the changing landscape of happy new year hepatitis c … · 2018-03-31 · december 2015 alaska...
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Board of Nursing News Flash . . . . . . . . . . . . . .2Palliative Care Fellowship Opening and Learning Opportunities . . . . . . . . . . . . . . . . .3Nurses in the News . . . . . . . . . . . . . . . . . . . . .4ANPA Announces New Officers at Fall Conference . . . . . . . . . . . . . . . . . . . . . . .4Advanced Practice Nurses in Alaska 2015 Survey Results . . . . . . . . . . . . . . . . . . .5
APRN Alliance Update . . . . . . . . . . . . . . . . . . . .5Happy New Year from the ANT 2016 . . . . . . 6-7Up and Coming Event Calendar . . . . . . . . . . .11New Years Resolution - Helmets for All . . . . .12Membership Magnet . . . . . . . . . . . . . . . . . . .12Updates from Alaska Respond . . . . . . . . . . . .13Are You in the Know? . . . . . . . . . . . . . . . . . . .14A Teaspoon of Science . . . . . . . . . . . . . . . . . .15
Volume 3 • No. 4 December 2015The Official Publication of the Alaska Professional Nurses Organization
Quarterly publication direct mailed to approximately 8,000 Registered Nurses and Licensed Practical Nurses in Alaska
UAA Health Policy Corner
Page 8-9
Happy New Year from the ANT 2016
Pages 6-7
ANPA Announces New Officers at Fall
Conference
Page 4
The Changing Landscape of Hepatitis C Therapy
Annette Hewitt, MSN, ANP
New medications for hepatitis C (HCV) available within just the last two years have changed the treatment for this disease completely. Yet, the high cost of these medications and the uneven access to them has made for a changing landscape of hepatitis C therapy that shows no signs of stabilizing.
It is estimated that 3.6-4.1 million US citizens are HCV antibody positive. This includes 2.8-3.2 million with active disease and those HCV RNA positive by PCR. It excludes homeless and incarcerated persons. The Institute of Medicine estimates that 45-85% of those affected are not aware of disease (1). In addition, there is a well documented lack of provider knowledge, including lack of screening for risk factors.
There is increasing morbidity and mortality from Hepatitis C. In 2007, deaths related to HCV outnumbered HIV, 74% of those deaths were in persons ages 45-64. Hepatocellular cancer is now the fastest growing cause of cancer mortality and 50% is from HCV infection. It is predicted that in the next 40-50 years if there are 1.76 million untreated, 60% will develop cirrhosis, 400,000 will develop hepatocellular cancer and 1,000,000 will die.
Persons infected with HCV are a significant burden on the healthcare system. Charges for HCV hospitalizations increased 291% from $0.9 billion to $3.5 billion from 2004 to 2011 and charges for advanced liver disease increased 44%. Increased rates of hospitalization associated with hepatitis C rose 190% from 2004-2011 (2).
Annette Hewitt
Hepatitis C Therapy continued on page 10
Happy New Year MessageThe Chronic Disease Prevention
and Health Promotion DepartmentEach year brings new hope and resolutions. As we
know, it is important for we nurses to start the year refreshed and set ourselves up for long-term success. How can we help our patients make a change regarding their chronic disease? For those patients who are first diagnosed with a chronic disease, it is important for them to attend a chronic disease self-management workshop. But, if that is not available, to at least provide them with education regarding their chronic disease. The Chronic Disease Prevention and Health Promotion Department has a website, that often gets overlooked.
The Safe and Healthy Me website. http://dhss.alaska.gov/dph/Chronic/Pages/SafeAndHealthyMe/default.aspx
The Safe and Healthy Me website has patient education material regarding: safety, obesity, diabetes, tobacco, and screening. It also contains stories from Alaskans addressing cancer, nutrition, physical activity, and tobacco. During the months of August and September, some of you received free patient education material addressing chronic disease. Please be sure to visit the Safe and Healthy Me website to look over our material.
If you would like to receive free patient education material, feel free to contact us via e-mail: [email protected].
We want to hear from you.
Nelly Ayala | E-mail: [email protected] | Website: www.diabetes.alaska.gov
Nelly Ayala, RN
Page 2 • Alaska Nursing Today December 2015
Contact AKPNOAlaska Professional Nurses Organization
200 W. 34th Ave. #118Anchorage, AK 99503
www.akpno.org
The Alaska Professional Nurses Organization is a statewide nursing society dedicated to improving the health of all Alaskans through fostering nurse leadership and excellence in nursing practice.
Board of DirectorsPresident Barbara Berner EdD, MSN, FNPVice President Mary Stackhouse CLNCSecretary LeMay Hupp MPHTreasurer Debbie Thompson BSN, CNOR
Directors at Large Pat Dooley BSN, CHPN, MHSA Patricia Barker BSN, NCSN Tina DeLapp EdD, MSN
Editor: Lynn Hartz MSN, ANP [email protected]
Author Guidelines:
ArticlesAlaska Nursing Today welcomes original articles for publication. Preference is given to nursing and health related topics in Alaska. Authors must identify potential conflicts of interest, whether financial or of other nature and identify any commercial affiliation if applicable. Resources, including websites should be listed at the end of the article. Photos may be sent as a .jpg file and become the property of AKPNO.
Editorials/Commentary/ Letters to the EditorLetters, comments, questions or opinions about nursing or health care in Alaska are a wonderful way to share information and viewpoints with colleagues across the state. Send your submission via email. Letters must be 500 words or less and may be edited for length, clarity and grammar. Editorials and Commentary do not have a word limit at this time though they are also subject to editing. The ANT is published every three months so be careful about sending time sensitive material.
AKPNO has the right to accept, edit or reject proposed material. Materials may not be reproduced without written permission of the Editor.
All submissions may be sent [email protected]
Publishing Information and Ad ratesAlaska Nursing Today is published quarterly every March, June, September and December.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. AKPNO and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Alaska Professional Nurses Organization of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. AKPNO and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of AKPNO or those of the national or local associations.
Published by:Arthur L. Davis
Publishing Agency, Inc.
Alaska Professional Nurses Organizationwww.akpno.org
Board of NursingSearch for New Executive Administrator
The Board of Nursing has finished another successful and busy October meeting. Although we were without an Executive Administrator, all went well. Thankfully the search for a new Executive Administrator has found qualified applicants with the hope that a new EA will be in place before the January, 2016 meeting. Many thanks to the Board of Nursing staff that have kept the office functioning with minimal glitches!
New MemberTina Gillis, RN was
appointed by Governor Walker to the Board last October and attended her first meeting in Anchorage. Ms. Gillis works in Bethel.
Licensure Delay AddressedAfter the July 2015 BON meeting the board
was made more aware of the delay in nursing licensure. Due to several circumstances there was a delay of up to 8 weeks in obtaining a nursing licenses. Lisa Maroney, Licensing Supervisor as well as Operations Manager Sara Chambers worked to resolve the issue so that now a license request can be completed in 10 business days. A provision for an expedited process is in place. The steps to follow are found at the Board of Nursing website. There remains some discussion regarding the place for a temporary license. This continues to be a work in progress.
Regulation ChangesA long awaited regulation project was
completed at the October meeting. Many of the changes were general housekeeping in nature. A couple of other items included Retired RN regulations and Advanced Nurse Practitioner competencies. These regulations have been returned to the regulation specialist for editing then they will be available for the 30day public comment period. You may have the proposed regulation changes sent to you by joining the listserv, which is found on the Board of Nursing website at www.commerce.alaska.gov. Please send all public comments to [email protected] who is the Regulation Specialist. If all goes well, the Board of Nursing will review all public comments and make any necessary changes at the January 20-22, 2016 Board meeting in Anchorage.
Denise Valentine, ANP-C
Chairperson, BON
Gillis
ARE YOU READY...TO
RESPOND?Our purpose is to identify and mobilize licensed
Alaska healthcare professionals to serve as volunteers in a disaster or public health emergency.
Happy Holidays to all of our dedicatedAlaska Nursing Professionals.
