nursing and health related education, research, best practices 
• Educating the public on nursing and health related matters 

Risks 

• Information can take on a life of its own where inaccuracies become “fact” 
• Patient privacy can be breached 
• The public’s trust of nurses can be compromised 
• Individual nursing careers can be undermined

 ANA’s Principles for Social Networking 

• Nurses must not transmit or place online individually identifiable patient information.
• Nurses must observe ethically prescribed professional patient — nurse boundaries.
• Nurses should understand that patients, colleagues, institutions, and employers may view postings.
• Nurses should take advantage of privacy settings and seek to separate personal and professional information online.
• Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities.
• Nurses should participate in developing institutional policies governing online conduct.

6 Tips to Avoid Problems

• Remember that standards of professionalism are the same online as in any other circumstance.
• Do not share or post information or photos gained through the nurse-patient relationship.
• Maintain professional boundaries in the use of electronic media. Online contact with patients blurs this boundary. 
• Do not make disparaging remarks about patients, employers or co-workers, even if they are not identified.
• Do not take photos or videos of patients on personal devices, including cell phones.
• Promptly report a breach of confidentiality or privacy.

Research for Capstone Research

I am currently developing a survey for my DNP capstone project to examine usage trends and perspectives on social media within a number of psychiatric healthcare disciplines.  I am looking into a number of online survey sites to determine which one provides the most feature with the lowest (free?) cost.  It seems there is not one company that dominates the Doctorate student market, but if anyone has a great experience with a particular company, I would love to hear about it! Here are the links:

QuestionPro

SurveyShare

FluidSurveys

SurveyMonkey

SocialSci

SurveyGizmo

PsychData

LimeSurvey

I hope to have the survey up and distributed via a number of social media platforms and professional organizations by the APNA conference in October.  Check back soon!

¡Viva, Terminado y Voladores!

It is off to Spain in a few hours . . . well, off to a 6 hour layover in Atlanta and THEN Spain. I get to play journalist for a week by gorging on cured meats and stomping through vineyards. But the biger point is:

• Group Meta-Analysis Project: Done and Sent to Project Leader
• Health Economics Paper: Done and Submitted
• PMH Pediatrics Quiz: Done with 100%
• PMH DB Posts for This/Next Week: Done
• APNA Slide Presentation: Done and Uploaded
• APNA Post Test Questions: Done and Submitted

Which means the only thing I ran out of time to do was pre-write my Health Economics DB posts for next week. Unless I want to stay up another 3 hours and pull an all nighter . . . which I don't. But I probably will anyway. 


I think I have put on 5 years in the last 12 months.

First Week Down

I have been spoiled by summer break and have now retreated into my isolative, distractible state. On-Campus week was a blast and I will get around to posting the highlights from Dr. Carter's talk on the future of primary care, but in the meantime, this is what I am looking at for a schedule:

Evaluation of Practice:
Formulate a PICO question to post to discussion board and respond to those who post on mine while also posting advice to others, complete 4 CITI modules, take the 7 IHI Open School courses, work on my part of the clinical phenomena group project on care transitions (testing), work on my portion of the group meta-analysis project, and read. A bunch.

Healthcare Economics:
Answer the assigned questions by posting on Blackboard and responding multiple times within the group to show I read all of the assigned readings and have some independent thought and understanding of the topics, format my first essay paper and decide what topic I want to write about, watch some powerpoint presentations of economic theories and applications in healthcare, and read a few chapters in the Health Economics texts (and these guys must know what they are talking about since the cover price for the book is $236 - I bought the international edition for $50 brand-new on eBay. How's that for economics?!).

Management of Mental Health and Psychiatric Disorders:
Attend a conference call . . . while inputting all of my clinical notes into Medatrax, spend 2 days at my clinical sites, decide which consultation project to tackle and hopefully get a couple of others to join in, and read a couple hundred pages from textbooks and secondary sources.

For this next week - see above. I also need to get my butt in gear for the APNA. I have most of the powerpoint complete but I find the balmy 85 degree temperatures much more tempting than my laptop.

What's in a Set of Initials?

During on-campus time this week (more on that later) some of us were looking through the UTHSC yearbook and realized every other health discipline with the exception of nursing only listed their highest academic/licensed achievement. For those that were strictly degreed and certified in one discipline (i.e. only a medical doctor or a pharmacist rather than a physical therapist with a philosophy doctorate), their formal listings looked something like this:

John Doe, MD
Neurology

Jane Doe, DDS

Will Brown, PhD

Sara Brown, DPT

Steve Norris, AuD

Nancy Norris, Pharm.D

 . . . and then there was the nursing department:

Ann Smith, PhD, DNSc, MSN, APRN, FNP/GNP-BC, BSN, RN-BC

(Really? Yes, really.)


On a few of my professional LinkedIn groups, a number of threads have been started questioning the need for alphabet soup credentials and in what order to put them in. One of the participants posted an informative article from ANCC called Playing the Credentials Game (and quite appropriately, the author had an absurd number of credentials listed after her name) which reccommends listing degrees highest to lowest, state license, ANCC certifications, fellowships, and other awards. So I guess my high school GED comes before my RN-BC which comes before the Walden Theatre Unicorn Award I won for being a team player, but after my Golden Key Honor Society membership.

What it comes down to is that without a national scope of practice represented by one designation, as most of our healthcare colleagues have, we are likely doomed to feel listing degree, licensure, state designation, and national certification essential. I suppose either bravado or compensation makes us feel it necessary to list awards and certifications. As for myself, I will stick with my original response to the question of how to present one's name:

I am passionate about the over-listing of credentials that nurses have adopted in comparison to other healthcare professionals that pick their highest degree/license. I list my highest licensing credential (APRN) and that is it because it encompasses my RN and graduate level education (which you cannot have without some level of undergraduate, and for that matter high school education). After reading the article Francis posted (thank you), I am more compelled with my plan to list my DNP only, since it is the terminal degree for advanced practice, just like the MDs, PsychDs, DPTs, and PharmDs do:

Jaclyn Engelsher, DNP
Family, Psychiatry

"We Take Care of It"

It's that time of year again. Time for me to curse Delta, humidity, and numb-butt. On campus for our third semester means 10 months until graduation . . . 10 months + 1 day until student loans go back into repayment. It also means I get to explore a bit more of downtown and contemplate how exacly to formulate a group session on alcohol therapeutics.

Compared to last year, it is almost like we are barely on campus. Monday was for the newbie and the only thing on the official agenda for Tuesday was Evaluation of Practice. I proudly waltzed in an hour late along with several other slackers (all of which I believe were from the Psych option) and spent most of my time looking up old evidenced-based practice lectures from my MSN to refresh myself on what a PICO question was. I would love to report I have any idea what the class was about, but a revised syllabus, 2 detailed assignment lists, and a lesson in literature search later and all I know is everything must be submitted electronically and the professors are willing to fire our group partners for us if they are not pulling their weight. You fire our problem? I don't think so. In psych, if we have a problem, we take care of it. No need to resort to tattling (I think that is a king to rook four on the lateral violence chess board, but I need to look it up to be certain).  I think this class is going to be the Epidemiology of year two.

Did I mention 10 months until graduation?