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Safe Travels Until We See You Again in Chicago and San Antonio

The 2009 ENA Annual Conference in Baltimore came to a boisterous end with much laughing, hugging and shout-outs to new and old friends. Attendees had jumped and sung along with the closing song, James Brown’s “I got you (I feel good)” and were making plans with colleagues for next year’s conferences. 2010 has much in store for emergency nurses and their peers.

At the General Session Friday, Jeff Strickler, chair of Leadership Conference 2010, Leading Into the Future, February 17 – 21, at the Hyatt Regency Hotel in Chicago, looked forward with a video preview of this world-class city where you will find interesting architecture, culture and shopping venues. Registration opens October 26, so watch for your Advance Program in the mail and all of the details on the ENA Web site at www.ena.org. Take advantage of the reduced rates due to the date changes and the early-bird discount.

At the Closing Session today, President-Elect Diane Gurney identified the 2010 ENA Annual Conference theme, EMBRACE Present Opportunities & Future Possibilities, that will be held in San Antonio, Texas, September 23 – 25, 2010, and introduced the video of this beautiful city.

ENA will honor its 40th anniversary in 2010 with the theme Transforming Practice Together, in a yearlong tribute to the association and its members.

As attendees travel home, we wish you happy returns, and to all of our blogging friends, thanks for the memories. See you in Chicago and San Antonio.

J.L.

Keynote and General Session Speakers

The three keynote and general session speakers shared inspirational and motivational ideas for attendees to take back to their emergency departments when they leave Annual Conference.

Juliet Funt, daughter of Candid Camera’s Allen Funt, presented Thursday’s Keynote Address: Overcommitted, Overwhelmed and Over It!

“The number one lifestyle complaint in America is that we have too much to do and too little time,” said Funt. “We live in what I like to call the culture of insatiability—we are addicted to quantity, even in the language we use: shop till you drop, bottomless cup, all you can eat. We go, go, go all day, and when our head hits the pillow at night, we think, ‘What else could I have done or bought to be even more impressive?’”

Funt shared her tools for relieving stress in our everyday lives, including CCPP—being calm, confident, patient and present. “If you can be calm, confident, patient and present in the middle of the frenzy, what a beautiful gift to give,” she said.

CCPP has special application for emergency nurses, she said. “Your patients need you when they come in to the emergency department logistically, but they really need you emotionally,” noted Funt. “If you can become a calm place of presence for your patients, it will go so much farther than if you come at them from a place of trying to get through all the problems of the day at one time.”

Funt also advised attendees to look for the white spaces in their lives—the little blocks of open time that occur in between the events of their day—where they can appreciate and see the beauty of what they do.

“When you’re in a crisis, it’s everybody’s job to put their hands on the oars and pull on the paddles,” said Friday’s General Session Speaker Joe Tye, who delivered The Florence Prescription. “We can’t afford to have anybody say, ‘This is not my job.’”

Tye related the history of how Florence Nightingale, from her experience in caring for soldiers suffering brutal injuries on the battlefront, created the blueprint for the hospital system we have today. She established the first medical records system and was the first to recognize the importance of nutrition and cleanliness in creating a healing environment. Although Nightingale would have been blown away by our modern health care system, she would have agreed that it is in a crisis, said Tye.

“We are forgetting the spirit and mission of purpose that drove Florence Nightingale,” he said. “We are losing our soul, and we need to reclaim our soul.”

Reclaiming our soul in health care comes from creating an inner sense of ownership. Tye shared the eight essential characteristics of the culture of ownership: commitment, engagement, passion, initiative, stewardship, belonging, fellowship and pride. He shared how an Arizona hospital implemented these eight characteristics in their ED and within three months eliminated many of the negative influences in their department.

“The work we do is privileged work, and you are called to do that work every day,” said Jeff Doucette, RN, MS, CEN, FACHE, NEA-BC, who delivered Saturday’s Closing Address: Privileged Interruption: A Call for Caring. “Regardless of how or where you practice, each one of us has the opportunity to be extended this privilege every day.”

Patients don’t come to the ED because they want to—they come because their lives were interrupted, and emergency nurses are privileged to be a part of that, he said.

“We’ve all worked with someone who’s been on the job a little too long,” said Doucette. “Those kind of people are nice because they have to be, and they do not understand that they’ve been given a privilege.”

Doucette pointed out that everyone in the room was a leader, whether he or she led from an office or from the bedside.

“People who are not leaders do not come to conferences like this,” he said. “The people who are constantly complaining, they’re the ones working so that you can be here.”

Choosing to lead from wherever you are in an organization is about how you choose to take care of yourself, the people you care for and your colleagues, said Doucette. He shared three tips attendees needed to do to keep themselves whole in the face of all the stress in their lives: Know and nurture your person, find your passionate purpose and pursue your passion.

A.C.A.