For more information and to register online visit us today.
www.akrespond.alaska.gov
Case Manager (Talkeetna & Willow) – The Sunshine Community Health Center is currently recruiting for a Case Manager, preferably with RN or comparable experience. Position participates as an integral member of the integrated primary and behavioral health care team. We offer competitive wages and a wide-ranging benefit package. Successful completion of a background check and pre-employment drug screening required.
Employment applications are available on our website at www.sunshineclinic.org. Please send a current resume, a letter of
interest and a completed employment application to:
Stephanie Stanley-Harrell, Human Resources ManagerSunshine Community Health Center | HC89 Box 8190, Talkeetna, AK 99676
Direct: (907) 733-9236 • Fax: (907) 733-1735mailto: [email protected]
We are in search of Experienced Registered Nurses who can make a significant contribution to their patients, co-workers, and professions by consistently providing the highest level of patient care and customer service.
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December 2015 Alaska Nursing Today • Page 3
News Release October 30, 2015Providence Alaska Medical Center
Palliative Care and Spiritual Care Department
The Providence Alaska Medical Center Palliative Care team is proud and eager to announce that the Providence Alaska Foundation has provided a generous grant to fund development of a Palliative Care Interdisciplinary Training Program.
PAMC Palliative Care will collaborate with the Providence Alaska Spiritual Care Department to add one Advanced Nurse Practitioner (ANP) Fellow and one Clinical Pastoral Education (CPE) Resident. These new Fellowships will run in conjunction with the Palliative Care Physician Fellowship which has been in place here at PAMC for nine years.
As the Director of the Palliative Care NP Fellowship, I am excited to notify ANPs of two important opportunities specific to the ANP portion of the grant. The first, a Palliative Care ANP Fellowship, is a one year learning commitment with our Palliative Care team and is expected to begin in July of 2016.
This learner will work with inpatient and outpatient Palliative Care providers, as well as with other providers within the community, such as Providence Hospice. The Fellow will be guided through various educational opportunities and encouraged to complete a project promoting the growth of Palliative Care. One of the educational opportunities will include a weekly lecture series to help prepare the Fellow to sit for the Advanced Certified Hospice and Palliative Nurse (ACHPN) Certification examination through the Hospice and Palliative Credentialing Center.
The weekly lectures series will aim to not only prepare the Fellow to sit for the board certification, but also as an opportunity to grow the Palliative Care network throughout Alaska. Our aim is to support experientially trained ANPs who work with patients facing life-altering illness towards obtaining their CHPN certification. The lecture series will be once a week either as on-site or a web based option.
There will be an opportunity, for those interested, to receive financial support towards the ACHPN examination through Palliative Care foundation funds. This certification requires national ANP licensure, 500 hours of Palliative Care clinical experience, and passing the examination. In addition, we are looking for persons interested in presenting a class for the lecture series.
In conclusion, we want to keep people informed, so please complete a questionnaire via Survey Monkey (the topics below will be addressed): at www.surveymonkey.com/r/QQ69K5N.
1. You or someone you know is interested to learn more about the fellowship.
Palliative Care Fellowship Opening and Learning Opportunities
UAA Doctor of Nursing
Program UpdateThe first University of Alaska
Anchorage Doctor of Nursing Practice (DNP) cohort began August, 2015. The program is focused on advanced nurse practitioners in Family or Psychiatric/Mental Health fields. UAA faculty is working diligently to provide a high quality and practical program that will demonstrate effective nurse leadership and expanded advanced practice skills. The DNP program is currently offered as a full time track. A part time option is anticipated for fall 2016. In addition to the Masters to DNP program option, a full time three year Bachelors in Nursing Science (BSN) to DNP curriculum is anticipated to start August 2018. Please check the graduate handbook for application requirements and deadlines. The UAA School of Nursing Graduate Handbook is available on line at https://www.uaa.a laska.edu/schoolofnursing/upload/2015-2016-DNP-Handbook.pdf. DNP program questions may be direct to Dr. Lisa Jackson at [email protected].
2. You are interested in participating in the lecture series, along with being supported to obtain ACHPN certification to strengthen your current practice with patient facing serious illness.
3. Your are willing to be a speaker for the lecture series.
4. You want to be notified of lectures even without interest in pursuing specialty certification.
We look forward to working with you and growing Palliative Care throughout our state.
Marianne Johnston-Petty, FNP-C, ANP, ACHPN and Dr. Ursula McVeigh, Director, PAMC Palliative Care Team
Page 4 • Alaska Nursing Today December 2015
Nurses in the News
2015 ANPA Nurse Practitioner of the YearLaura Sarcone was
honored at Alaska Nurse Practitioner Association’s fall conference with their Nurse Practitioner of the Year Award. The annual tradition honors outstanding nurse practitioners in the state. Sarcone, a CNM at the Alaska Native Tribal Health Consortium and Southcentral Foundation, Co-Chairs the APRN Alliance and has been instrumental in the effort to pass SB53, legislation that will change the title “Advanced Nurse Practitioner” to “Advanced Practice Registered Nurse.”
Laura Sarcone, CNM, ANP
Hand Sanitizer QuizWhat part of the hand do clinicians miss
most often?
According to a study published in the American Journal of Infection Control, the THUMB is covered the least often (37.45%).
ANPA Announces New Officers at Fall Conference
At the September 17 Alaska Nurse Practitioner Association annual fall conference, officers for the next year were announced. Tracey Wiese, ANP (lt), past President introduces incoming
President Shannon Hilton ANP.
Shannon Hilton currently practicing at Anchorage Neurological Associates assumes the ‘presidential’ gavel. Not pictured are President-Elect J.Nick
Manwaring, ANP and Secretary Sarah Bilak-Larson, ANP.
Mary Anne Rowen, ANP, kindly consented to serve another
term as Treasurer.
Tracey Wiese (lt) with retiring Board of Nursing Executive Administrator, Nancy Sanders, PhD, RN
who was given a plant as a token of appreciation of her contributions during her time with the Board.
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December 2015 Alaska Nursing Today • Page 5
Advanced Practice Nurses in Alaska2015 Survey Results
Total ANPs living, licensed, and practicing in Alaska 590*
ANPs practicing in urban areas 82.7%**
ANPs practicing in rural areas 48.2%**
In subregions 24.6%
On road system 9.6%
Off road system 11.4% In remote areas 2.6%
2% of NPs are sole licensed providers in their communities.
37.7% of NPs practice in medically underserved communities.
NPs in Alaska averages 2112 primary care visits per year.
NPs in Alaska provide 910,272 primary care visits per year(based on a total of 431 NPs who provide primary care services).
73% of NPs accept Medicare reimbursement for services.
83% of NPs accept Medicaid reimbursement for services.
NPs care for the underserved Average % of Practice % of Alaska Pop.
African American 6.0% 3.9%
AI/AN 24.7% 14.8%
Asian/P Islander 7.5% 7.4%
Hispanic/Latina 5.5% 6.8%
Uninsured 26.8% 18.9% (2014)
<100% Poverty Level 42.5% 9.9% (2013)
Not Fluent in English 15.1% 16.2% (other than English at home)
*surveys were sent to 590 ANPs, 120 were returned** NPs may practice in more than one area
The annual NP survey is sponsored by the Alaska Nurse Practitioner Association and is published with their permission. Results were provided by Barbara Berner EdD, APRN-BC, FAANP
APRN Alliance UpdatePress Release from APRN-A 11/3/2015
On October 24th, the APRN Alliance met for a strategic planning meeting at the Gathering Room, which is a wonderful venue that was provided by South Central Foundation. A facilitated meeting was held with the purpose of redefining the vision, direction and leadership of the APRN Alliance given that the bulk of their original goal (the creation and passing of SB53) has been completed. Approximately 15 nurse leaders representing all four of the APRN specialties (Nurse Practitioners, Nurse Midwives, Nurse Anesthetists and Certified Nurse Specialists) were present.
Facilitated by Carrie Doyle, a Certified Nurse Specialist, the group started by doing a bit of a modified SWOT analysis where they examined both short and long term opportunities and threats to the APRN Alliance remaining functional, and also the same for if it were to disband. The group felt there was overwhelming opportunity for the APRN Alliance to remain a voice for these four professional groups.
