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Princeton, MNPermit No. 14

IndexASNA Board of Directors . . . . . . . . . . . . . . . . . . . . 2

CE Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ED’s Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Elizabeth A . Morris Clinical Sessions (FACES)

Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Legal Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

LPN Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Membership News . . . . . . . . . . . . . . . . . . . . . . . 19

President’s Message . . . . . . . . . . . . . . . . . . . . . . . 3

Research Corner . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Save These Dates . . . . . . . . . . . . . . . . . . . . . . . . . 8

Quarterly publication direct mailed to more than 84,000 Registered Nurses and Licensed Practical Nurses in Alabama Alabama State Nurses Association • 360 North Hull Street • Montgomery, AL 36104

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NMarch, April, May 2015 Volume 42 Issue 1

2015Four Things You Don’t Want to Miss

Nurses Day at the Capitol

March 11, 201510 AM – NOON

FACES ’15

See pages 9-12for details

and registration

AlAbAMA NurSE TAg Deadline April 2015

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• The Alabama Nurse March, April, May 2015

ASNA board of Directors

President: Brian Buchmann, BSN, RN, MBAPresident-Elect: Rebecca Huie, DNP, ACNPVice President: Diane Buntyn, MSN, RN, OCNSecretary: Donna Everett, BSN, RNTreasurer: Debbie Litton, MSN, RN, MBADistrict 1: Sarah Wilkinson, MSN, BSN, BA, RNDistrict 2: Julie Savage Jones, MSN, RN, CNEDistrict 3: Wanda Spillers, DNP, RN, CCMDistrict 4: Erica Elkins Little, MSN, RNDistrict 5: Tammy Smith, MSN, RN

Commission on Professional Issues:Wanda Spillers, DNP, RN, CCM, and

Marilyn Sullivan, DSN, RN, CPE, FCN, Co-Chairs

Special Interest Group:Advance Practice Council:Lanette Sherrill, MSN, RN

ASNA Staff

Executive Director, Dr. John C. Ziegler, MA, D. MINDirector Leadership Services,

Charlene Roberson, MEd, RN-BCASNA Attorney, Don Eddins, JD

Administrative Coordinator, Betty ChamblissPrograms Coordinator, April Bishop, BS, ASIT

Our Vision

ASNA is the professional voice of all registered nurses in Alabama.

Our Values

• Modelingprofessionalnursingpracticestoothernurses

• AdheringtotheCode of Ethics for Nurses• Becomingmorerecognizablyinfluentialasan

association• Unifyingnurses• Advocatingfornurses• Promotingculturaldiversity• Promotinghealthparity• Advancingprofessionalcompetence• Promotingtheethicalcareandthehumandignityof

every person• Maintainingintegrityinallnursingcareers

Our Mission

ASNA is committed to promoting excellence in nursing.

Advertising

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]. ASNA 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 Alabama State Nurses Association 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. ASNA 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 ASNA or those of the national or local associations.

The Alabama Nurse is published quarterly every March, June, September and December for the Alabama State Nurses Association, 360 North Hull Street, Montgomery, AL 36104

© Copyright by the Alabama State Nurses Association.Alabama State Nurses Association is a constituent member of the American Nurses Association.

Alabama nurse

Published by:Arthur L. Davis

Publishing Agency, Inc.

ASNA Websitealabamanurses.org

PublICATIONThe Alabama Nurse Publication Schedule for 2015

Issue Material Due to ASNA OfficeJune/July/Aug April 27, 2015Sep/Oct/Nov August 3, 2015Dec/Jan/Feb 2016 October 26, 2015

Guidelines for Article DevelopmentThe ASNA welcomes articles for publication. There is no payment for articles published in The Alabama Nurse.

1. Articles should be Microsoft Word using a 12 point font.2. Article length should not exceed five (5) pages 8 x 11.3. All reference should be cited at the end of the

article – not in body.4. Articles should be submitted electronically.

Submissions should be sent to:[email protected]

orEditor, The Alabama Nurse

Alabama State Nurses Association360 North Hull Street

Montgomery, AL 36104

ASNA reserves the right to not publish submissions.

Condolences:Annitta Love in the death of her aunt.

Rickie Varner in the death of his mother.

Joyce Varner in the death of her mother-in-law.

AlAbAMA bOArD OF NurSINg VACANCIES

There will be 2 RN positions open as of January 1, 2016. The term of Francine Parker, Nursing Education and Catherine Dearman, Nursing Education will expire December 31, 2015. Applications will be accepted for Nurse Educator only. RN applications are available from the ASNA office. Call Betty!

ASNA

March, April, May 2015 The Alabama Nurse •

Brian Buchmann

The President’s message

Brian Buchmann, BSN, RN, MBA

Hello Alabama nurses! Spring is my favorite time of the year. I enjoy the time of renewal and changes that occur like the beauty of new life, bright colors, warmer weather and the excitement that only spring-time brings. I am just as excited about the forthcoming changes for the Alabama State Nurses Association (ASNA) in 2015. This year is going to be wonderful for Alabama nurses. Your ASNA Board of Directors (BOD) has been busy creating a strategic plan that will help meet the ASNA mission to promote excellence in nursing practice while benefitting Alabama nurses and our communities.

The ASNA 2015 Strategic Plan includes the following goals:

• Providingleadershipforhealthpolicyandlegislative activities

• AdvocateforAlabamanursesonprofessionalpractice issues

• Providecontinuingprofessionaldevelopment• Improvethevisibilityandimageofnursing

Action items have been set by the ASNA BOD to help us meet these goals. These action items include but are not limited to a) lobbying at the state and national level to support legislation that benefits nurses and those we serve while opposing the legislation that does not, b) continuing

to provide updates on legislative and practice issue to keep nurses informed, c) providing continuing education on the latest evidence-based practice, and d) delivering nurse leadership activities.

In 2015, ASNA will also focus on the resolutions approved by the House of Delegates at the ASNA 2014 Annual Convention last October. These resolutions include:

• Safestaffingandstaffingdecisionmaking• Developinga20-30’stask-forcetolookatengaging

our younger generation of nurses • Provideinformationandeducationondomestic

violence• DevelopanASNAmentoringprogram• ImprovingadolescenthealththroughSTD,HIV,

and unintended pregnancy awareness• Nursessavelives,andwewanttoleteveryone

know by encouraging people to pre-order a car tag saying “Nurses Save Lives!”

• Recognitionofallgraduatelevelnursingspecialtyroles

ASNA will also support the American Nurses Association 2014-2016 goals and their initiative to promote 2015 as, “The Year of Ethics”! So, it is going to be a wonderful and busy year! ASNA needs your help! We now have over 90,000 nurses in Alabama. If we unite, there is so much more that we could accomplish together.

As your ASNA President, I am asking all of Alabama’s nurses to join ASNA. As nurses, we represent the largest health care profession. Therefore, we have the responsibility to lead the way for excellence in health care, our profession, and for our state.

We are Alabama nurses, let’s unite and stand together!

Spring Forward with ASNA in 2015

Excellent Nurse Opportunity

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This position offers competitive compensation, generous paid time off and excellent benefits. Extensive overnight travel is required. For more information and to apply please go to:

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If you have questions please contact Diane Mann at (334) 206-5078

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Dr. John C. Ziegler, MA, D, MIN.

Like it or not… politics impacts policy and policy impac t s YOUR nu r s i ngp r a c t i c e . A S N A / A N A members get advance warning political updates, have a voice in federal and state policy development councils and have peer and mentor support for daily practice issues. With the midterm election changes of the 114th U.S. Congress andthe changes in the Alabama Legislature, 2015 stands to be a watershed year in the healthcare politics, policy and ultimately, practice arenas. On the federal side, more than $3.6 billion was spent on House and Senate races. One hundred women were elected to Congress and the Republicans gained nine seats in the Senate establishing a majority, after 8 years in the minority.

The Alabama Legislature met in mid-January for their Organizational Session. During that Session they electedthe Leadership for both the Senate and the House for the next four years. They also made committee assignments and named committee leadership. With both the Alabama Senate and House increasing their Super Majorities this Legislature will likely look at issues like tax reform, downsizinggovernment,CharterSchoolsandothersocialissues that are Republican concerns. The General Fund budget is projected to have a shortfall from $500 to $700 million dollars! Legislators and the Governor will be scrambling to acquire “revenue streams” without raising

taxes. Some are calling for the elimination of deductions from your state income tax forms. (This takes $$$ out of your pocket without “raising taxes.” HA!) There is also talk about raising the tobacco tax by as much as $1.00 per pack. Even with these increases in revenue, it is unlikely that Corrections, Medicaid and Mental Health will be adequately funded. Possible Medicare and Mental Health cutswouldaffectmorethanafourthofAlabamacitizens.

Governor Bentley has chosen to develop Alabama’s own version of Medicare exchanges through a network of Regional Care Organizations. Alabama’s versionof Medicaid reform will continue in 2015. Governor Bentley has said he would not expand the current “broken Medicaid program.” However, there is talk that he may seek a Federal Block Grant that would provide additional Medicaid services to citizens. This is an issue thatASNA will watch carefully, given the multi-billion dollar impact of Medicaid on our state’s healthcare system. The political/policy impact on nursing practice is evident in just this one issue. ASNA members receive weekly updates when the Legislature is in session. The 1,300 ASNA members are supporting two full time lobbyists that represent all 86,000+ nurses in the state. I guess its OK with some people to let the “few” support the “many.” Something about that just doesn’t seem right.AREYOUA MEMBER? If not, join. Also, participate in advocacy events like Nurses Day at the Capitol.

Nurses Day at the Capitol will be March 11, 2015. The annual event will be different this year with two powerful educational sessions followed by a rally with hundreds of nurses at the Alabama State House in Montgomery. At 10 am there will be the option of an educational session on Legislative Advocacy and Policy in the Capitol Auditorium and in the Capitol Tunnel there will be an alternate session on Protecting Yourself Legally in Your Practice. Everyone will unite for the rally at 11 am-12. Governor Bentley will bring remarks along with key Legislators and nursing leaders. The event, sponsored by the Alabama Coalition of Nursing Organizations, bringsnurses from all specialties together.