Anxiety Is the Last Diagnosis on the List

Mental health disorders account for 5.5 percent of emergency department (ED) visits, and of these visits, 21 percent are due to self-identified anxiety, said Lisa Wolf, RN, MS, CEN, in her Friday session.

The initial assessment goal for the emergency nurse is to determine whether anxiety is the primary problem or the primary symptom of another problem, said Wolf.

“In the ED we have knives coming at our heads and people bleeding, so it’s not the best environment for us to delineate what is going on with our patient,” she said.

So it is important to know what can look like anxiety. Hypoxia, hypoglycemia, hyperthyroidism, acidosis, some reactions to alcohol and certain drugs, and impending doom can all present as anxiety, said Wolf. She discussed what to look for, how to identify it and how to treat each problem.

The take-home information from this session included the importance of conducting a thorough evaluation on patients who exhibit “anxiety-plus” or have that extra dollop of pain, difficulty breathing or a funny color, said Wolf.

“We want to pay attention to these folks,” she said. “Sometimes it is just anxiety, but delineating that is crucial. Ask your patients, ‘Why are you in my ED? What is different about how you’re feeling today?’”

A.C.A.

Are You Going to Eat That?

With the enormous shift that Americans have made from an agrarian culture, where food travelled literally from the land to the table, to a culture that relies on primarily processed foods, it is no wonder that food borne illnesses are a concern, said Cheryl Randolph, RN, MSN, CCRN, CPEN, FNP-BC. In her Friday presentation, “Are You Going to Eat That? The Dangers of Food Poisoning in a Modern World,” Randolph pointed out that Americans have left food safety responsibilities in the hands of large companies which value corporate profits first.

Food borne illness is very common, and pathogens have evolved to become quite dangerous, noted Randolph. The speed with which food is processed and distributed results in food landing on our tables before the pathogen is even discovered. The globalization of food processors and distributors means that fewer companies are in control, so if one has a contamination or illness, it is passed on to more consumers.

Common industrial food production procedures include meat recovery, in which nothing is wasted when making ground meat product, said Randolph. A recent study found that a single four-ounce hamburger contained DNA from 55 different animals, she said. The practice of adding large doses of antibiotics to animal feed has produced larger animals and litters but added to the problem of antibiotic resistance in the humans who eat the animals.

Randolph discussed the three most common food borne pathogens—E. coli, salmonella and campylobacter—and the symptoms and treatments for each. Patients who die of E. coli die from an overwhelming systemic infection, and the pathogen can also cause acute renal failure. Approximately 400 people die from salmonella poisoning each year, and the elderly and children are most susceptible to the severe dehydration and sepsis caused by the pathogen. Campylobacter is the most common bacterial infection, and 80 percent of supermarket chickens are infected before you bring them home.

“Understand it and appreciate it,” advised Randolph. “Wash your chicken and don’t cross-contaminate.”

A.C.A.

Reducing Pediatric Procedural Pain in the Emergency Department

Poorly managed pain has both long-term and short-term negative effects on children, Denise Ramponi, MSN, CRNP, CEN, DNP-S, said in this Fast Track session presented Saturday. Children who endure numerous painful procedures can develop hypersensitivity to pain and a conditioned anxiety response.

“Even one bad experience can result in a lifelong fear,” Ramponi said.

While numerous nursing groups agree that non-pharmacological agents are usually not enough to effectively manage pain in children undergoing procedures, there has been resistance to using topical anesthetics in the emergency department (ED), said Ramponi. In addition to the argument that it takes too much time and effort, she once had a father tell her his son “needs to feel that stick” in order to build character.

Ramponi, who successfully introduced a resolution on improving pediatric procedural pain management in the ED to the ENA General Assembly earlier this week, offered several options for busy emergency nurses who want to better manage their pediatric patients’ pain during such procedures as IV insertions and stitching and stapling minor wounds.

Establishing trust and giving the child a choice, even over something as minor as what color lollipop the child will receive after, gives the child a sense of control and makes him or her feel less vulnerable, said Ramponi. Positioning is very important in this context; she suggested having infants lie in a parent’s arms, while allowing toddlers to sit in a parent’s lap and giving older children the choice of how to position themselves.

“The words we say must always be positive with children: ‘I want you to hold still, I want you to look at Mom when I put the cream on your hand,’” she said. “Negative words, such as ‘Hold still or this will hurt,’ will invoke fear and cause negative responses.”

Ramponi reviewed several topical anesthetics appropriate for use in children, including gels, cream, sprays and a patch. She also shared a slide on cost comparisons and time to effectiveness for each agent she discussed.

“I want you to be advocates for your pediatric patients to reduce their pain,” she said.

A.C.A.

Research and Evidence-Based Practice Poster Award Winners

ENA President William T. Briggs, RN, MSN, CEN, FAEN, announced the two winners of the first ENA Poster Awards program at Friday’s General Session.