For the rest of the meeting, discussion surrounded the focus of the APRN Alliance moving forward. Some general themes that were noted during this meeting were that it was vitally important to all APRNs for the Alliance to remain an active voice in the legislature as well as with the Board of Nursing. In addition, there needs to be more active participation from nurses located outside of the Anchorage area.
The Alliance is committed to maintaining an active presence in all professional aspects of these four groups. It was recognized that for the Alliance to remain a sustainable presence, there must be increased participation from all four professional groups. We need you to participate! There are currently multiple legislative and regulatory “trains” which have left the station. APRNs must continue to be aware and be a voice in order to protect our current level of independent practice, and ensure that we are leaders of the rapidly changing health care arena in the state of Alaska. The age old adage remains true, if we are not at the table, we will be on the menu.
There were many creative ideas which were presented to address the barriers of “too little people and not enough time.” The APRN Alliance encourages increased participation from all four groups, especially if you reside outside of the Anchorage area. If you would like to be added to the APRN Alliance email list, please send an email to [email protected]. We encourage all APRNs to join us January 9th for our Legislative and Pharmacology update. There will be CEs provided.
Email [email protected] for registration and information.
www.nursingALD.com
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Page 6 • Alaska Nursing Today December 2015
Happy New Year from the ANT 2016
An Alaska Photo Round UpAlaska Board of Nursing Alaska Nurse Practitioner Association
Advanced Pain Centers of Alaska, Anchorage
Alaska Regional Hospital
Three of the seven Board members. Happy=Sharyl Toscano, PhD, MS, RN-CPN, Associate Professor at UAA, New= Carrie Miller, LPN,
Year = Tom Hendrix PhD, RN, Associate Professor at UAA.
Happy= Past President Rachael Carlson ANP, New= Past President Robin Bassett ANP, Year= Past President Tracey Wiese ANP.
Ginnie Miller, RN and Tim Hilts, RN, BS Operating Room Nurses greet 2016.
Bassett Army Community HospitalBassett Army Community Hospital
For more information please contact CPT Wilson at [email protected]
GREAT EMPLOYMENT OPPORTUNITIES!All positions come with competitive benefits.
RNs • NPs • PAsLPNs • Psychologists
Physical Therapists • Medical Receptionists Billers/Coders, and many more...
December 2015 Alaska Nursing Today • Page 7
Happy New Year from the ANT 2016Alaska Professional Nurses Organization
Nurses Outward Bound Nurses in the Making
Alaska Regional Hospital
AKPNO members Happy= Colleen Bridge, RN New= Anita Watts, RN Year= AKPNO President, Barb Berner, EdD, APRN, FAAN.
Dianne Tarrant, FNP, APRN-C, FAANP, long-time Alaskan, newly retired and now living in Arizona
pictured with her daughter Tiffany Tarrant, APRN, FNP.
Pictured are some of the students of the NS 300 Foundation 1 class at the UAA BS program. This is their first trimester in the program. The students are: Back row H = Ashley Powell, A =
Melina Mack, P = Maribeth Murray, P = Regina Burzinski, Y = Laura DeVaney, N = Besarta Aliju, E = Alexis Lochner, W = Brandon, Wolfe. Front Row: Y = Stacy Hunter, E = Olivia Ramseth, A = Jolene Felde, R = Kalia Thao, Leandra Carl. Not pictured is Bernice Carmon, their instructor.
Recovery room nurses at AK RH.
Thank You ANT Contributors
We would like to take this opportunity to give a special thank you to those who have contributed articles and photos this year to the ANT. Writing is a solitary, many times unnoticed effort. We appreciate your work and hope you will continue as authors and photographers into your future!
Marianne Schlegelmilch Shelly Burdette-TaylorDenise Valentine Nelly AyalaPat Dooley Autumn MuseSusan Pridgen-Webb Tina de LappLisa Seifert Jordin ThompsonAmanda Alexander Celeste ShumateOnome Okurume Tom HendrixDianne Maythorne Jill RamseyBarbara Berner Jessica DavisDarbi Daley Bernice CarmonAudrey Frone Erin FrolanderLaurie Racenet Leanne Troop
Now Seeking RN OpportunitiesCase Management • ER • ICU • Med/SurgOB • OR • Outpatient Clinics • PACU • PHN
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Page 8 • Alaska Nursing Today December 2015
Health Policy Corner
Pre/Post-Natal RN Home Visits – A Health Policy That Works
Leanne Troop, RN, BSN
In August of 2012, the Nurse Family Partnership (NFP) program was contracted to Providence Health System in Anchorage. It was made possible by a federal grant the Alaska Department of Health and Social Services (DHSS) was awarded. DHSS applied for a federal grant to fund the NFP program in Anchorage and was awarded $1 million dollars that would fund the program from 2012 through 2018. After the grant money was awarded to the state, DHSS went in search of an entity within Anchorage to utilize and run the program. In the end DHSS contracted with Providence Healthcare in Anchorage to utilize the grant and start the Nurse Family Partnership program.
The Nurse Family Partnership program is a national model founded by David Olds, PhD a professor of pediatrics, psychiatry, and preventative medicine at the University of Colorado in Denver, Colorado. “While working in an inner-city day care center in the early 1970s, Olds was struck by the endemic risks and difficulties in the lives of low-income children. He realized the children needed help much earlier—at home, with their mothers, when they were infants, and even before they were born. Olds’ determination to help young children and families get a better start in life led to the development of a nurse home visitation program for first-time, low-income moms and their children.” (Program history, 2011. para 1)
Olds set out to design a program to meet the needs of this unique maternal/child population where they lived, in the home. For the next 35 years he designed and refined the NFP program using evidence based research and random controlled trials to test his NFP model. The results showed not only improved pregnancy outcomes but improved health and developmental outcomes of the children involved. For the parents in the program it helped “create a positive life course for themselves.” (Program history, 2011. para 2). Not only were there short term benefits but the trials showed benefits lasting through the teen years in which the experimental group showed less criminal behavior. A characteristic of this model not necessarily shared by other early visitation programs is its use of trained and
experienced RNs. When NFP was slated to start in Anchorage, staff and RNs were sent to the program headquarters in Denver, Colorado for training. As a buy in program, NFP in Anchorage has the same access to materials and support that every NFP program in the country has access to.
Since January 2013, the Nurse Family Partnership program in Anchorage has been seeing clients and the program has proved to be very successful. NFP works with first time mothers or parents that qualify as at or below low-income status, ie. qualifying by WIC guidelines. The clients qualify for entry into the program if they are 28 weeks gestation and then they can be seen through gestation until their child is 2 years of age. RNs meet with their clients at their home whenever possible per client comfort. The first graduation from NFP in Anchorage occurred last April 2015 for a client who had completed the entire 2 year 3 month program.
At the start of the NFP program clients were enrolled in the program mainly through clinics and physician referrals to the program. Now, at over two years, many of the referrals are word of mouth from current clients, as well as referrals, and individuals seeking information after seeing advertising on the program. When I spoke with Patty Wolf, RN, nurse supervisor of the Providence Nurse Family Partnership program in Anchorage, she indicated that they are now at capacity for their current program and the number of clients on the wait list seems to grow every week. Patty also stated that the feedback she has received from the clients they see has been very positive. Along with seeing clients in their homes, the program also emphasizes the enrichment of the clients and children’s lives through client mixers where clients all receive donated gifts and then families have a chance to network with other clients in the program.
Due to privacy issues, the program cannot set up small groups at this time so the mixers and parties the program does host are a valuable part of the program. Ms. Wolfe spoke about how the program puts a lot of value into the education and bonding of parents with their children. With some pride she indicated that by the time families’ graduate from the program the goal is that each child has a “small but substantial library” and reading is emphasized as extremely important for language development and bonding. It is through donations from the community that the Nurse Family Partnership can host gatherings and provide gifts at these mixers and provide books to their clients. The program is very grateful for all the generous support it has received from the Anchorage community.
The NFP program is entirely voluntary and free to its clients. “There is a fair amount of turnover,” Ms. Wolfe stated, “but with the waiting list we are then able to get other clients into those spots easily.”