Politics Impact Policy and Policy Impacts Practice

The E.D.’s Notes legal Corner

Peace of Mind for the rNDon Eddins, BS, MS, JD

Registered nurses often ask me about the Alabama State Nurses Association legal program. Really, it should be classified as two programs.

An ASNA member is entitled to a free one-hour’s consultation per year on any subject that the ASNA attorney – myself – feels qualified to discuss. Probate matters, domestic relations, accidents, job issues – whatever legal issue the nurse wants to discuss.

Often just a talk with an attorney on am important matter can lead to resolution and peace of mind.

If you are an ASNA member and need such a consultation, call the ASNA office in Montgomery, my office in Auburn at (334) 821-9981 or, better still, email me at [email protected].

It is important to note, however, that often nurses think because they receive the Alabama Nurse, they are entitled to ASNA benefits. Those membership advantages are only available to nurses who sign up for membership and pay dues each month (or year).

The second part of the legal program provides that if a nurse receives a letter from the Alabama Board of Nursing indicating that the nurse’s license is under investigation, the ASNA lawyer will represent the nurse on the matter without charge.

The stipulation is that the nurse must be an ASNA member when the act that led to the investigation occurred. It’s sort of like automobile insurance. You can’t wait until the accident occurs and then go purchase insurance to cover it.

Frequently, I discuss licensure matters with non-members, but if I represent them, that representation is not free. So sign up before you get that dreaded letter from the BON.

Sitting across the desk from me, nurses have told me that they never thought their license would be on the line in connection with a BON investigation. But the truth is anyone can make a mistake.

And often the investigation is not really related to an error or omission by the nurse. I’ve done cases in which a patient’s family did not get the outcome that they desired, so they blamed in on the physician, the medication facility and/or the attending registered nurse.

The legal program is just one of so many ways ASNA advocates for registered nurses in Alabama. ASNA monitors to support or oppose BON rules changes, for instance. ASNA fights for you at the Alabama Legislature. Other nursing groups may be for a certain subset of nursing, but ASNA is for all registered nurses.

The legal program is an important benefit in spectrum of advocacy activities the Association is involved in. ASNA is, after all, the state’s oldest and most influential nursing organization.

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As a Flushing Agent for Enteral Nutrition, Does Sterile Water Compared to Tap Water Affect the Associated risk of Infection

in Critically Ill Patients? Reprinted with permission from author

Sohayla M. Allen, R.N.FNP Student, Gonzaga University, Spokane, WA

Email: [email protected]

In the critical care setting, many patients are prescribed enteral nutrition. While caring for these patients, nurses routinely use water to dilute the feeding solutions, flush the enteral tube, and administer medications. Inevitably, the question that emerges is what type of water is the best agent. In 2006, the American Association of Critical Care Nurses (AACN) released a practice recommendation in response stating, “We aren’t sure.” The AACN (2006) stated that many factors must be considered in answering the question about choosing the flushing agent for enteral nutrition. The official AACN recommendation is to use, at a minimum, universal precautions and good handwashing. Filtered water should be used in enteral systems rather than using water directly from the hospital taps. According to the AACN (2006), sterile water should always be used when working with immunocompromised patients.

Although this best practice recommendation was made by the AACN in 2006, hospitals have yet to fully adopt this practice. Of further concern is the continued practice by critical care nurses of not using sterile water in enteral feeding tubes. This continued practice can result from the misconceptions about the use of sterile water: e.g., that it is not necessary to use sterile water because the stomach isn’t sterile and that patients routinely drink non-sterile water without a problem.

A systematic literature search with analysis was conducted by this author to review the scientific evidence

regarding the clinical question of the use of sterile versus tap water in enteral feeding tubes. The expected outcome of this literature search was to determine the underlying rationale for using sterile water in enteral tube feeding systems.

Research StrategyA systematic inquiry of electronic databases was

conducted in order to address this research topic. Databases searched included CINAHL, The Cochrane Library, Medline, PubMed, and the National Guideline Clearinghouse. Initially, several research parameters and exclusion criteria were set (more information available upon request from the author). However, the lack of studies pertaining specifically to intensive care patients receiving either temporary or long-term enteral nutrition was a significant obstacle. Thus, the study selection criteria were broadened to include all studies that compared the relative risk of using sterile versus tap water in enteral feeding tubes. Interestingly, only one out of eight keeper studies focused exclusively on critically-ill or immunocompromised populations, presumably because these patients are more susceptible to hospital-acquired infections.

Evidence CharacteristicsAt the time of writing, the bulk of available research

on this topic consists of case reports, expert opinion, and cohort studies. These types of research studies are historically not held as the gold standard of evidence- based practice. However, the findings in the research are consistent; there is an increased risk of nosocomial infection for critically ill patients when tap water is used Sterile Water continued on page 6

in enteral feeding tubes (Bert, Maubec, Bruneau, Berry, & Lambert-Zechovsky, 1998; Hosein et al., 2005; Marrie et al., 1991; Rogues et al., 2007; Padula, Kenny, Planchon, & Lamoureux,2004;Venezia,Agresta,Hanley,Urguhart,&Schoonmaker, 1994).

The survey of literature suggests that bacteria, identified as causative organisms in nosocomial outbreaks, have been isolated from hospital sinks and taps (AACN, 2006; Bert et al., 1998; Hosein et al., 2005; Rogues et al., 2007;Veneziaetal.,1994).Thereareseveraldocumentedincidents of hospital-acquired infection within the ICUsetting. These incidents can be attributed to outbreaks of Pseudomonas aeruginosa and Legionella sp. In most cases the causative organismwas found to be colonized in thehospital sink faucets (Bert et al., 1998; Hosein et al., 2005; Roguesetal.,2007;Veneziaetal.,1994).Bertetal.(1998)established that Pseudomonas aeruginosa was directly

research Corner


transmitted to patients via enteral feeds contaminated with tapwater. Similarly,Hosein et al. (2005) andVenezia etal. (1994) found that cases of nosocomial Legionnaires’ disease could be attributed to the documented aspiration of patients on enteral feeds, whose formula was likely contaminatedwithcolonizedtapwater.

Critical care patients are at risk for bacterial translocation in the gastrointestinal system. The risk can be attributed to their critical disease processes, increased pH of the gastrointestinal track allowing for abnormal bacterial growth, and their decreased use of the intestinal tract (AACN, 2006; Padula et al., 2004). These risk factors can contribute to the patient’s critical state and lead to longer hospital stays, pneumonias associated with enteral feeds, and possibly death (Padula et al., 2004). A survey of literature has suggested that bacteria, identified as causative organisms in nosocomial outbreaks, have been isolated from hospital sinks and faucets (AACN, 2006; Bert et al., 1998; Hosein et al., 2005; Rogues et al., 2007; Veneziaetal.,1994).

The relationship between contaminated tap water and nosocomial infection is particularly relevant in the ICU.A large percentage of critically ill patients are at risk for aspiration of contaminated enteral feeds secondary to mechanical ventilation, decreased level of consciousness, and significant maladies. However, evidence from the literature suggests that perhaps environmental infection control should be the first line of defense rather than a focus on aspiration prevention. For example, Rogues et al. (2007) found that once a particular ICU’s tap waterwas disinfected, the number of Pseudomonas aeruginosa carriers decreased by 65%. This finding was confirmed by replacing tap water with sterile water; the relative number of nosocomial infection cases decreased significantly (Hosein et al., 2005; Rogues et al., 2007;Venezia et al.,2004).

Most of the literature on this topic is dated and encompasses a noticeable lack of both randomizedcontrol trials and statistically significant data to support the clinical practice guideline conclusions. As such, the next step will be to initiate further research on the subject. Specifically, more information is needed to compare findings among different patient populations as well as to compare the efficacy and cost-effectiveness of different interventions (e.g., using sterile water versus decontaminating the hospital water supply).

Best PracticeBased on the available existing research, current

clinical practice guidelines suggest that for critically ill or immunocompromised patients, sterile water should be used exclusively in enteral feeding systems including medication administration and flushes (National Guideline Clearinghouse, 2009). The level of evidence supporting this recommendation is rated as “fair,” (using the Agency for Healthcare Quality and Research categories) and is based on well-designed research studies without randomization. Not only is exclusive use of sterile wateran effective way of decreasing nosocomial infection associated with contaminated tap water, but sterile water has also been shown to be safer for medication administration as the chemical contaminants in tap water

Sterile Water continued from page 5

Who are you?Greg Howard, LPN

We live, breathe, dress ourselves with cloths and trinkets, eat, talk and perform acts of survival, passion and necessity.

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No one can answer or define this but you.

Every individual is responsible for their own lives. Be clear about your intentions and the universe will rise up to meet you.

Self-worth, determination and instinct should guide your path. Look into your heart with a positive mind and let the magic happen.

We were not meant to be perfect just whole. For we are all on a journey and the things we encounter will shape our lives. Find a place of joy within and joy will burn out any pain.

lPN Cornercan potentiate drug-drug interactions, thus decreasing the bioavailability of certain medications (Boullata, 2010; Bankhead et al., 2009; National Guideline Clearinghouse, 2009).

The AACN (2006) has suggested that hospitals collaborate with their epidemiology departments to test water supplies for infectious organisms. This suggestion may be problematic because of its feasibility in small, rural settings and costs to the practice settings. The costs of frequent water testing and the subsequent treatment of an entire water system may be far more than the cost of sterile water use in lieu of tap water. Therefore, unless there is contradictory evidence, if the quality of tap water cannot be established, the best practice is to err on the side of caution and use sterile water exclusively in the enteral feeding systems of critically ill patients.

ReferencesAmerican Association of Critical Care Nurses (AACN). (2006).