 

Cynthia Arslanian-Engoren

 Research Poster Award Winner:
“The Effectiveness of the Aid to Cardiac Triage (ACT) Intervention”

Presented by Cynthia Arslanian-Engoren, RN, PhD, ACNS-BC, FAHA; Associate Professor, University of Michigan School of Nursing, Ann Arbor, Michigan

Co-authors are: Bonnie Hagerty, RN, PhD, CS; Cathy Antonakos, PhD; and Kim Eagle, MD, FAAC, FAHA


 

Peter J. Eisert

Evidence-Based Practice Poster Award Winner:
“CSI: New @ York: Development of Forensic Evidence Collection Guidelines”

Presented by Peter J. Eisert, RN, BSN, SANE-A; Staff Nurse NICU/ SAFE Team, York Hospital, York, Pennsylvania

Coauthors are: Kelli Eldredge, RN, CCRN, MSN; Tami Harlaub, RN, CEN; Emily Huggins, RN, BSN, MHA, SANE-A, SANE-P ;Geneva Keirn, RN, SANE-A; Heather Rozzi, MD, FAAEM, FACEP; Patti O’Brien, RN, SANE-A, SANE-P; Nicole Shue, RN, BS; Heidi Wilkerson, RN, BSN, ATCN; Linda C. Pugh, RNC, PhD, FAAN; Karen S. March, RN, PhD, CCRN, ACNS-BC.

 

 A.C.A.

Don't Want to Wait in Line at Cyber Cafe?
Line of Lemurs

You may obtain your CEs after the conference beginning October 12th at 5:00 CST until November 16th, 5:00 CST. There will be a link to the Continuing Education CE system on the top of the ENA home page at www.ena.org

Thank you for using the ENA Cyber Café - see you next year in Chicago & San Antonio!

D.Z.

BCEN Certification Recognition Breakfast

Kay Ella Bleecher & Maha Habre

2009 Distinguished CEN Award Winner Kay Ella Bleecher of Pennsylvania (left) expressed pride for Maha Habre, RN, BSN, CEN, who became the first Certified Emergency Nurse (CEN) in Lebanon after passing the CEN Exam Friday at Annual Conference. Habre is an emergency department staff nurse at the American University of Beirut Medical Center in Beirut.

Bleecher received her award at the BCEN Certification Recognition Breakfast Saturday morning. Oak Hill Hospital of Brooksville, Florida, also received the 2009 BCEN Honorary Certification Award.

Breakfast attendees, including CENs, Certified Flight Registered Nurses, Certified Transport Registered Nurses, and for the first time, Certified Pediatric Emergency Nurses, enjoyed a rousing, inspirational presentation by speaker Willie Jolley. Jolley later held a book signing (below).

Willie Jolley

A.C.A.

Surviving Once-Fatal Childhood Disease Lifelong Fight

Emergency nurses are seeing children, adolescents, young and older adults with once-fatal child diseases, now commonly survived because of recent health care advances including transplants early in life. With the reality of childhood  disease survival comes unique problems in treating this special patient population, Laura M. Cridde, RN, PhD, CEN, CCRN, FAEN, explained to Annual Conference attendees Friday.

For adults with a pediatric disease the impact is mild to severe. When they present to the ED, nurses encounter previous surgical procedures, medications, lines, tubes and hardware. There is no way to fix many of these diseases, but we can treat them, she said.

Once considered fatal, disorders such as cystic fibrosis, biliary atresia, brain tumors, hydrocephalus, spina bifida, congenital cardiac anomalies, Down syndrome and hemophilia are now survivable. But there are long-term effects of surviving these childhood diseases, said Criddle.

“That these kids made it to adulthood is somewhat of a miracle,” she continued, and “we’re appalled now that children die.” For the first time in history, patients with pediatric conditions move to adult and geriatric care, she said.

Open heart surgery is performed on Down Syndrome babies extending their life span from 9 years in the 1930s to 50-plus today. As adults, they face health problems such as mental illness, thyroid disfunction, seizure, Alzheimer’s disease and geriatric issues at age 45.

The incidence of Spina Bifida, a congenital neural tube defect, has dropped to 1,500 births per year in the U.S. and can now be picked up on an ultra-sound. With early surgical closure, 90 percent of babies with Spina Bifida will survive to adulthood. As adults, Criddle said they deal with hydromyelia, tethered cord syndrome, urinary and bowel issues, VP shunt problems, and musculoskeletal and immobility issues.

G.B.

ENA Foundation Jewelry Auction Ends at Noon         

Bidding ends promptly at noon today on all the gorgeous jewelry items in the 2009 ENA Foundation Silent Auction. Hurry over to Booth 833 when the Exhibit Hall opens at 9:15 a.m. to stake your claim on those earrings you’ve been eyeing all week.

Click to Enlarge Image Click to Enlarge Image Click to Enlarge Image

While you’re treating yourself, you’ll also be benefitting emergency nurse scholars: All proceeds from the Silent Auction support the Foundation’s mission to provide educational scholarships and research grants in the discipline of emergency nursing.

Now that’s what we call fabulous.

A.C.A.

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