At this time the program is funded by the grant DHSS received until 2018. In 2014 DHSS applied for an expansion grant, which they received that will allow the Anchorage NFP to hire additional RNs to expand the program and see clients in Matsu-Valley. Rebekah Morisse RN, Nurse Consultant from DHSS works closely on the grant and with Patty Wolf in a continual process of evaluation, quality improvement measures, and measuring evidence on the program’s outcomes that is required under the federal grant process. They are anxiously awaiting additional federal funding through Senate Bill S.799- Protect Our Infant Act 2015, Federal legislation that has incorporated maternal child health funding into the bill. If S.799 passes that would allow the NFP program in Anchorage to be funded 2018-2020. Without the funding from this federal bill, NFP would be at risk. As of October 22, 2015, the bill had passed the House and Senate but had not been signed into law.
For further information or to donate books or gifts go to Providence Nurse Family Partnership
http://alaska.providence.org/locations/pamc/services/homehealth/Pages/nursefamily.aspx or www.nursefamilypartnership.org
[The author would like to thank Rebekah Morisse RN, Nurse Consultant at DHSS and Patty Wolf, RN Supervisor at the Providence Nurse Family Partnership program in Anchorage for their assistance with this project. This is a project of UAA’s graduate Health Policy Course.]
ReferencesFamily Nurse Partnership. 2014. Current Research
Agenda Table Summary. Retrieved from: h t t p : // w w w. n u r s e f a m i l y p a r t n e r s h i p . o r g /a s s e t s / P DF/A g e n c y-D o c s /C u r r e n t R e s e a r c h AgendaSummaryTable_July2014.aspx. Retrieved on: 04/14/15.
Family Nurse Partnership. 2011. Program history para 1 and 2. Retrieved from: http://www. nu rsefa m i ly pa r t nersh ip.org /about /prog ra m-history#sthash.chEnD6b3.dpuf. Retrieved on: 04/08/15.
Olds, David; Hill, Peggy; Rumsey, Elissa. 1998. Prenatal and Early Childhood Nurse Home Visitation. Juvenile Justice Bulletin. US Department of Justice. Retrieved from: http://babel.hathitrust.org/cgi/pt?id=mdp.39015055818168;view=1up;seq=1. Retrieved on: 02/23/15.
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December 2015 Alaska Nursing Today • Page 9
Health Policy Corner
Screening Alaskan Women for Perinatal Mood Disorders
Erin Frolander, RN
Women of all ages, ethnicity, religious background, and socioeconomic status have babies every day. According to a Camp (2013), fifteen percent of women suffer from postpartum depression. That is about one in six women that give birth. There are risk factors such as low socioeconomic status, poor support systems, history of depression or anxiety, and gestational diabetes that predispose women to perinatal depression and anxiety. Even though these risk factors have been identified, perinatal mood disorders can affect any woman in the perinatal period . If undetected and untreated, perinatal mood disorders can have severe effects on the woman, the child, and the entire family.
Symptoms for perinatal mood disorders include change in appetite, fatigue, diminished ability to think or concentrate, hypersomnia or insomnia, and agitation. Some women may experience feelings of hopelessness, worthlessness, and in extreme cases, thoughts of suicide (Camp, 2013). These symptoms can decrease the ability for the woman to bond with her newborn child and family members.
Currently, there is not a policy in place for public health nurses in Alaska to screen all women in the perinatal period for mood disorders. Women are seen through the perinatal period in public health clinics and in the home during the well child visits. These visits provide opportunities to screen women throughout the perinatal period and if screened positive, to assist them in referral for additional treatment.
There are screening tools available such as the Edinburgh Postnatal Depression Screen or Postpartum Depression Screening Scale that can be used to screen women through the entire perinatal period. These tools are simple, written at a fourth grade reading level, and take less than ten minutes to complete. They can then be scored at the time of completion and if positive, the woman can be referred on the spot for further management of symptoms.
Mood disorders can affect any woman in the perinatal period and early education of symptoms and the commonality of mood disorders could provide the mother with the support needed to seek assistance. According to Grier and Geraghty (2015), if early education is provided and women are screened and treated accordingly, they are more likely to have enhanced outcomes. Interventions can range from increased exercise, holistic approaches, cognitive behavioral therapy, to pharmacologic treatment.
State of Alaska Public Health Nurses have begun the process of formulating a policy to address the need for perinatal mood disorder screening. Recently, I assisted the team tasked with creating a policy, by performing an initial literature review and drafting a preliminary screening policy. There is more work to do to tailor the screening policy to Alaska women and to line up referral systems for those women that do screen positive. A screening tool will need to be instituted and the policy will need to include when the screening will be performed. This process will take a joint effort between the public health nurses that do the screening and the mental health resources to coordinate care for those women affected.
The perinatal period can be a joyous time with new life and new life experiences. With
this also comes the stress of becoming a parent to a new baby. Fatigue is a given when caring for an infant. Stress and fatigue combined with the enormous responsibility of caring for an infant can increase the risk for perinatal mood disorders. It is time to embrace the commonality of mood disorders in women in the perinatal period, educate them and their families on symptoms and causes, and address how to help the individuals cope.
Perinatal mood disorders are common in all populations and can have detrimental effects on the woman and their family. Screening women at every point of care for up to one year postnatal needs to become common practice not only by public health nurses, but by all primary care clinicians that care for women and children in this time frame. If we educate and screen expectant mothers and those in the postnatal period, we may be able to identify symptoms early and help the women seek care and hopefully erase the stigma.
[Author information: I graduated in 2012 from UAA with a bachelors degree in nursing. I have been with Alaska regional for the past 3 years working in the orthopedic and spine unit. I recently became certified in orthopedic nursing. I live in Anchorage with my fiancé Eric, our dog, two cats, and three chickens. This is a project of UAA’s graduate Health Policy Course]
ReferencesCamp, J. M. (2013). Postpartum depression
101: Teaching and supporting the family. International Journal of Childbirth Education, 28(4), 45-49.
Grier, G., & Geraghty, S. (2015). Mind matters: Developing skills and knowledge in postnatal depression. British Journal of Midwifery, 23(2), 110-114.
UAA Health Policy Course Partners
with the ANTThe School of Nursing
at the University of Alaska is partnering with Alaska Nursing Today to present the selected works of some of our graduate students. These scholarly products are a result of a semester long partnership between the graduate student and a community stakeholder and must involve some aspect of Nursing Policy or the wider universe of Health Policy.
Thomas J. Hendrix, PhD RN teaches the graduate Health Policy course that facilitates this work and he has an open and ongoing invitation to any person or organization that has an interest in a policy matter to contact him to see if a future partnership with a student is a possibility. For the purposes of these projects, “policy” is defined in the broadest sense possible and includes, but is not limited to, organizational, inter-organizational, professional, regulatory and legislative at any level of government. The course requires 25 – 30 total hours of community work. According to Dr. Hendrix, “If you have an idea that fits these criteria, please let me know and let’s see if we can figure something out that works for all parties.” Dr. Hendrix can be reached at [email protected].
Dr. Tom Hendrix, UAA Associate
Professor
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Page 10 • Alaska Nursing Today December 2015
‘Cure’ of HCV is defined as a sustained virologic response (SVR) meaning there is no detected hepatitis C virus 12 weeks after the end of treatment. Studies have shown that achieving SVR results in a 90% reduction in cirrhosis and end stage liver disease and a 70% reduction in liver cancer (3,4,5).
TransmissionCurrently, the major risk for transmission/
infection is IV drug use (60-90%). Historically there was a risk in blood transfusions before testing (pre July 1992) and clotting factors before inactivation (pre 1987). Needlestick injuries carry a 1.8% risk. There is a perinatal risk to the infant of 6% but no breastfeeding risk. Sexual activity has a 1.5% risk which increases with multiple partners and high risk behaviors such as MSM without barrier use. Other risk factors include long term hemodialysis, use of intranasal cocaine, sharing razor blades and toothbrushes with infected persons and unregulated tattooing.
Screening/ConfirmationBecause of the number of ‘baby boomers’
who might be unknowingly infected with HCV, all persons born between 1945-1965 should be screened once regardless of risk factors (6). All children of infected mothers should be tested between 12 and 18 months. Otherwise all persons at high risk should be screened, some on an ongoing basis depending on risk factors. With numbers of heroin users again on the rise, those infected with HCV will be rising also. The heroin epidemic in KY, TN, VA, and WV resulted in a 364% increase of acute HCV infection from 2006-2012 among persons aged 30 years old and younger (7).