Practice resource network: Is sterile water preferred over tap water for irrigation of enteral feeding tubes and medication administration by nasogastric or feeding tubes in critically ill adult patients? AACN News, 23(7), 4-5. Retrieved from http://www.aacn.org/wd/aacnnews/content/2006/jul-practice.pcms?menu=practice

Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J. & Weesel, J. (2009). ASPEN enteral nutrition practice recommendations. JPEN Journal of Parenteral & Enteral Nutrition, 33(2), 122-167. doi: 10.1177/0148607108330314.

Bert, F., Maubec, E., Bruneau, B., Berry, P., & Lambert-Zechovsky, N. (1998). Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. The Journal of Hospital Infection, 39(1), 53-62.

Boullata, J. (2010). Enteral nutrition practice: the water issue. Support Line, 32(3), 10.

Hosein, I., Hill, D., Tan, T., Butchart, E., Wilson, K., Finlay, G. & Ribeiro, C. (2005). Point-of-care controls for nosocomial Legionellosis combined with chlorine dioxide potable water decontamination: A two-year survey at a Welsh teaching hospital. The Journal of Hospital Infection, 61(2), 100-106.

Marrie, T.J., Haldane, D., MacDonald, S., Clarke, K., Fanning, C., Le Fort-Jost, S., ...Joly, J. (1991). Control of endemic nosocomial Legionnaires’ disease by using sterile potable water for high risk patients. Epidemiology & Infection, 107(3), 591 – 605. doi: 10.1017/S0950268800049293.

National Guideline Clearinghouse (NGC). Guideline summary: Enteral nutrition administration. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); [cited 2009 Jan]. Retrieved from http://www.guideline.gov.

Padula, C., Kenny, A., Planchon, C. and Lamoureux, C. (2004). Enteral feedings: What the evidence says. The American Journal of Nursing, 104(7), 62-69. Retrieved from http://journals.lww.com/ajnonline/toc/2004/07000.

Rogues, A., Boulestreau, H., Lasheras, A., Boyer, A., Grunson, D., Merle, C. and Gachie, J. (2007). Contribution of tap watertopatientcolonizationwithPseudomonasaeruginosain a medical intensive care unit. Journal of Hospital Infection, 67(1), 72-78.

Venezia, R., Agresta, M., Hanley, E., Urguhart, K., &Schoonmaker, D. (1994). Nosocomial Legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infection Control and Hospital Epidemiology: The Official Journal of the Society of Hospital Epidemiologists of America, 15(8), 529-533.

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In 2011, the ASNA Board of Directors articulated the goal of creating a Leadership Academy to enhance Alabama’s nursing leadership capability from the bedside to the boardroom. A small group of ASNA members grew into a steering committee that met and developed a curriculum to help nurses explore effective leadership strategies. Leadership concepts include team building, communication, ethics and values, health care knowledge relationship building, professionalism, business orientation, networking, community service and advocacy.

The Alabama State Nurses Association Leadership Academy has graduated two phenomenal cohorts of participants. These nurse leaders presented their capstone projects that have and will continue to positively impact nurses’ workplaces and communities:

Titles of Recent Leadership Academy Projects• EmpoweringNursingasaProfession• PalliativeCareAccess:DevelopingacultureforChange• FormalRecognitionofallSpecialtyRolesinAdvance

Practice Nursing in Alabama• MovingTowardSharedNursingGovernanceina

SpecialtyHospital:BestExperience.• Sports-relatedHeadInjuriesinthePediatricPopulation• ImprovingAdolescentHealthThoroughSTD,HIV,and

Unintended Pregnancy Awareness• ThePowerofOne:ObesityRiskAwarenessinAlabama• TransitiontoCare• NursingLeadership,Role-Modeling,&Mentoring• AcuityBasedStaffinginanAcuteCareHospital

ParticipantObjectives• Todeveloppersonalleadershipcharacteristics• Toincorporateethicsandvaluesinleadership• Tounderstandeconomicsandpolicyinthe

health care system and its effects on leadership in nursing

• Toengageincollaborativeactivitiesemphasizingcollegialityandchange

• TobuildonnursingcompetenciesinCommunication, Knowledge, Ethics, Leadership, Relationships, Service, Networking, & Advocacy

• Toinitiatecommunityandhealth-relatedprocesses to improve the practice environment

Selection: Any Alabama Nurse interested in Leadership Development is invited. Institutions or agencies may sponsor participants or be a contributing sponsor for the ASNA Leadership Academy

Costs:The registration fee of $400 per participant covers all meetings, session meals, materials and 40 Contact Hours. Three or more participants from the same agency/association registering together will receive a 10% discount. Additional costs covered by participants include travel and lodging. Contributing sponsors ($1000) receive two participant registrations.

FORINFORMATIONCONTACTCharlene Roberson 334-262-832 or [email protected] REGISTRATIONLINK:https://www.surveymonkey.com/s/ASNA_2015_Leadership_Academy

The 2015 ASNAAlabama Nurse leadership Academy

‘NURSES LEAD THE WAY”

TIMElINE

The ASNA Leadership Academy is a year-long experience of active engagement, content on applied leadership in nursing, with opportunity to initiate a community-based project and reflect on the process of transformational leadership. Participants will attend three “face-to-face” experiences, virtual meetings, and produce a collaborative project that contributes to improvement in their immediate nursing environment.

Phase I: Developing leadershipApril 13-14, 2015 Montgomery, The Leadership Academy begins with a one and one-half day immersion in leadership guidelines and techniques. Workshop essentials include team building and networking for leadership development. Participation in FACES sessions and special Leadership Academy Sessions links the Academy experience with issues in Alabama Nursing. At this time topics are explores for individual and group projects.

Interval PhasesBetween phases the groups will meet at least monthly, through virtual technology and participate in reflection on what leadership is needed in their nursing environments. ASNA Leadership Advisors and participants will provide support for ongoing transformative change and project development. Participants will attend one Executive Leadership Meeting of their choice during the program. Opportunity for reflection be shared by technology among participants.

Phase II: Contributing to Policy & Advocacy July 11, 2015 Montgomery, ALIn phase II, the Leadership Academy will build on initial concepts and develop these further in legislative, interprofessional and economic perspectives. The meeting will facilitate an interim project appraisal and an opportunity to identify obstacles and achievements in leadership development.

Phase III: Celebrating the JourneyOctober 1-3, 2015 Gulf Shores, ALIn the culminating phase, participants will share successes and project completions at the ASNA Convention,. Participants will attend the ASNA Board Meeting and present posters or podium presentations on their projects. Emphasis will be on the processes of building leadership effectiveness in one’s community and nursing environment.

The2014ASNALeadership Academy, Participants and Steering Committee

ASNA leadership Academy

Mission:Tocreatea community of effective nurse leadersVision: Prepare thenextgenerationof nurse leaders for the state of Alabama

“TheLeadershipAcademy is an excellentresourceto help engage and empower Alabama nurses to action in our state.”

Julie Savage Jones

“Fromfirsthandexperience,Iknowparticipation in the Academy teaches nurses from all walks of life to capitalize on skills and knowledge gained through service to improve practice conditions for all nurses and health outcomes for communities where patients and patient families live.”

Dr. Beverly J. Myers

“ThestrengthsoftheAcademywere the passion that was exhibited,theavailabilityofthe mentors, their willingness to share information, and the opportunity to mentor nurses who have a desire to promote the nursing profession for those individuals who have put their trust in our abilities.”

Dr. Marilyn Whiting

“I gained confidence that a formal leadership position is something I would like to pursue….I have already used myprojectwithintheschoolof nursing... we have taken a leadership role within the university and community with regard to disaster readiness….Themoreofusthathavetheexperiencethe more we can do to make Alabama a great place for nurses in all roles to make a real difference in healthcare.”

Dr. Cindy Berry

“Becoming more confident in my leadership abilities will help me become more involved in many activities of my employment and will encourage me in being a leader in my community.”

Dr. Mary Beth Bodin

Minimum 33 hours for completion.

“Build your potential; Secure your future”

Apply now!Contact: (256) 372-5277

www.aamu.edu

MBA ProgramNursing and Rehabilitation Center, LLC

Looking for qualified LPNs, RNs & CNAs

to work in a loving environment

Contact Mattie Banks at 205-798-8780http://www.birminghamnursing.iapplicants.com

BirminghambECOME A PArT OF Our FAMIlY

AT BROOKWOOD MEDICAL CENTER,webelieveinchanginglives…notjustthe lives of our patients, but the lives of our employees as well .

Founded in 1973, Brookwood Medical Center is the largest private hospital in Alabama with 630 plus beds, and a leading provider of advanced medical care to the community and region . Our medical staff is comprised of more than 900 privately practicing physicians, and our workforce includes more

than 2,500 employees and volunteers . Accredited by the Joint Commission, Brookwood is widely recognized for its cardiology, oncology, psychiatry,

women’s and orthopedic programs .

We are currently offering Sign-On bonuses for experiencedRN’s in the following areas:

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If you are excited about your profession, please visit our website,www.bwmc.com, for a complete list of open positions . E .O .E ./We Drug Test


Elizabeth A. Morris Clinical Education Sessions - FACES ‘15

TIME AANS ACADEMIA CLINICAL 1 CLINICAL 2 CLINICAL 3 CULTURE ORTHOPEDIC VETERANS

0800-0915 PLENARY A – The State of Public Health in Alabama – Dr. Don Williamson, State Health Officer, Alabama Department of Public Health

0915-1000 BREAK – VISIT EXHIBITORS, (Exhibit Hall)VIEW POSTERS (2nd floor Hall)

1000 - 1100How to Pass

NCLEX(No CE Credit)

Ostomy Bootcamp: …

Reducing the Number of

Patient Falls…

Animal Assisted Therapy

Hitting the Target: … Pt. 1

The Tornado Inside! AND

Managing and Moving Patients…

Women Veterans: Changing the Face of

the VA

1115 - 1215Public Health

Nursing in Malawi Africa

Disruptive Innovation:

Implementing a Partially-

Flipped Classroom …

UnhookFromJunk Food to Manage Type

2…

Patient Belongings:…

They Say I have ADHD…

Hitting the Target: … Pt. 2

Ouch!! Pain Management…

AND“Oh My Gosh!”…

Transforming Healthcare for

Veterans

1215-1315

LUNCH~Fellowship HallOptional ASNA Legislative Update/MeetingOptional Taking Control of Your Retirement(Provided by Merrill-Lynch) – No CE Credit

View Posters (2nd Floor)

1315-1430 PLENARYB~AlabamaNursingWorkforceData;EssentialInformationfortheFutureofAlabamaNursingDrs. Kathleen Ladner, Carol Ratcliff & Ellen Buckner

1430-1440 BREAK – VISIT EXHIBITORS, VIEW POSTERS

1440-1540How to Get a

Job… and Keep It!

