AASCIN News: Special Interest Group Reports
Submitted by Linda C. Smith, RN, MSN, CRRN
The 2007 Annual Education Conference in Orlando, Florida provided attendees with the opportunity to meet with their professional colleagues and discuss topics of concern at Special Interest Group Meetings (SIGs). The information outlined below highlights the topics discussed by each SIG group that convened on August 28, 2007.
1. Canadian Nurses
• Attendance––1
• Attendee joined the Wound/Ostomy Nurses
2. Wound/Ostomy Care
• Attendance––5
• What do we want to accomplish?
• How can we attract more people to our group in the future?
Potential Topics
• Role of seating with sacral and ischial ulcers in rehab
• Management/coordination of patient wound care, especially clinicians vs. traditional physician care
• Benchmarking of results at various facilities and adapting best practices, such as VA system
• Nutritional interventions, best practices
• Sitting after flap surgery
Economic driven:
• Policy that a patient with an “unstageable” sacral ulcer will not be seated
• Sacral usually will seat
• Upward shear of sitting may impair speed and quality of wound healing
• SCI guidelines do not have seating guidelines for SCI patients
• Practices vary – length of seating vs. bed rest, etc.
• VA & Canadian systems are examples where economics are different compared to County Hospitals
• Respiratory, organ function, additional ulcers all depend on treatment option chosen, seating vs. bed rest
• Canadian system patients get up on ischial and sacral ulcers regardless of staging. Exact plan depends on staffing and other issues.
• In one VA, patients with sacral wounds get a seating evaluation and revert to bedrest if wound does not improve. Patients with ischial wounds are on bed rest.
• Quality of life issues come up for patients feeling too confined to bed.
• National Pressure Ulcer Advisory Panel (NPUAP) has new staging guidelines for ulcers:
Blister with blood = suspected deep tissue injury
Necrotic tissue making wound not visible = unstageable
• NPUAP has wealth of info online
• University of Utah suggestions:
Stage 1 or 2 – 22 hrs/day in bed for 7-10 days
Stage 3 or 4 - same plus 4-5 hrs outing
• After a flap one VA requires 4 weeks of bed rest then sitting if mobility is good
• Others have similar protocols with up to 6 weeks of bed rest followed by progressive seating.
3. Pediatrics
• Attendance – 2
• Continue Communication (web site) for Best Practice
• Low numbers represented
• Peer support
4. Nurse Practitioners•
•Attendance – 10
• National Level NP-PhD 2020, DNP (Doctorate NP)
• VA:
• Clinical practice
• Acute care
• Diaphragmatic pacing
• Spoke-clinic following SCI/D for primary care
• Admitting privileges
• Issues:
• 3rd party billing
• Under physician orders
• State-by-state regulations for Medicaid
• Nurse practice acts differ by state
• Facility issues
• Standardization of Nurse Practice – NP Role
National Prescribing privileges:
No controlled substances
Protocol by state law
Approved by Dr ______________
Schedule I vs Schedule II and III controlled substances
Standardization of Practice
• Right to be independent practitioners
• Limit people who work in rural areas
• Fear of physicians taking their patients
• Minute clinic – Walmart:
Screening – quick treatment
• AMA lobbying against NPs
• Standardization of NPs
Clinical Ladder issue in VA system:
• Clinical III – NP MSN
5. Clinical Nurse Specialist
• Attendance – 4
• Title protection
• Ventilator assistance
• Outcomes – FIM
• EBP
6. Staff Nurses
• Attendance – 6
• Concerns :
Staffing
Acuity Level
Training consistency of staff, patient and family
Bowel care program (new staff)
Owning responsibility of nursing care
Issue of training new nurses and fear factor with SCI patients;
AD – Autonomic Dysreflexia – look at the whole picture, process, critical thinking
Experienced preceptor SCI
Curriculums to include more in depth issues pertaining to SCI patient in nursing schools
(Me generation) Orienting new nurses to help them understand “TEAM” concept (assisting each other)
Create a video teaching patients concerning each aspect of SCI Issues
Divide into sections
Create audio-visuals
Acuity – should be higher acuity related to other patient groups
Staff according to acuity not numbers of patients
7. Gerontology
a. Attendance – 5
b. Issues
• How to disseminate info related to SCI to community and rural health care centers when a patient is admitted for a non-SCI related medical-surgical problem?
• Aging associated with co-morbidities. How to keep nurses abreast of new care information. How to disseminate latest research – evidenced based care - to nurses in community and rural health centers?
• Aging patient with aging caregiver
• Aging patient with generation X or Y caregivers
• Solutions
• GeroNurse Online - get info about aging with an SCI from AASCIN website onto GeroNurse website
• Use of available technology, such as lifts, need to get this info to the aging caregiver
• Put bulleted info on AASCIN website on Gerontology topics related to SCI care
8. Nurse Managers / Administrators
Attendance – 13
Recruitment and Retention
Young
Age 20-22
Lift teams
Patient classification system does not adequately capture spinal cord injuries. Nurse patient ratios
Conflict resolution and inappropriate behaviors when not satisfied with their assignments
Crucial conversations
CREW = Teambuilding in the workplace
Careful conflict
AASCIN membership dropped from 1000 to 500
President elect advised the group of reason for decline in membership
Magnet status – accountability
Concerns re LPNs getting decreased membership rates
Clinical Symposium – poster presentation
Application process onerous – not encourage increased membership
ASIA & AASCIN coming together in 2009 for combined symposium in mid September
9. Community / SCI Prevention
• Attendance – 2
• Use of ATVs
No laws
Look at problem and come up with stricter laws
No helmets
Complicated problem
Responsible party
• Competitive Motocross
Course helmet
Trails do not want ambulance on trail
Very touchy politically
Increased insurance rates
• Website
What’s going on around the states?
• Solutions
Educate the public to the problem
Involve legislators & police / sheriff
What happens at time of purchase?
License, helmet, protective equipment
Check laws, re: age
People will not stop
Impact of use of substances (DUI)
Passengers
How to influence key populations (Children & teens)
Corporate manufacturers / Sponsors
TV & Computers showing extreme sports
Two sides
Competitive
Recreational