Screening for Hepatitis C begins with ordering a test for antibodies to the hepatitis C virus. If the test is positive, an HCV RNA which measures the amount of virus, should be obtained. Many labs now reflex to HCV RNA if HCV antibody is positive, eliminating the need for the provider to place another order and the patient to return for another lab draw. If virus is detected, infection is present. If HCV RNA is not detected there is no active infection. HCV RNA may be repeated in 4-6 months for confirmation. HCV antibody will be positive and HCV RNA not detected in individuals who have spontaneously cleared the virus or been successfully treated.
Hepatitis C Therapy continued from page 1
Further evaluation will determine how much liver damage, if any has occurred. This is especially important for those patients whose ability to access medication depends on if they have liver damage. Liver biopsy has been considered the gold standard and historically was done if the patient and provider wished information about fibrosis stage for prognostic purposes or to make a decision regarding treatment. With new medications and the use of ‘Fibroscan®,’ the need for liver biopsy is changing.
There are several non-invasive tests to evaluate fibrosis of the liver. Transient elastography (Fibroscan ®) uses an ultrasound shear wave to measure liver stiffness, which correlates to fibrosis and is quickly becoming preferred over biopsy. Serum fibrosis tests measure a variety of blood markers and uses computerized formulas to predict the amount of
fibrosis. Lastly, the APRI, or AST to platelet ratio index uses the AST and platelet count to predict fibrosis level. It is quick and easy to calculate with free, online calculators.
TreatmentThe hepatitis C virus is an RNA virus
with 6 genotypes and more than 50 subtypes. The heterogeneity, or dissimilarity of the composition of the virus may account for the difficulty in developing a vaccine for the virus and the difficulty in treating it. In the U.S. 70% of HCV cases are genotype 1, 20-30% are genotype 2 and 3, the remainder are genotypes 4, 5 and 6.
Response to treatment or ‘cure’ was at best 30% in 1998, by 2002 it had risen to 60%. In 2014, with the introduction of the first direct acting antiviral, sofosbuvir (Sovaldi) cure rates of 90% became possible. Direct acting anti-virals (DAAs) target the virus protein particle itself preventing replication. and have become the standard of care in treatment of HCV infection.
Direct acting antivirals act on the hepatitis C virus enzymes preventing replication and are presented in the following figures along with treatments and SVR rates.
Cost of TreatmentThe DAA medications are very expensive. For
example a typical 12 week course of Harvoni ®, one of the new drugs for treatment of the genotype 1 (the most commonly occurring genotype in the US) is $92,400. Another drug used for treatment of genotype 1 is the Viekira Pak, with an estimated cost of $83,319 for a 12 week course.
In Alaska reimbursement for HCV treatment medications variy. All insurance carriers require prior authorization and pharmacy benefit plan drug formularies may not offer all available DAA medications. Medicaid requires drug testing before treatment and only covers those patients with moderate liver fibrosis to cirrhosis. Medicare Part D typically does not require fibrosis or drug testing prior to authorizing treatment. The Alaska ACA Marketplace insurers, Moda and Premera cover treatment only for those with advanced fibrosis or cirrhosis. Private insurance companies require prior authorization and some only cover advanced fibrosis or cirrhosis. VA covers treatment for all with priority given to persons with moderate or advanced fibrosis and cirrhosis. Pharmaceutical company patient assistance programs may cover the cost of these medications for those who are uninsured.
December 2015 Alaska Nursing Today • Page 11
Even the restrictions by state Medicaid to patients regarding the new medications may change in the future. On November 5, 2015, the Obama administration reminded states that they “cannot legally restrict access” by low-income people to cures for liver-wasting hepatitis C infection. Specifically noted in the letter to state Medicaid directors was the practice of states (such as AK) that patients must have advanced liver disease first before being able to access a drug that would cure them. The administration is also pressuring the drug companies to make their products more affordable (8).
SummaryAs the drugs and their regimens become
simpler and safer, clinical management of patients infected with hepatitis C will enter the primary care arena. Understanding, advocating and overcoming the barriers of reimbursement for the new drug therapy for patients is the new challenge.
Further Resourceswww.hcvguidelines.org — AASLD/IDSA/IAS-
USA. Recommendations for testing, managing, and treating hepatitis C. Always check on line for updates prior to treatment.
www.anthc.org/hep — Liver Disease and Hepatitis Program website with an educational section for patients and providers.
[Annette Hewitt is on staff at the Liver Disease and Hepatitis Program at the Alaska Native Tribal Health Program Consortium. This article was taken from a talk given at the AKPNO Wednesday Night Forum November 4, 2015. For more information contact Ms. Hewitt at [email protected]]
Reference:1. Institute of Medicine 2010/CDC 20122. Fujie Xu, Xin Tong & Leidner, Andrew J. (2014).
Hospitalizations and costs associated with Hepatitis C and advanced liver disease continue to increase. Health Affairs. 33, no. 10 :1728-1735.
3. Morgan, RL, et al. Ann Intern Med. 2013;158 (5 Pt 1);329-337.
4. van der Meer, et al. JAMA. 2012;308(24):2584-2593.5. Veldt, BJ et al. Ann Intern Med. 2007;147(10):677-
684.6. US Preventive Services Task Force. www.
uspreventiveservicestaskforce.org retrieved 11/12/15.
7. CDC Increased in Hepatitis C Infection related to IDU Among Persons Aged <31 years – Kentucky, Tennessee, Virginia and West Virginia, 2006-2012.
8. Alonso-Zaldivar, R. (Nov. 5, 2015). Obama administration worries that some states are restricting costly hepatitis drugs. US News and World Report [online www.usnews.com accessed 11/12/15]
Up and Coming Event Calendar$0.00 members, $10.00 non-members payable
online or at the door
Sponsored by AKPNO and State of Alaska Division of Public Health
Upon completion of the learning activity , you will be awarded 1 contact hour. You must attend
the entire session to receive contact hours. Alaska Division of Public Health is an approved
provider of continuing education by the Montana Nurses Association, an accredited approver by the American Nurses Credentialing Center’s
Commission on Accreditation.There is no conflict of interest for anyone involved
in planning or presenting this learning._____________________________________________
APRN Alliance 3rd Annual Pharmacology & Legislative Update
January 9, 2016Cancer Center Conference Room, T Tower
Providence Campus, Anchorageemail: [email protected] for registration,
and information on out of Anchorage participation
_____________________________________________
50th AnnualAlaska Pharmacists Association
Convention & TradeshowFebruary 12-14, 2016
Hilton Anchoragewww.alaskapharmacy.org
*member rates for ANPA members, Pharmacology CE
EventsAlaska State Board of Nursing - Upcoming Meetings
January 20-22, 2016 Anchorageagenda deadline December 30, 2015
The Alaska Board of Nursing has a list-serve that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers and the public. To sign up for this free service, go to www.nursing.alaska.gov. Choose the “Subscribe to listserv” hyperlink on the homepage below the Board of Nursing Listserv Heading.
Inquiries regarding meetings and appearing on the agenda can be directed to:
Lisa Maroney, CEDAlaska State Board of Nursing550 West 7th Ave, Ste 1500, Anchorage, AK 99501Ph: 907-269-8161, fax 907-269-8196, email [email protected]
To attend by audio conference call 907-269-8161 for access number.
Continuing EducationANT readers. Rather than typing in all those
hyperlinks, you can also go to akpno.org and download the latest .pdf issue of the ANT and just click on any hyperlinks in the newsletter you are interested in._____________________________________________
AKPNO Wednesday Night CE Forum
6:15-7:15 pm BP Energy Center900 E. Benson Blvd.
1 contact hour per sessionupdated information at www.akpno.org
February 4, 2016 — Kidney Disease, Q & ARobin Bassett ANP, CAPT. USPHS
Internal Medicine, NephrologyAlaska Native Tribal Health Consortium
p: 509.667.7359e: [email protected]
w: www.cwhs.com
To learn more about Confluence Health and our nursing opportunities please go to: www.confluencehealth.org/recruiting/.