Leading the Change in Health

Literacy….

Do I have to eat THAT!...

Quality and Safety Education

for Nurses…

Lateral Violence and Men in

Nursing

Taking Health Promotion Self

Care To…

HazardsofImmobility…

ANDOsteoarthritis

The Development of Charge Nurse

Orientation…

1550-1650 Mentoring

Academic Collaborations

to Provide Rural School-based Screenings

A Diabetes Education

Program in a Rural…

Turning a Patient & Visitor

Guide…

Perinatal Core Measures…

Post-Operative Assessments…

ANDEscalation in Providing…

Implementing Early Warning Signs…

Posters will be located on the second floor above the Sanctuary



Elizabeth A. Morris Clinical Education Sessions - FACES‘15

Tuesday,April14,2015Eastmont Baptist Church

4505AtlantaHwy,Montgomery,AL

7:15–8:00AMREGISTRATION

8:00–9:15AMOPENING PLENARY

PLENARY ATheStateofPublicHealthinAlabamaDr. Don Williamson, State Health Officer, Alabama Department of Public Health

At the conclusion of the presentation the participant should be able to:1. Explore current state of Public

Health services in Alabama.2. Contrast challenges and opportunities in Alabama

Public Health today.3. Examine the status of Medicaid in Alabama today.

9:15–10:00AMBREAK

VISITEXHIBITORS,VIEWPOSTERS

10:00–11:00AMSESSION A

AANSA–HowtoPassNCLEX(NoCEcreditforthisprogram)Tina RayfieldAt the conclusion of the presentation the participant should be able to:1. Describe the process for application of NCLEX and

licensure.

CLINICAL1A–OstomyBootcamp:SurvivalSkills,Innovations,andTrendsinOstomyCareDr. Allison Terry; Jimmy Terry, WOCN, BSN, RN; & Dr. Ginny LanghamAt the conclusion of the presentation the participant should be able to:1. Assess a patient having an ostomy for evidence of skin

breakdown.2. Discuss troubleshooting techniques that can be used

when caring for a patient having an ostomy.3. Describe body image changes that may be experienced

by the patient having an ostomy.

CLINICAL2A–ReducingtheNumberofPatientFallsonSurgicalandOncologyFloorsAnna Maria Francesca Ceravolo, BSN, RNAt the conclusion of the presentation the participant should be able to:1. Verbalizeacost-effectivestrategyaimedatreducing

the number of patient falls.2. Discuss the relevance of congruency between hospital

fall policies and procedures and national guidelines for fall reduction.

3. Discuss the importance of both personal and professional accountability related to keeping patients free of injuries secondary to falls.

CLINICAL3A–AnimalAssistedTherapy(AAT)Dr. William Stuart PopeAt the conclusion of the presentation the participant should be able to:1. Define AAT.2. Describe an understanding of the uses of AAT with

various populations.3. Define the human-animal bond.

CULTUREA–HittingtheTarget:AimingforImprovedHealthLiteracyandOutcomes(Part1)Dr. Arlene MorrisAt the conclusion of the presentation the participant should be able to:1. Identify factors that relate to health literacy.2. Describe 2012 updates to CLAS Standards.3. Demonstrate three specific strategies for health

teaching in response to scenarios.

ORTHOPEDICAPt1–TheTornadoInside!Sheila Ray Montgomery, MSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify two causes of compartment syndrome.2. Discuss assessment of patient with compartment

syndrome.3. Identify two interventions that are effective in the

treatment of patients with compartment syndrome.

AND

ORTHOPEDICAPt2-ManagingandMovingPatientswithOrthopedicInjuriesKate McConathy, BSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify two reasons it is important to move orthopedic

patients after surgery.2. Discuss assessment of orthopedic pre and post-

operative patient.3. Identify two ways to prevent complications in the post-

operative patient.

VETERANSA–WomenVeterans:ChangingtheFaceof the VAAmy Southern, MSN, RNAt the conclusion of the presentation the participant should be able to:1. Describe how the culture of the Veterans Health

Administration (VHA) is changing to embrace women veterans.

2. Identify the unique health risks of women veterans.3. Describe the gender-specific care provided by the

VHA.

11:15AM–12:15PMSESSION B

AANSB–PublicHealthNursinginMalawiAfricaDr. Constance S. HendricksAt the conclusion of the presentation the participant should be able to:1. DiscussparametersoftheAUNursingAfricaStudy

Abroad option.2. Describe at least one unique experience as shared by

the participants.3. Describe how students fulfilled their CHN course

requirements.

ACADEMIAB–DisruptiveInnovation:ImplementingaPartially-FlippedClassroominNursingDrs. Tedra Smith, Lynn Stover, & Sylvia Britt; and Connie Hogewood, MSN, RN; & Sherita Etheridge, MSN, CRNPAt the conclusion of the presentation the participant should be able to:1. Define the value of a partial flipped classroom to

nursing education as it related to teaching analysis, synthesis, evaluation, and problem-solving.

2. Describe classroom strategies that enhance critical thinking skills in undergraduate nursing students.

CLINICAL1B–UnhookFromJunkFoodtoManageType2DiabetesDr. Anita H. KingAt the conclusion of the presentation the participant should be able to:1. Describe both the effects of junk food on blood

glucose.and biochemical addictive effects of junk food.2. Outline research findings on Type 2 Diabetes and

obesity.3. List 4 junk food traps.4. List at least 5 teaching tactics about “unhooking” from

junk food that the nurse can provide to the person with diabetes.

CLINICAL2B–PatientBelongings:BlazingNewTrailsBrigitte Vola, BSN, RN, CRRN & Daniel Nash, BSN, RN-BCAt the conclusion of the presentation the participant should be able to:1. Explain problems with the current management of

patient belongings during hospital admission.2. Describe changes made in regards to documenting

patient belongings and educating patients on their responsibilities with their belongings.

3. Relate the outcomes of the changes made and be able to implement similar changes at other facilities.

CLINICAL3B–TheySayIhaveADHD,OhLook,There’saDuck!Dr. Moniaree JonesAt the conclusion of the presentation the participant should be able to:1. Discuss the history of medications used for ADHD2. Review the common symptoms and pathology of

ADHD.3. Differentiate between diagnosis and misdiagnosis.4. Describe current treatment trends in ADHD

CULTUREA–HittingtheTarget:AimingforImprovedHealthLiteracyandOutcomes(Part2)Dr. Arlene Morris

Continuation of Part 1

ORTHOPEDICBPt1–Ouch!!PainManagementinthe Orthopedic PatientSolana Johnson, BSN, RNAt the conclusion of the presentation the participant should be able to:1. Describe several common pain management

techniques beneficial to the orthopedic patient.2. Describe alternative pain control techniques, besides

medication, used in the orthopedic patient.

AND

ORTHOPEDICBPt2–“OhMyGosh–WhatisTHAT!”ExternalFixationDevicesandRoutineCarein the Orthopedic PatientKate McConathy, BSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify why external fixators are used.2. Discuss assessment of care for a patient with an

external fixator.3. Describe the process of pin-site care.

VeteransB–TransformingHealthcareforVeterans–PatientAlignedCareTeam(PACT)Dr. Rebecca HuieAt the conclusion of the presentation the participant should be able to:1. Describe the focuses of a patient aligned care team

(PACT)2. Describe the roles of patient aligned care team (PACT)

members and T-Coaches.3. Describe the patient-centered strategies and measures

for success.

12:15–1:15PMLUNCH

OptionalASNALegislativeCommitteeMeeting/Update

1:15–2:30PMAFTERNOONPLENARY

PLENARY BAlabama Nursing Workforce Data; Essential InformationfortheFutureofAlabamaNursingDrs. Kathleen Ladner, Carol Ratcliff & Ellen BucknerAt the conclusion of the presentation the participant should be able to:1. Discuss the Institute of Medicine (IOM)

recommendation for better data collection and an improved information infrastructure.

2. Define the national Minimal Data Set for nursing workforce data and why it is needed in Alabama.

3. Discuss the significance of nursing workforce data in planning for the health needs of Alabamians and in addressing needs of underserved and diverse populations.

4. Contribute to the dialogue on Alabama Nursing Workforce data and its applications for workforce planning.

Ladner Ratcliff Buckner

FACES ‘15 continued on page 11



2:30–2:40PMBREAK

2:40–3:40PMSESSION C

AANSC–HowtoGetaJob…andKeepIt!Brian Buchmann, BSN, MBA, ASNA President At the conclusion of the presentation the participant should be able to:1. Review dos & don’ts during interviewing, hiring

process, and orientation.2. Discuss expectations employers have for new nurses.

ACADEMIAC–LeadingtheChangeinHealthLiteracy:TheRoleoftheNursingProgramandNursing Student in Community OutreachDr. Yolanda TurnerAt the conclusion of the presentation the participant should be able to:1. Explore opportunities where nursing programs

can make intentional and sustainable changes in community health outreach to improve health literacy.

2. Discuss the impact on program outreach on the professional growth and development of the academic nurse and student nurse.

3. Discuss impact of intentional and programmed intervention by nursing programs on community health and health promotion.

4. Review examples of health literacy outreach by nursing program and nursing students in a four part poster series.

CLINICAL1C–DoIHavetoEatTHAT!TheNurse’sResponsetoRecentFrustrationswithSchoolLunchesand Health Eating Initiatives.Christy Rials, MSN, PNP, RNAt the conclusion of the presentation the participant should be able to:1. Relate the healthy eating policy and the issues that

are preventing the school systems from effectively executing these changes.