To speak with a recruiter directly,please call 509.667.7359.
EMPLOYMENT OPPORTUNITIESBBAHC has a wide range of available positions in the
health care field.
We are currently searching for candidates for the following positions:
Outpatient and Inpatient/ER Staff Nurses
When you join BBAHC, you’ll find a community of capable healthcare professionals dedicated to providing quality care to the Native community of the Bristol Bay region. While working and living in Southwest Alaska, you’ll also enjoy rugged, pristine landscapes matched by few places on Earth.
The quality of the workplace and co-workers is important to you, and to us. BBAHC, a Joint Commission accredited organization, offers what few other hospitals and healthcare organizations can - a modern facility and a must-see-to-believe rural environment.
We believe you’ll find our pay and benefits to be competitive and attractive.
For more information about any of these positions or to submit an application, contact the Human Resources Department.
Toll free in Alaska: 1 (800) 478-5201, ext. 6323Direct: (907) 842-9323
BBAHC’s Human Resources DepartmentP.O. Box 130, Dillingham, Alaska 99576
www.bbahc.org
Telehealth:Spanning the
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Page 12 • Alaska Nursing Today December 2015
2016 Alaska Professional Nurses Organization Membership Application
Membership is available to individuals and is nontransferable.Term of membership: January 1, 2016 – December 31, 2016 - Join or Renew Now!
MEMBER INFORMATION
Name: _____________________________________________________________________________________
Title: _____________________________________________________________________________________
Organization/Employer: ____________________________________________________________________
Preferred Address: _________________________________________________________________________
City: __________________________________________ State: ________ Zip: ________________________
Phone: Mobile ________________ Home ______________ Work _____________ Fax _________________
Email Please Print Clearly ___________________________________________________________________
Email (secondary) __________________________________________________________________________
DUES and PAYMENT INFORMATIONMember Dues: $100
Students in first year after graduation: $25
Return application and check made out to: AKPNO, 2922 Yale Drive, Anchorage, Alaska, 99508 or go to www.akpno.org and pay online!
*Alaska Professional Nurses Organization is a non-profit organization.
You are IMPORTANT to AKPNO
o Please check this box if you would like to be contacted about joining one of our committees; membership, conference or legislative.
• Interestedinworkingonthenewsletter?photos?writing?contactlhartz@ak.net.
• IunderstandthatIwillreceiveAKPNOemailsasaprimaryformofcommunication.
Membership Magnet
Celebrate the nurses in your community for everything
they do on the Alaska Nursing Action Coalition website by
sending in a photo!
www.akcenterofnursing.orgwants to include more pictures of
ALASKAN NURSES*caring for patients, leading
groups, providing education, working on community projects, doing research – all the critical things nurses do each day for
Alaskans.
Send photos to:[email protected]
*a photo release for individual nurses featured in pictures
would be appreciated. Remember HIPPA if any patients are
included.
New Years Resolution—Helmets for All
Pictured is Dianne Maythorne, ANP-C on her beloved horse Jupiter. On 7/19/15, Dianne suffered a severe fall from her horse necessitating a hospital stay overnight in the ICU with frontal lobe bleeds and a subdural hematoma. Fortunately, the subdural did not require evacuation. She had a 15 minute loss of consciousness, dangerous in and of itself, and has had residual problems with speech, balance, and unusual fatigue. Dianne has asked that this photo and her story be reprinted as a reminder to all of us to wear “appropriate protective gear for all sports.” Ms. Maythorne is convinced that had she not been wearing her helmet, she’d have died from her injuries.
State-of-the-art equipment • Education & professional supportExcellent pay with benefits • Outstanding lifestyle – work balance
Click on “Careers” to learn more about our available RN opportunities and to apply online.
Central Peninsula Hospital | 250 Hospital Place, Soldotna, Alaska 99669(907) 714-4785 • (907) 714-4674 Fax
Screening is required prior to employment. EOE
At Central Peninsula Hospital, you can have the job of your dreams AND enjoy an active lifestyle!
Join us on Facebook and Linkedin
Visit us online at www.cpgh.org
A journey that will take you farther.A culture that will bring you closer.
NurSiNG OppOrtuNitieSServing the people of Southwestern Alaska, the Yukon-Kuskokwim Delta Regional Hospital is a 50-bed general acute care medical facility. Fully accredited by TJC, services Include adult med/surg, pediatrics, obstetrics, emergency room, as well as outpatient family medicine clinics, pharmacy, lab, and imaging. Consider the following RN openings:• Case Management • Inpatient• Charge • OB/GYN• Emergency Room • OR• EPSDT/Well Child • Outpatient Ambulatory Care• Infection Control
Requries at least 1 year of relevant experience, RN license in the stateof Alaska, and current BLS and ACLS.
LPN opportunities also available.For more information, please contact YKHC Recruitment at:[email protected] or 907-543-6065.YKHC exercises Federal Law (PL 93 638), which allows American Indian/Alaska Native preference in hiring for all positions.
Working Together to Achieve Excellent Health www.ykhcjobs.org
Apartment style living with 24 hour awake care staff and a RN on-call to triage residents’ needs. Accepting residents 60 and older. Certified for Medicaid CHOICE Waiver and qualifies for most long term care insurances.
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Improving the way clinicians diagnose, treat,
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The UW PTC is dedicated to increasing the knowledge and skills of healthcare providers in the area of sexual health.
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December 2015 Alaska Nursing Today • Page 13
Updates from Alaska RespondSusan Pridgen-Webb, RN NC II
Alaska Respond
The year 2015 produced many lessons to the Alaska (AK) Respond Program. AK Responders participated in “A Rock and a Hard Place” in March, an exercise at the South Peninsula Hospital in Homer. The scenario included heavy rainfall, rockslides and the road to Homer being rendered impassable. Goals of this exercise included patient movement, mass fatality response, identification and successful delivery of appropriate care to patients during a medical surge.
On June 14, 2015 the Willow Sockeye Fire started and spread to 7,500 acres. The fire displaced roughly 200 residents, destroyed homes and secondary structures. Fifty-two homes were confirmed damaged as of June 29. The Department
of Health and Social Services (DHSS) Emergency Operation Center (EOC) and Division of Behavioral Health and Alaska Respond coordinated with the Red Cross to provide health support for the Sockeye Shelter at Houston Middle School. The AK Respond behavioral health professionals supported face-to-face fire loss notifications to individuals who experienced property destruction or loss.
In October, AK Respond participated with multiple volunteer organizations across the US in a call down drill using emails and texting to exercise and evaluate our systems process and readiness to deploy volunteers. The exercise scenario was a severe pandemic involving a new strain of Avian Flu. Responders were needed to deploy for Point of Dispensing (POD) sites. The second scenario involved a deployment to Georgia following a severe storm.
The upcoming year offers new and exciting opportunities to build upon the lessons of 2015. The Alaska Respond Volunteer Handbook will be completed; there will be more training to maintain responders’ readiness and continue to improve their level of response competencies. New mass fatality planning is under development in conjunction with the Medical Examiner’s office, including a family call center training and Psych First Aid will be available for 2016.
In 2016, we will see the re-emergence of the Hale Borealis Forum, with a wide array of seminars and workshops that will be open to all interested participants. So, watch for the news on Hale Borealis Forum. If you are an Alaska Respond Volunteer you will get notices and other helpful information for personal preparedness. Start the New Year with a new volunteer activity! Go to www.akrepond.alaska.gov.
Full-time, salaried position benefits include:• Payrange:$97,000-$119,000,DOE• $500/mo.retentionbonus• Medicalinsurance• Dentalinsurance• 401(k)retirementplan• PTO
Responsibilities:• Educatestudentsaccordingtoapprovedcoursesyllabus• Prepareandsubmitaweeklylessonplan• Maintaincurrentknowledgeofthebusinessworld/
healthcaresystemthroughcontinuingeducation• Adjustteachingapproachtosupportstudentsofvarying
abilities• Maintainstudentretentionexpectationsasoutlinedby
supervisor• CompletereportsasrequiredbyProgramDirector
Qualifications:• Master’sDegreeinNursingrequired• NursingspecialtyofMentalHealth,Medical/Surgicalor
Maternal/Childcarenursingexperiencedesired• Teachingexperiencepreferred• KnowledgeofAlaskaNursingLaw/Boardregulations
stronglydesired
Apply at www.chartercollege.edu/jobs
AnchorageCampus2221EastNorthernLightsBlvd.,Suite120
Now Hiring RN Nursing Instructors
TheRNNursingInstructorisresponsibleforprovidinginstructioninnursingsubjectmatterthatwillleadtothedevelopmentand/orenhancementofanursingcareerandprofessionalskillsinstudents.ThispositionreportstotheDirectorofNursingand/ortheProgramDirectorinrelatedfield.