2. Highlight effective changes that will help with compliance and not sacrifice quality or quantity.

3. Describe methods to encourage nurses to become advocated for the pediatric student population and share this information with their schools.

CLINICAL 2C Quality and Safety Education for Nurses(QSEN)BeyondtheClassroomDrs. David H. James, Patricia Patrician, & Rebecca S. MiltnerAt the conclusion of the presentation the participant should be able to:1. Relate the role of the Quality and Safety Education for

Nurses (QSEN) initiative in the reshaping of nursing education.

2. Describe how the QSEN competencies were used to revise a hospital’s orientation program.

CLINICAL 3C Lateral Violence and Men in NursingDr. Lori HillAt the conclusion of the presentation the participant should be able to:1. Describe the impact of gender bias on the male nurse.2. Define the meaning of lateral violence and its impact

on patients.3. Identify appropriate strategies to promote civility

among nurses.

CULTUREC–TakingHealthPromotionSelfCaretothe People Southern StyleDr. Constance Hendricks, Sola Popoola, RN, MSN, Christopher Wilburn, MS, Joyce German, MS, & Chanrda Darden, RN, MBAAt the conclusion of the presentation the participant should be able to:1. Relate how technology and health literacy can promote

health.2. Describe use of non-traditional strategies to influence

behavior.

ORTHOPEDICC Pt 1 – Hazards of Immobility andCare of the Orthopedic PatientSheila Ray Montgomery, MSN, RNAt the conclusion of the presentation the participant should be able to:

1. Identify two risks associated with immobility in orthopedic patients.

2. Discuss two orthopedic injuries that present challenges inmobilization.

3. Demonstrateknowledgerelatedtothemobilizingofone type of orthopedic patient.

AND

ORTHOPEDICCPt2–OsteoarthritisKate McConathy, BSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify 2 signs and symptoms of osteoarthritis.2. Identify 2 different patient populations who are at risk

for osteoarthritis.3. Discuss 2 treatment options for osteoarthritis. VeteransC–TheDevelopmentofaChargeNurseOrientationPlanatTuscaloosaVeteransAffairsMedical CenterDr. Pamela L. JacksonAt the conclusion of the presentation the participant should be able to:1. Apply Rosswurm and Larrabee’s Model for Change

framework to process improvement issues within an organization.

2. Identify the role and responsibilities of charge nurse/frontlineleadersthatareessentialtoorganizationalsuccess.

3. Compare the American Nurses Association (ANA) dimensions of practice with the scientific evidence outlining the role and responsibilities (core competencies) charge nurses should possess.

3:50–4:50PMSESSION D

AANSD–TheValueofaMentorDr. Rebecca Huie, ASNA President-ElectAt the conclusion of the presentation the participant should be able to:1. Describe how to find a mentor.2. Explore how to use a mentor.

ACADEMIAD–AcademicCollaborativesProvideRural School-based ScreeningsDrs. Constance Hendricks and Barbara Wilder; and Marilyn Stanford, FNP-BCAt the conclusion of the presentation the participant should be able to:1. DescribeclinicaleducationvalueoftheAUschool-

based screenings.2. RelateAUSON’sTigerCheckscreeningprocess.

CLINICAL1D–ADiabetesEducationPrograminaRural Home Health Care AgencyDr. Amy BeasleyAt the conclusion of the presentation the participant should be able to:1. Relate techniques to provide diabetes education in a

rural community.2. Describe methods to avoid unnecessary

hospitalizationsduetodiabeticcomplications. CLINICAL2D–TurningaPatient&VisitorGuideIntoaWorkingToolkitDr. Shannon Graham & Brigitte Vola, BSN, RN, CRRN

At the conclusion of the presentation the participant should be able to:1. Describe how an interdisciplinary team redesigned a

visitor guide into an interactive toolkit.2. Relate the impact of an interactive visitor guide on the

patient experience and patient satisfaction.

CLINICAL3D–PerinatalCoreMeasuresforCesarean DeliveryConnie M. Hogewood, MSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify The Joint Commission reporting requirements

regarding cesarean delivery.2. Describe the perinatal core measures related to

cesarean delivery.

ORTHOPEDICDPt1–Post-OperativeAssessmentsinthe Orthopedic PatientSheila Ray Montgomery, MSN, RNAt the conclusion of the presentation the participant should be able to:1. Identify one reason the post-operative assessment is

important.2. Discuss two common complications associated with the

post-operative patient.3. Demonstrate items that should be included in any post-

operative assessment.

AND

ORTHOPEDICDPt2–EscalationinProvidingPatientCare in the Post-Operative Orthopedic Patient Kristen Noles, MSN, CNL, RNAt the conclusion of the presentation the participant should be able to:1. Describe the importance of escalation in advocating for

the orthopedic patient.2. Describe the use of SBAR when communicating to other

disciplines involved in the care of the post-operative orthopedic patient.

VETERANS D – Implementing an Early WarningSigns Scoring System for Rapid Detection of Clinically DecompensatingPatientsandCriticalAssessmentTeamInterventionCharly Murphree, RN, MSN & Karice Haywood, RN-BC, MSNAt the conclusion of the presentation the participant should be able to:1. VerbalizeunderstandingoftheimpactofaCritical

AssessmentTeamontheStandardizedMortalityRate.2. Relate understanding of the Early Warning Signs system.3. Demonstrate the use of the Early Warning Signs

calculator.

FACES ‘15 continued on page 12

FACES ‘15 continued from page 10

Nursing and Rehabilitation Center East, LLC

Birmingham Eastlooking for qualified

LPNs, RNs & CNAs to work in a loving environment

Contact Melody Burch at 205-854-1361http://www.birminghamnursingeast.iapplicants.com

*$3,000 Staff RN Sign-OnDCH Health System is hiring!

System Director of Neonatal Intensive Care (NICu)

Nursing Operations / Analytics ManagerNursing Team leader (l&D/Ob)

*RN Career Opportunities Available in:Cardiac Med/Surg

DialysisEmergency

Home HealthObstetrics (OB)

Stroke UnitWound Center

*For more information and to apply online, visit the DCH website atwww.dchsystem.com

Bilingual candidates encouraged to apply.DCH Health System is an EOE.



PosterSessions:

1. TheImpactofAlcoholAbuse – Drs. Beverly J. Myers & Sandra Jemison2. AnOverviewofTwoEatingDisorders – Drs. Beverly J. Myers & Sandra Jemison3. TheAgingPatient:ProvidingSafeQualityCare

ThroughtheUseofTechnology – Valarie F. Thomas, RN, MSN & Laurie C. Harris, RN,

MSN4. Microvascular Complications of Diabetes – LaKeva Harris, RN5. PatientHandHygiene:AMissingLinkin

NosocomialInfections:InterventionStrategiesforHealth Care Workers – Margot Fox, MSN, RN

6. Adverse Effects of Stimulant Medications in ADHA – Stacey King, RN, BSN & Dr. Susan Hayden

7. Stress Incontinence in Women – Jessica T. Hardy, BSN, MPH, RN

8. A Diabetes Education Program in a Rural Home Health Agency – Dr. Amy Beasley

9. Student Perceptions of a Global Initiative to Reduce Health Disparities in a Culturally Diverse Population – Tanya Johnson, MSN, RN

10. FosteringHealthandWellnessThroughPreventative Healthcare and Complementary and Alternative Medicine – Abby Grammer Horton, MSN, RN

11. On Campus Simulation with Baccalaureate Nursing Students – Drs. Mary A. Kelley, Stephanie Turner, Haley Strickland, Olivia W. May, Michele Montgomery , Paige Johnson, & Leigh A. Booth, MSN, RN, CNL and Jazmine Hoggle, MSN, RN, CRNP

12. CultivatingNursingLeadership:ThePursuitofaFulbrightGrantforCulturallyDiverseHealthPromotion – Kinsey Crow

ContactHours:

ANCC=1.0CH/session–7.0CHPossible(includesposters)

ABN=1.2CH/Session–8.4CHPossible(includesposters)

PHARM = 1.2 CH Clinical 3B0.6 CH Ortho B Part 1

Elizabeth A. Morris Clinical Education Sessions-FACES’15–RegistrationForm

Print Name: __________________________________________ ABN License Number: ____________________

Address: ______________________________________________________________________________________

______________________________________________________________________________________________City State ZIP

Credentials: _______________________________________ Day Phone: ______________________________

*Email: _______________________________________________________________________________________*Confirmations by Email Only

ASNA is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

Alabama Board of Nursing (ABNP002) expires March 30, 2017.

Refund/Substitutions:If cancellation is received in writing prior to April 2, 2015, a refund minus a $20 processing fee will be given. After April 2, 2015, no refund will be given. We reserve the right to cancel the program if necessary. A full refund will be made in this event. A $30 return check fee will be charged for all returned checks/payments.

Makecheckpayableto:

Alabama State Nurses Association

MailRegistrationformandfeeto:

ASNA~360N.HullSt.~Montgomery,AL36104

FaxRegistrationformto:

334-262-8578

Onlineregistrationopenuntil11:59PM,April2,2015atwww.alabamanurses.org

Ifunabletoregisterpriorto11:59PM,April2,2015,you may register at door. Please note that you will be

charged a $10 late fee.

*TheoptionallunchofisavailableonlyuntilApril2,2015–it is notavailableafterApril2,2015OR

for at door registrations

Credit Card #: _______________________________________

Exp. Date: _____________________ CVV# ______________

Signature: __________________________________________

FeesifreceivedbyApril2,2015:

( ) $49 ASNA Member( ) $69 Non member( ) $20 Student( ) $45 Presenter ( ) $12.50 *Optional Lunch( ) $0 Presenter Optional Lunch

Amount Enclosed __________________

ConcurrentSessionChoices–Circle Only 1 ClassforEachTimeFrame:

10:00AM 2:40PM

AANS A AANS C

CLINICAL 1A ACADEMIA C

CLINICAL 2A CLINICAL 1C

CLINICAL 3A CLINICAL 2C

CULTUREA CLINICAL3C

ORTHOPEDICA CULTUIREC

VETERAN’S A ORTHOPEDIC C

VETERAN’S C

11:15AM 3:50PM

AANS B AANS D

ACADEMIA B ACADEMIA D

CLINICAL 1B CLINICAL 1D



CULTUREB ORTHOPEDICD

ORTHOPEDIC B VETERAN’S D

VETERANS B

Posterexhibitsavailableforviewingfrom9:00AM–3:40PM

FACES ‘15 continued from page 11

Annual Alabama Chapter E.A.P.A. ConferenceMay 5th-8th, 2015

Phoenix West, Orange Beach, AL“On The Beach”Who Should Attend?

Nurses in Psych, E.D., E.R., E.A.P. setting24 CEU’s applied for Nurses – $300

For more information please call Boyd Scoggins 256-282-6828

Print Brochure, Registration, & Condo Information: www.eapa-al.com

28th


CE Corner

Authoredby: Charlene M. Roberson, MEd, RN- BC, Director of Leadership Services, Alabama State Nurses Association.

Disclosures: Neither the author or planning committee have any conflict of interest.

TargetAudience: All health care workers.

Goal:Review the current status of Leprosy both in the UnitesStatesandworldwide.

Objectives:At the conclusion of this activity the learner should be able to

1. Describe the profile of a patient with Leprosy.2. List the medications used to treat Leprosy.3. Explore the psychosocial implications of having

Leprosy.

Directions:Read the article carefully. Complete the answer sheet and evaluation and send to:

ASNA360 N. Hull StreetMontgomery, Al 36104(fax) 334-262-8758Email scanned documents to: [email protected]

❯ You must score at least 80% for a passing score.Allow 2 weeks after receipt of evaluation and answer sheet in ASNA office for the activity to be posted on the Alabama Board of Nursing transcript.

Accreditation:This activity is provided by the Alabama State Nurses Association, which is an accredited provider of continuing education in nursing by the American Nurses Credentialing Center (ANCC).

Alabama Board of Nursing (exp. 30 March 2017).

ContactHours: 2.5 contact hours (ANCC) and 3.0 contact hours Alabama Board of Nursing.

PharmacologyContactHours: 2.0

Activity is valid through January 20, 2017 ❯ 80% or higher is a passing score.

Cost: ASNA members free and non members $25

Leprosy:TheQuestforWorldwideElimination Continues

Despite the fact that the more appropriate name for Leprosy is Hansen’s Disease few use this term and in this paper Leprosy will be used as it is the better known term. Leprosy had been mentioned in historical documents since the earliest recorded records. The first were in an Egyptian Papyrus document written around 1550 BC. Later, about 600

leprosy: Quest for Worldwide Elimination ContinuesBC Indian writings described a disease resembling Leprosy. Following this after Alexander the Great returned from India documents from Ancient Greece described a Leprosy type disease. And even later similar writings were noted in Roman documents following the return of Pompell’s troops from Asia Minor.

All the way through history this disease has been feared and misunderstood. It was believed to be either hereditary, a curse or punishment from God. Individuals with Leprosy havealwaysbeen shunned,ostracized fromsociety and thishas prevailed even into modern times. In Medieval Europe an individual with Leprosy was made to wear special designated clothing, walk on a particular side of the road depending on the prevailing wind, or ring bells to warn others to remain far away. This disease continues to be one of the most misunderstood of all diseases. The stigma remains worldwide - even today. In many cases the psychological and social stigmas are far more difficult to treat than the disease.

Some basic facts about Leprosy that not everyone acknowledges:

• Leprosyisachronicbacterialdiseasewhichprimarilyaffects the skin, peripheral nerves, and upper airway

• 95%ofthehumanpopulationisimmunetothecausative bacteria

• Treatmentwithstandardantibioticsiseffectiveandinfact patients become non infections after taking only a few doses

• Earlydiagnosisandtreatmentpreventsnervedamageand disability

• IfthereisnonervedamageLeprosyisaminorskindisease

• Treatmentisoftendelayedashealthcareprovidersareunaware of the symptoms

• Itisbelievedthatthereareapproximately7000casesintheUnitedStatesandofthatnumberabouthalfrequire active medical management.

• In1946LeprosypatientsweregiventherighttovoteintheUS

• Everytwominutessomeonearoundtheworldisdiagnosed with Leprosy

Since the mid 1800’s individuals being treated were placed separate hospitals or forced to live in colonies called a leprosarium. In the modern era some individuals cured of the disease have refused to leave the leprosarium due to the never ending social stigma. This is especially true if the diagnosis was made late in the disease course and they had obvious deformities of the nose, fingers or toes. At times entire families would move into the leprosarium even though only one member of the family had Leprosy.

Of note the first modern leprosarium was founded on the island of Molakai (modern day Hawaii) in 1866 and Lepers were forced to live there. The mandatory isolation law was lifted in 1969 and during this time more than 8000 individuals were housed there. In 1894 the Louisiana Leper Home was established in Carville, Louisiana. It became known simply as Carville in 1917 when it became the designated national leprosarium in the United States. Thefirst patients were five men and two women brought in on a barge to an abandoned sugar plantation, located in a bend in the Mississippi River between Baton Rough and New Orleans. The Commonwealth of Massachusetts opened the Penikese Island Leper Colony located on a island off the coast of New Bedford and Woods Hole. Anyone in the state having Leprosy was sent there. It was operational from 1905 - 1921 and during this time 36 people were treated.

In 1873 Dr. Gerhard Henrik Armauer Hansen of Norway identified the cause of Leprosy under a microscope. This intercellular pathogen became known as Mycobacterium leprae. It is a strong acid fast rod shaped bacterium. Other characteristics include parallel sides and a rounded end. It measures 1-8 microns in length and 0.2 - 0.5 microns in diameter. It very much resembles the tubercle bacillus. This bacteria has a 13 day doubling time which is the longest of all known bacteria. Therefore doing laboratory research in vitro is very difficult; therefore, growing the disease for study has proved to be problematic. To solve this scientists most often inoculate the foot pad of a mouse or use an armadillo for research. M. leprae has an affinity for nerve cells and is the only mycobacterium to infect nerve cells. It also thrives on the skin because of skin temperature being slightly lower that the temperature of internal organs.

There are only two known reliable reservoirs for M. leprae. One is humans and the other is the armadillo. Most authorities feel the armadillo is such a great reservoir for the bacteria because of their low body temperatures. They have become the main source of the bacteria for research. Much of this research has occurred at Carville. In Louisiana approximately 5% of armadillos have a naturally occurring clinical disease and about 20% have serologic evidence of some type of infection which has organisms indistinguishable from M. leprae. Individuals handling armadillos rarely, if ever develop Leprosy. Other very rare naturally occurring sources of infection include the African chimpanzee, sootymangabey (old world monkey), and the cynomolgus macaque (crab eating macaque). The M. leprae has been found in biting insects; but no one is absolutely sure if it is transmitted by a bite so questions remain if insects can be vectors. These sources are so rare they are not even considered for research.

Despite all the research, continuing questions remain about mode of transmission - especially in light of the prolonged incubation period of years not days. Scientists have studied insects, infected soil, and animal reservoirs as

Leprosy continued on page 14

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potential modes of transmissions and nothing has proved promising. Almost all scientists believe that Leprosy is spread person to person through respiratory droplet /nasal discharge. The organism can survive outside its human host for hours or even days. There are several types of Leprosy (which will be discussed later in article) and only the lepromatous form is contagious. Of importance is that most individuals are immune to Leprosy. In areas of the world where the disease is widespread many may have a sub clinical form but very few progress to a clinical level which would necessitate treatment. There are two risk groups for contracting Leprosy. The first is living in close contact with a person who has an untreated, active predominately multibacillary Leprosy and others who live in countries with endemic Leprosy.

According to CDC approximately 2 million people are permanently disabled as a result of Leprosy. Countries where it is widespread include the following:

AngolaBrazilCentral African RepublicDemocratic Republic of CongoFederated States of MicronesiaIndiaKiribatiMadagascarMozambiqueRepublic of Marshall IslandsUnitedRepublicofTanzania

Most new cases of Leprosy are located in the following states: California, Florida, Hawaii, Louisiana, Massachusetts, New York, and Texas. The National Hansen’s Disease Program operates ambulatory clinics inArizona, Arkansas,California, Georgia, Illinois, Massachusetts, New York, Puerto Rico, Texas, and Washington. In addition the Hawaii Department of Health operates a separate clinic. The location of these clinics makes seeking specific health care services problematic for many patients, thus non adherence to the treatment plan may be a concern. Another issue is with health care providers, as few have actually cared for individuals with Leprosy so the diagnosis is delayed until more obvious symptoms occur and the possibility of more severe nerve impairment.

The mode of transmission of M. leprae is thought to be respiratory secretions, very similar to tuberculosis. The pathogenesis is not clearly understood. Close physical contact with resulting inoculation through broken skin lesions cannot be ruled out. Nine banded armadillos carry the M. leprae bacillusinthesoutheasternUnitedStatesandit ispresumedthat these animals are the causative agent of new cases in thisarea.However,mostnewcasesofLeprosyintheUnitedStates are immigrants from higher risk areas of the world. At thesametimeitisrecognizedthat95%ofallindividualsareresistant to the bacillus.

Clinical symptoms of Leprosy occur on a continuum. The earliest are so benign and often overlooked until some type of disease eruption occurs. About 90% of patients notice the following progressive losses: numbness, lack of sensation to heat, touch or pain and finally progresses to lack of sensation to deep pressure. Most often the losses are noted on the hands and feet. The first skin symptom is usually a hypopigmented macule.