Both full-time and part-time positions available.
Page 14 • Alaska Nursing Today December 2015
Are You in the Know?Can’t stand typing in all those websites? Go to
www.akpno.org to download the online ANT and just hit the link.
Scholarships/Funding/Volunteer
David E. Knox Memorial Nursing Fellowship Are you a current nursing
student committed to practicing in rural Alaska? If so, you are eligible to apply for tuition assistance from the David E. Knox Memorial Nursing Fellowship offered by The Alaska Community Foundation. This scholarship honors the memory of David Knox, a longtime Sitka resident and Sitka Community Hospital nurse, who understood the complex medical care issues facing small Alaskan communities. His family and friends established the fellowship in his memory as a way of providing continued support for the rural medical community. Successful candidates will embody the same nurturing compassion, detailed organization, high technical standards and devotion to health care for which Knox was known.
The scholarship opens for applications on January 15, 2016 and the deadline for the scholarship applications is April 15, 2016 [please check online for updates]. Awards will be announced at the end of April. The Fellowship will award up to $2,500 to a nursing student who agrees to practice as a nurse/RN in a small Alaskan community (less than 50,000 residents) for a minimum of one year. Applications and more information are available online at www.alaskacf.org/scholarships._____________________________________________
HOSPICE VOLUNTEERS NEEDED Frontier Home Health & Hospice will soon offer
hospice services in Anchorage and the vicinity. In preparation, we are seeking compassionate individuals eager to share their time and talents with our community. As a hospice volunteer you will make a difference in the lives of our patients, their families and caregivers. Volunteers offer both companionship and respite. You might read to patients, reminisce, sing with them, play an instrument, bring in a friendly pet, go for walks, or simply hold a hand. Please join us for our next volunteer training, meet our staff and gain the knowledge to provide invaluable support at the end of life. To receive more information, call Keith, Volunteer Coordinator, at 907-272-1275. We also invite you to visit www.frontierhhh.com/anchorage to learn more about Frontier Home Health and Hospice and this incredible opportunity.
National Guidelines/Resources/Websites
Updated USPSTF Recommendation in High Blood Pressure Screening in Adults
website: www.uspreventiveservicestaskforce.orgRelease date: October 2015
The U.S. Preventive Services Task Force recommends screening for high blood pressure in all adults aged 18 years or older. In those with an elevated blood pressure, ambulatory and home blood pressure monitoring can be used to confirm a diagnosis of hypertension after initial screening._____________________________________________
David Knox, RN
PCV13 and Multi-Pediatric VaccinesVaccine information statements have recently
been updated and are now available. The edition date is 11/5/15 for both. Go to CDC website for update._____________________________________________
Health groups update chronic hepatitis C treatment recommendations
The Infectious Diseases Society of America and the American Association for the Study of Liver Diseases have issued updated guidelines for treating chronic hepatitis C patients. The guidelines recommend treating virtually all patients with new direct-acting antiviral drugs and disregarding treatment priority tables. The document is based on physician experience with newer treatments. AANP Smartbrief 10/30/15_____________________________________________
Groups release guidelines for pulmonary hypertension in children
The American Heart Association and American Thoracic Society released the first-ever guidelines for diagnosing and treating pediatric pulmonary hypertension. The guidelines, published in the journal Circulation, include information on the different types of the disorder, suitable and approved treatments and dosages, and the role of pulmonary hypertension centers that offer specialized treatment. AANP Smartbrief 10/28/15_____________________________________________
USPSTF issues recommendations for type 2 diabetes screening
The US Preventive Services Task Force has issued new recommendations urging providers to screen overweight and obese patients ages 40 to 70 for type 2 diabetes and abnormal blood glucose levels. The recommendations, published in the Annals of Internal Medicine, also called for the use of intensive behavioral counseling for people with high blood glucose levels. AANP Smartbrief 10/27/15_____________________________________________
WHO guidance recommends antiretroviral drugs for all with HIV
The World Health Organization says all people with HIV should receive antiretroviral drugs once a diagnosis is confirmed. The new guidelines would expand treatment to an additional 9 million people worldwide. AANP 10/1/15_____________________________________________
USPSTF reaffirms 2008 guidelines for colorectal cancer screening
The US Preventive Services Task Force reaffirmed 2008 guidelines for colorectal cancer screening that recommended testing begin at age 50 and continue through age 75 using colonoscopy, fecal occult blood tests or a combination of FOBT and endoscopy. There may be a moderate benefit to screening adults ages 76 to 85, especially if they have not been previously screened, the task force said, but it noted that mortality benefits do not outweigh possible harms of screening those over age 85. AANP Smartbrief 10/8/15_____________________________________________
Task force develops well-woman visit guidelines for providers
An American Congress of Obstetricians and Gynecologists-convened task force has recommended guidelines for providers, including nurse practitioners, to follow during well-woman appointments. The recommendations, determined by a patient’s age and reproductive potential, are focused on breast and pelvic examinations and screening for depression and domestic violence. The guidelines were published in the journal Obstetrics & Gynecology. AANP Smartbrief 9/14/15
Alaska Guidelines/Resources/Websites
The State of Alaska announced the 9-Valent HPV Vaccine is now available through the Alaska Immunization Program. October 16, 2015 ____________________________________________
Homer Chronic Disease Self-Management Workshops Available
South Peninsula Hospital Training Center now provides a 6 week series of workshops for people with ongoing health conditions or their family members. The workshops include setting goals, understanding and handling symptoms, eating well and staying active and collaborating with the health care team. They are led by RNs trained in guiding Living Well Alaska workshops.
The series cost is $10.00 and no referral is needed.
For information on upcoming dates or to register, call Bonita at South Peninsula Hospital 907-235-0285 ____________________________________________
The Alaska Immunization Program has a newly designed website. Go to http://www.epi.hss.state.ak.us/id/iz/default.htm. ____________________________________________
Mat-Su Pre-Diabetes Classes Offered Every Other Month
Pre-diabetes Classes are offered every other month in Mat-Su.
You can greatly lower your risk of developing Type 2 Diabetes by adopting healthy lifestyle changes.
This class is taught by a Dietitian and no physician referral is needed.
1. Cost: this class is offered free of charge as a service to the Mat-Su community.
2. Contact: to register for a class, please call: (907) 861-6687.
____________________________________________
Register for Alaska Public Health Alerts at www.epi.alaska.gov/.
Recent Bulletins: Chlamydia Infection Update — Alaska 2014, April 29, 2015 ____________________________________________
State of Alaska Information Page on Marijuanawww.dhss.alaska.gov/dph/Director/Pages/
marijuana/law.aspx ____________________________________________
DHSS section of Chronic Disease Prevention and Health Promotion presents a monthly webinar series, 30 minutes each that can be participated in live or viewed in You Tube. go to www.dhss.alaska.gov/dph/Chronic/Pages/webinars/default.aspx to register or view previous webinars. ____________________________________________
211 Alaska’s number to get connected to get answers
For your patients who need to find help in Alaska, including disability services, counseling, senior services, health care and a variety of other social services. The line is open M-F 8:30-5:00. The website is www.alaska211.org. ____________________________________________
www.akhcnews.com for healthcare business news in Alaska.
December 2015 Alaska Nursing Today • Page 15
Screening Saves Lives•
•
•
Will you help Alaskan women by reminding them to get their regular breast cancer
screening?
Encourage your patients to call today
1-800-410-MAMM (6266)
South Peninsula Hospital is a modern facility with 22 Acute Care beds and an attached 28 bed Long Term Care Nursing Facility.