The various Leprosy types according to the Ridley-Jopling scale are based on clinical, histopathologic and immunologic findings. These types are as follows:

1. Intermediate (IL) - the earliest and mildest form. The person will have a few hypopigmented macules and rarely experience loss of sensation. This type may progress to more severe types. It is believed that if you have a strong immunity the disease may lie dormant without progressing or disappear.

2. Tuberculloid (TT) - The person is seen with large hypopigmented and erythematous macules which experience a loss of sensation resulting in the involved nerves thickening and losing function. They may progress to borderline-type Leprosy and if untreated for many years may progress to Lepromatous Leprosy.

3. Borderline borderline (BB) - The person exhibits numerous cutaneous lesions but they are less well defined as compared to the TT type. This stage may regress, improve, or remain the same.

4. Borderline Lepromatous (BL) - This stage involves many macules as well as papules, plaques, and nodules. There may be multiple “punched-out” appearing lesions which resembele an inverted saucer. There may be a loss of sensation. This disease stage may remain the same, progress, or improve.

5. Lepromatous (LL) - early in the disease process lesions are small, diffuse, and symmetric often having pale macules. Without treatment the disease

progresses to larger and deeper lesions and these lesions contain many bacilli. In the beginning the skin texture does not change and the patient experiences very little loss of sensation. Nerves are not thickened. But with disease progression the eyebrows are lost followed by loss of eye lashes. The next involvement is the trunk although the scalp hair remains. The eyes become involved as evidenced by photosensitivity and decreased visual acuity followed by glaucoma and blindness. In cases where the larynx becomes involved hoarseness will develop. Nasal infiltration will cause a saddle - nose deformity. Edema of legs is a late occurrence. This type of Leprosy cannot convert back to a less severe form tuberculoid type of disease.

NOTE: only BL and LL forms are contagious

The World Health Organization emphasizes that thefollowing symptoms are NOT Leprosy. Skin patches that:

• presentfrombirth(birthmarks)

• thathavenormalfeeling

• itch

• areblack,white,ordarkredincolor

• resemblescalingofskin

• appearordisappearsuddenlyandspreadfast

The examination for Leprosy should be in a well lit room or in daylight. The entire body should be examined for the presence of lesions (and ensure patient privacy). Ask about itching of the patches and if it itches it is not Leprosy. Test several different patches for sensory loss and if there is a definite loss of sensation it is Leprosy. Ask about any treatments in the past for the symptoms. If they have completed a entire course of MDT (standard medication regime) they rarely need more treatment. Evaluate for any deformity of eyes, face, hands or feet. If there is any doubt send to nearest referral center.

Testing for Sensory Loss - First explain the procedure to the patient and provide for privacy. Then take a pointed object such as a pen and lightly touch the skin and ask the patient where they felt the touch. Then ask them to close their eyes and lightly touch the center of the most prominent skin patch and ask them where they felt the pen touch. Repeat the procedure on normal skin and then repeat again on the same patch. If they feel nothing on the skin patch they have Leprosy. They should be started on treatment immediately.

The treatment of Leprosy. Leprosy is curable if treated properly. The treatment protocols depend on the classification. Before treatment starts patient and family/significant other education should include the following:

• Leprosywillbecurediftheytakethemedicationasprescribed

• Themedicationisfreeeverywhereintheworld

• TheyMUSTcompletethefullcourseoftreatmenttobe cured

• Thedrugskeepthediseasefromspreading

• Themedicationsaresafeduringpregnancy

• Theywillleadanormallife-canliveathome,gotoschool, work, play outside, get married, have children, and participate in social activities

• Medication(blisterpacks)mustbekeptinasafe,dry,and shady place

• Keepmedicationoutofreachofchildren

• Ifpillschangecolororarebrokenreturnthemtothehealth center/clinic and they will be replaced with no questions

• Themedicationwillturnurineredandtheskindarkerand once the pills are stopped both urine and skin will return to normal

• GotohealthclinicIMMEDIATELYiftheyhavepain,fever, malaise, new lesions, muscle weakness

• Mustreturnforacheckuponcethepillsarefinished

Leprosy continued from page 13


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If they have disabilities provide patient education. Disabilities include:

A. Eye Care1. Eyes are red, painful, blurring of vision, or

discharge - take aspirin or acetaminophen, if available 1% Atropine drops and steroid ointment, cover eye with pad and go to a hospital if possible.

2. Injury or corneal ulcer - antibiotic ointment, cover eye with a pad and if possible go to the hospital.

B. Hand Care1. Injury while working or cooking - clean wound

and apply dressing, rest if possible, advise to use a cloth when touching hot objects.

2. Dry cracks and fissures - soak hands for 20 minutes every day in water and apply Vaseline or cooking oil regularly.

C. Foot Care1. Dry cracks and fissures - soak feet 20 minutes

every day in water and apply cooking oil/Vaseline regularly.

2. Wear shoes.3. Blisters on sole or between toes - dress blister

with a clean cloth and cover with a clean dressing and advise rest.

4. Ulcerswithoutanydischarge-cleanulcerwithsoap an water and cover with a clean dressing and advise rest

5. Ulcerswithdrainage-cleantheulcerandapplyan antiseptic dressing. Advise rest and if not improved in 4 weeks should go to hospital.

Medication Profile – The treatment of Leprosy is standardized worldwide by theWorld Health Organization.NOTE: The US Public Health Department uses a slightlydifferent treatment regime; however, the medications are the same. This classification depends on the number of patches on the skin. 1-5 patches is classified as paucibacillary (PB) and more than 5 patches is classified as multibacillary (MB) Leprosy. The medication protocols are superimposed on the Ridley-Jopling scale into two distinct multidrug therapy protocols and are as follows:

1. Initially count the number of skin patch in order to classify the type of Leprosy.

2. 1-5 patches is called paucibacillary Leprosy (PB) and the patient is administered 6 blister packs of medications

3. 6+ patches is called multobacillary Leprosy (MB) and the patient is given 12 blister packs

4. Give the first dose in the health center/clinic and show them which drugs are to be taken daily and which one are to be taken monthly

5. Give patient enough blister packs to last until the next visit. Arrange the next appointment and if the patient cannot return to the health center/clinic give them the full course of treatment.

ITISIMPERATIVETHATPATIENTLEAVETHEHEALTHCENTER/CLINICKNOWINGHOWAND

WHENTOTAKETHEMEDICATIONS

The Medications PB Adult treatment:• Day1ofmonthtake2capsulesrifampicin(Rifampin)

300 mg X 2 or 600 mg• Day1ofmonthtakeDapsone100mg• Day2-28ofmonthtakeDapsone100mg• Eachblisterpackwillhaveenoughfor4weeksand

the full treatment course is 6 blister packs or 24 weeks

PB Child treatment:• Day1ofmonthtake2capsulesofRifampin300mg+

150 mg or 450 mg• Day1ofmonthtake1tabaletofDapsone50mg• Day2-28ofmonthtakeDapsone50mg• Eachblisterpackwillhaveenoughfor4weeksand

the full treatment course is 6 blister packs or 24 weeks The dose must be adjusted according to body for

children under 10 years old.

MB Adult treatment:• Day1ofmonthtake2capsulesofRifampin300mg

X 2 or 600 mg • Day1ofmonthtake3capsulesclofazimine

(Lamprene) 100 mg X 3 or 300 mg• Day1ofmonthtakeDapsone100mg• Day2-28ofmonthtake1capsuleofclofazimine• Day2-28ofmonthtake1tabletofDapsone100mg• Eachblisterpackwillhaveenoughfor4weeksand


MB Child treatment:• Day1ofthemonthtake2tabletsofrifampicin300

mg +150 mg or 450 mg

• Day1ofmonthtake3capsulesofclofazimine50mgor 150 mg

• Day1ofmonthtake1tabletdapsone50mg• Day2-28ofmonthtake1capsuleclofazimine

EVERY OTHER DAY 50 mg• Day2-28ofthemonthtake1tabletdapsone50mg• Eachblisterpackwillhaveenoughfor4weeksand


The dose must be adjusted according to body for children under 10 years old.

After treatment has been completed a few patches may still be visible and over time they will disappear. On very rare occasions a new patch may develop and if this occurs the person should return to the health center/clinic for an evaluation.

Disease complications and medication management - The disease course of Leprosy involves some complications. And these complications or reactions are not medication induced rather a natural part of the disease process which are mediated by the medications. The reactions do not mean the established medication profile is ineffective nor the disease process becoming worse. Reactions include the following: current lesions become reddish or swollen; painful reddish nodules appear; peripheral nerves become painful, tender, and swollen; symptoms of nerve damage appear - loss of sensation and/or muscle weakness; fever and malaise; and edema of hands and feet. If these symptoms occur the patient should go immediately to the health center/clinic AND should continue to take the prescribed medications. The patient and care givers need to understand that these reactions require immediate attention and if untreated may lead to deformities. The patient should take aspirin or acetaminophen and rest until treatment for the complications is effective. Several medications are effective. The first usually employed is corticosteroids such as prednisolone. The following is the accepted daily steroid protocol:

• 40mgweeks1and2• 30mgweeks3and4• 20mgweeks5and6• 15mgweeks7and8• 10mgweeks9and10• 5mgweeks11and12 During this process the patient must be examined and

the steroid dose reduced every two weeks.



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Another drug of choice to reduce inflammation is Thalidomide; however, its use is limited to non child bearing women due to teratogenic birth defects.

When discussing drugs in the treatment of Leprosy the Chaulmooga Oil injections must be mentioned. In the early 20 century and until the late 1940’s this was the only treatment available. This herb has some sedative and antipyretic properties; however, it’s effectiveness to mediate the M. leprae is questionable. The oil was given subcutaneous or intravenous. The injections were very painful.

In 1941 promin was successfully developed and used to treat Leprosy and the use Chaulmooga oil ceased. The treatment, although successful in treating Leprosy, required many painful injections.

Again the World Health Organization and U.S. PublicHealth Service do not agree on the exact medication regimes but both agree on the basic antibacterial agents. They are:1. Dapsone is a sulfone and the first antibacterial drug

used against Leprosy. It was developed in the 1950’s and replaced promin as the gold standard treatment for Leprosy. When used as monotherapy resistance develops. The method of action is to prevent folic acid synthesis. It is effective with or without food and has peak concentrations between 2-8 hours. Excretion is via the urine. Individuals with hepatic impairment must be monitored as it has been known to cause hepatitis and cholestatic jaundice. Monitoring is basically all that is done as no dose reductions are published. Initially this drug was used as a monotherapy and resistance developed. Today it is used as a cornerstone of multidrug therapy. Adverse effects do occur. The most serious are methemoglobinemia (hemoglobin can carry oxygen but cannot release effectively to body tissue) and hemolysis related to G6PD deficiency. Ideally the person should be screened for this deficiency before the first dose. If the person has a mild case a reduced dose of dapsone may be administered. This drug is a pregnancy category C drug but is considered safe with pregnant patients. It is freely secreted in breast milk and is potentially harmful to nursing infants with G6PD deficiency. A few adverse symptoms occur - anemia, lymphadenopathy, fever, hepatitis, leukopenia, acute psychosis, and even more rare peripheral neuropathy.


Leprosy continued from page 15 2. Rafampin, another cornerstone in Leprosy treatment isnotrecommendedbytheU.S.FoodandDrugAdministration as a treatment for Leprosy; however, it is given off label by both WHO and the National Hansen’s Diseaseprogram/USPublicHealthService.Despitethe very slow division of the M. leprae bacterium the medication has rapid bactericidal results with success within 3 weeks of the first dose. It is readily absorbed via the GI tract and has a half life of about 3 hours. Rafampin is also a class C pregnancy drug and is readily excreted in breast milk. Despite these facts the American Academy of Pediatrics considers it a safe drug during pregnancy. Resistance develops quickly so Rifampin should only be used in combination therapy - never monotherapy. Most often it is paired with dapsone to prevent resistance to either drug. An expected side effect is the turning of sweat, urine, and tears orange in color; which is reversible when drug is stopped. Contact lenses will also be stained orange. Other unexpected adverse effects are hepatotoxicity, malaise, rash, and occasionally thrombocytopenia. This drug increases the metabolism of dapsone but this is not a factor in Leprosy treatment. It also interacts with prednisone therefore should be reduced from 600mg/day to 600mg/month as long as the person remains on the steroids. It is also contraindicated in the active state of reversal reactions (inflammatory states).

3. Clofazimineisaphenazinedyewhichhasantibacterialproperties very similar to that of dapsone. No one is exactly sure of the exact mechanism of the antibacterial action. Most authorities believe it to be of use during drug reversal (inflammatory states). The drug is taken orally but is not absorbed completely and the absorptions is increased with food. There are two adverse effects - gastrointestinal symptoms and the more troubling is the skin discoloration produced by increased melanin. This results in photosensitivity. The darkened skin does not resolve completely following discontinuation of the medication. The drug is excreted in sweat, tears and urine so those wearing contact lens must be cautioned about the darkening of the lenses. This drug is not commercial availableintheUSbutmaybeobtainedthroughspecialconsent forms/arrangements with FDA.

4. Second line medications are used when there is a clinical failure, resistance, or tolerance to the main line drugs. They are as follows:

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• Fluoroquinolonessuchasmoxifloxacinanditworksmuchlikerifampin.• MinocyclineistheonlytetracyclineeffectiveagainstM.leprae and is used with

single lesion therapy. It should not be use in pregnant women or children because of tooth enamel discoloration. It is not as effective as Rifampin.

• Clarithromycinisusedonlywhentolerancehasdevelopedtootherfrontlinemedication for Leprosy have been used. It is not a s strong as te other medications mentioned above.

Nonadherence to the medications – Despite excellent responses to medication treatment many do not complete the course of treatment or they will take the pills in an non approved manner. Reasons cited almost always reflect culture. Women in general have higher default rates as compared to men. The default rates usually fall into several categories 1.) personal factors, 2.) medical problems, and 3.) health service related issues.

Personal issues include no control over life because of stigma; incorrect beliefs of causation (contacted from dogs, eating fish, living in poverty, eating burned blood, etc.); punishment fromGod; family and friends ostracized them.Medical problems include sideeffects of the medicine (darkening of skin, red urine, edema and other steroid side effects); peripheral nerve involvement often resulting in numbness or pain thus making work problematic; and feeling that the patches are disappearing so they are well so no longer need the medications. Health service issues involve difficulty getting to the Health center/clinic; complaints about the clinic staff behavior; or lack of proper guidance by the staff.

The leprosarium in Carville, Louisiana has now been closed to sequester individuals with Leprosy. Many of the buildings remain and it is now The National Hansen’s Disease Museum. This museum tells the story of patients, health care professionals including the Daughters of Charity, and researchers. Virtual visits of the museum are available and provide interesting insights into the world of Leprosy. It may be accesses at http://www.hrsa.gov/hansensdisease/museum/virtualtours.html#life. These virtual tours are an excellent view into the past in the treatment of Leprosy.

Selected BibliographyAngier, Natalie. 2014. Leprosy, Still Claiming Victims. The New York Times. June 30, 2014.Armadillos and Hansen’s Disease (Leprosy). Center for Disease Control. April 29, 2013Duthie Malcolm S, Balagon Marivic F, Maghanoy Armi, Oracullo Florenda M, Cang Marjorie, Dias Ronaldo F. 2013. Rapid Quantitative Serological Test for Detection of Infection

with Mycobacterium leprae. Am Soc. Microbiology. Dec. 11, 2013.Global leprosy update, 2013; reducing disease burden. Weekly epidemiological record. 2014. WorldHealthOrganization. September 5, 2014Guide to Eliminate Leprosy as a PublicHealth

Problem.WorldHealthOrganization.2000Legendre Davey P, Muzzy Christina A, Swiatlo Edwin. 2012. Current and Future

Pharmacotherapy and Treatment of Disease-related Immunologic Reactions. Pharmacotherapy. 2012;32 (1):27-37 Nolen Leisha, Haberling Dana, Scollard David, Truman Richard, Rodriguez-Lainz, Blum Laura. Blaney David. Incidence of Hansen’s Disease- United States, 1994 - 2011. 2014. Morbidity and Mortality Weekly Report (MMWR).October 31, 2014


Goal: Review current status of Leprosy both in the UnitesStatesandworldwide

Objectives:At the conclusion of the activity, the participant should

be able to:1. Describe the profile of a patient with Leprosy2. List medications used to treat Leprosy3. Explore the psychosocial implications of having

Leprosy

PostTestSelect one correct answer and place on evaluation.

1. Leprosy is a minor skin disease if there is NO nerve damage.A. TrueB. False

2. The Mycobacterium leprae has brief doubling time.A. TrueB. False

3. Leprosy is spread by droplet /nasal discharge secretions from an infected person.A. TrueB. False

4. The early stages of Leprosy are usually painful.A. TrueB. False

5. Some types of Leprosy may spontaneously heal or disappear.A. TrueB. False

6. Leprosy skin patches sometimes itch.A. TrueB. False

7. The orange urine noted when taking Rifampin returns to normal after the drug is discontinued. A. TrueB. False

8. Multobacillary Leprosy (MB) is treated for only 24 weeks.A. TrueB. False

9. During treatment if the lesions become reddish or swollen the medication should temporarily be discontinued.A. TrueB. False

10. Dapsone should ONLY be taken on an empty stomach.A. TrueB. False

Leprosy:TheQuestforWorldwideEliminationContinues

2.5contacthours(ANCC)and3.0contacthours(ABN)and2.0Pharmacologyhours

Activity#:4-0.972ANSWERSHEET

Name: _______________________________________________ Fee and Payment Method

Address: _____________________________________________ _____ ASNA Member free

_____________________________________________________ _____ Non Member $25 City/State/Zip

Phone: ____________________ Email: ___________________________________ ABN License # _____________ Check - Make Payable to ASNA _____Visa _____ M/C ____ Exp. Date CC Security Code ___________

____________________________________________ ____________________________________________ Card Number Signature

POST TEST ANSWER SHEET:

1. A B 6. A B2. A B 7. A B3. A B 8. A B4. A B 9. A B5. A B 10. A B

ACTIVITYEVALUATION

GOAL:ReviewcurrentstatusofLeprosybothintheUnitesStatesandworldwideCircle your response using this scale: 3 – Yes 2 – Somewhat 1 – No

Rate the relationship of the objectives to the goal of the activity 3 2 1Rate your achievement of the objectives for the activity 3 2 1

Objectives:1. Describe the profile of a patient with Leprosy. 3 2 12. List medications used to treat Leprosy. 3 2 13. Explore the psychosocial implications of having Leprosy 3 2 1Program free of commercial bias 3 2 1On a scale of 1 (low) – 5 (high) knowledge of topic before home-study 5 4 3 2 1On a scale of 1 (low) – 5 (high) knowledge of topic after home-study 5 4 3 2 1

How much time did it take you to complete the activity? _______ hours ______ minutes.

ADDITIONAL COMMENTS:________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Complete form and return to: ASNA, 360 N. Hull St., Montgomery, AL 36104If paying by credit card, may fax to 334-262-8578



Membership News

If you are willing to serve, please indicate your choice(s) on this form and return it to the ASNA office.

STANDINGCOMMITTEES SPECIALCOMMITTEES

___ Committee on Governance ____ Committee on Awards

___ Committee on Membership ____ Committee on Convention

___ Committee on Finance ____ Committee on Ethics & Human Rights

___ *Committee on Continuing Education ____ Committee on Legislative

* Appointed by each District Board of Directors

Name _________________________________________ Credentials _______________

Address ________________________________________________________________

City, State & Zip _________________________________________________________

Home Phone _________________________Work Phone _________________________

Fax: ___________________________e-mail: __________________________________

District ___________

Meetings may be held at the ASNA office, virtual (online) or by telephone conference.

BE AN ACTIVE MEMBER!ServeonanASNACommitteefor2015-2016


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