South Peninsula Hospital is seeking dedicated and talented Nursing professionals to join our diverse team:
• LongTermCareRN • NurseEducator(RN)• AcuteCareManager(RN) • AC/ICURN• QualityServicesRN • UM/CaseManagementRN• HomeHealthRN
Homer, Alaska is a quaint town nestled on the shores of the beautiful Kachemak Bay offering breathtaking views of glaciers, mountains and wildlife. If you are looking for adventure, culture, scenery or solitude, you’ll find all of that and more here!
We offer highly competitive wages and benefits including:health/lifeinsurance,retirement,wellness,loan forgiveness, generous paid leave and a recruitment bonus.
Health Treatment Nurse The Anchorage School District is seeking applicants for the position of Health Treatment Nurse. Health Treatment Nurses provide individualized, skilled nursing service to students with medically complex needs. They also provide care and management of medically fragile and technology dependent students in the school setting. Applicants must hold current Alaska RN licensure. Prior acute care nursing experience is helpful. The successful candidate will serve as a valuable member of the Anchorage School District team! This position offers an attractive salary and benefit package. For a complete listing of the minimum requirements and position responsibilities, please visit our website at www.asdk12.org. To apply, please visit our website and submit an online Classified Job Application.
Anchorage School DistrictHuman Resource Department5530 E. Northern Lights BlvdAnchorage, Alaska 99504Phone 907-742-4116www.asdk12.org
RN Opportunities - Fairbanks, Galena & Tok
Exceptional Benefits, Profit Sharing, PTO, Tuition Assistance & More
Apply Online: www.TananaChiefs.org
Contact: Brad Clark, Medical Staff Recruiter(907) 452-8251 x3079 [email protected]
-Nature versus nurture goes the way of the dodo
Lynn Hartz MSN, FNP-CEditor
I have just read a book. Not that this in itself is shocking but this time instead of the usual novel, it was a book of essays on scientific theory. You might think the fact that the title is “Monkeyluv” detracts a bit from its credibility on the scientific front but I assure you the author is a Stanford professor in biology and neurology, writer of many books and was awarded a MacArthur Foundation genius grant. (He is probably revered too).
The thing is there was one chapter in which Dr. Sapolsky turns over two competing theories that I have had great pleasure arguing about with friends for years. You may already be aware of advances in this area but sadly I had missed the bus. For those who may also be waiting at the bus station, here is the scoop.
The old argument goes something like this: the genetic ‘package’ determines behavior, or genes are destiny in behavior ie. “the boy was born bad” or “the bad seed.” The other side of the argument is that nurture, or the environment, trumps genes and though a person be dealt a bad hand, a good environment can turn things around. Or, behavioral patterns are formed by environmental and sociological influences and that these override intrinsic behavioral tendencies.
Argument one (nature) says that a person’s genes, comprised of DNA determines their behavior. I leaned toward this theory when my son veered toward toy trucks, made loud ‘Grr’ noises and wanted Mohawk haircuts despite all attempts to banish sexual stereotyping. But, Sapolsky says that theory does not work so well in studies with identical twins. Identical twins start out as virtual genetic clones of each other. Yet, if an identical twin is schizophrenic, the other twin has only a 50% chance of developing the disease. Genes can increase a risk but are not destiny in this instance.
Argument two (nurture), suggests the environment starts affecting mammals in the womb. From the cellular level to the relationships with parents, friends, just about everything you can think of, are environmental factors determinants of behavior?
Sapolsky says it is meaningless to talk about nature OR nurture, only their interaction. Apparently behavioral biologists have been trying to unteach the two as mutually exclusive for years. Who knew?
Consider what a gene does. A gene, or a stretch of DNA specifies the construction of a protein, not an emotion, though the proteins it produces do include hormones and neurotransmitters that affect feelings and thoughts. Think estrogen, testosterone and serotonin. The production of proteins can occur as a response to the environment (hold on ANT readers, this is the link! The genes are interacting with the environment.).
A great example of how genes can relate and interact with the environment is the following. Suppose Gene 4037 in our pet duck is in the DNA string but not active because a particular messenger just in front of 4037 binds to the regulatory element shutting down Gene 4037. But, what if that inhibitory messenger is sensitive to temperature. If the cell gets hot, the messenger unwinds, coming off the regulatory element, freeing Gene 4037 to become active and produce testosterone. Voila, seasonal mating occurs! An intrinsic gene reacts to an environmental stimulus that leads directly to a behavioral change.
A more human and subtle example is anxiety. In a normal response, when there is a threat we become vigilant, try to gain information about the nature of the threat and find a coping response. Once we determine the threat is gone, we relax. This does not happen in a person with anxiety. There can be a frantic working through coping responses, an agitation to cover
A Teaspoon of Science
Lynn Hartz
all bases, or even an inability to recognize that the threat is gone and we remain in a hyper vigilant and anxious state. According to Sapolsky, “By definition, anxiety makes little sense outside of what the environment is doing to the individual. In that framework, the brain chemicals and, ultimately, the genes relevant to anxiety don’t make you anxious. They make you more responsive to anxiety provoking situations, and make it harder to detect safety signals in the environment.”
Going back to the duck and seasonal mating, as of course one does. Do you remember the young polar bear and brown bear that we had at the Alaska Zoo from 1998-2003 who were raised together as cubs? During the time they lived together, the brown bear did not hibernate. I wonder if it is an example of the power the environment and peer pressure can have interacting with genetic messages!
So, it is not nature versus nurture. It is much more subtle and complex as we might have suspected. It really is the whole of nature isn’t it, and by that I mean holistic. From the genetics inside us to the environment outside, our behavior is an interaction of the whole, taking place on a continuous basis over time. More complicated but really, so much more elegant.
Finally, if there are any errors in my attempt to explain Dr. Sapolsky’s essay on genes and behavior, they rest solidly on my head not his J
To enjoy more essays about human behavior read:
Sapolsky, R.M. (2005). Monkeyluv: and other essays on our lives as animals. New York: Scribner.
Page 16 • Alaska Nursing Today December 2015
We are looking for a qualified Registered Nurse to join our team
in Surgical Services.
Surgical Services at Bartlett Regional Hospital includes the operating room, central processing, the Post-Anesthesia Care Unit, anesthesia services, pre-admission testing, and Same-Day Surgery.
This position is an Operating Room/Circulating Nurse. Experience with minimally invasive, general, ENT, eyes, plastics, orthopedics, spines, urology, endoscopy cases preferred. With CNOR certification recommended or willingness to obtain within one year of employment. The ideal candidate would have one (1) year of OR experience within the last three (3) years. PACU experience or willingness to learn PACU required.
For complete job description, and to apply online go to: www.bartletthospital.orgor call Human Resources at: 907-796-8418 or 888-668-9962
Bartlett Regional Hospital
3260 Hospital DriveJuneau, AK 99801
www.bartletthospital.org
Join the Samuel Simmonds Memorial HospitalTeam in Barrow, Alaska
Samuel Simmonds Memorial Hospital (SSMH) is a facility unlike most others; it is located in the northernmost city of the United States and serves a population that spans across a region larger than the state of Washington. Serving the North Slope, a region that is colored by the heritage of the Iñupiat people, SSMH works to preserve the health of the region as well as the culture.
By joining SSMH, you’ll be embarking on an adventurous journey as enriching as it is rewarding. Here you’ll have the unique opportunity to provide health care to a vibrant community ready to share its culture and heritage. More than a once in a lifetime opportunity, you’ll provide care in a small community environment, and partner with a familial, professional staff. It’s an experience you won’t forget. Join us today.
Direct care positions qualify for the IHS tuition reimbursement of up to $20,000 per year. For more information on this loan repayment: www.ihs.gov
We are recruiting for the following Nursing positions:• LDRP/OB
• Emergency Department• Inpatient Med/Surg RN
• Case Managers• Risk Management
• Employee Health/lnfection Cntl
Contact Us:E-mail: [email protected]: (907) 852-9204Fax: (907) 852-3365Mail: P.O. Box 29 Barrow, AK 99723Visit: www.arcticslope.orgTo speak with someone in Nursing Leadership feel free to call 907-852-9256.