MVC-AACN NEWSLETTER
Spring 2013
Boston Welcomes NTI in
May!
Our Chapter is one of the three
local Chapters who will be hosting the
Chapter Booth at NTI in Boston this
year! Thank you to all the Chapter
members who have volunteered two
hours of time to hand out ribbons and
welcome NTI attendees to Boston!
If you have never been to NTI
before this is your chance to attend this
event close to home! Attending even
one day of the 4-day celebration is
inspiring and motivating. You owe it to
yourself as a critical care RN to
experience NTI!
The 4 day event runs from May
20th - 23rd with classes being offered on
May 18th and 19th as well. To find out
more about NTI in Boston go to:
http://www.aacn.org/dm/nti/ntihome.asp
x?selnti=nti2013&menu=nti2013.
Chapter Celebrations at NTI:
Linda McGowan, ICU Nurse
Manager at Winchester Hospital, will be
receiving the AACN 2013 Circle of
Excellence Award! This award will be
presented at NTI on Monday, May 20th
during the Super Session! Please be
sure to cheer for our Chapter member
and deserving recipient of this honor!
Congratulations Linda!!
Lowell General Hospital’s ICU
will also be honored at NTI on Monday
for earning the AACN Beacon Award!
The ICU at LGH is only the 7th critical
care unit in Massachusetts to earn this
distinction and the first community
hospital ICU. Congratulations to the ICU
team at Lowell General!
Don’t forget as a Chapter member you can get a $75 rebate from AACN if you attend all
4 days of NTI. Simply fill out the form on-line at:
http://www.aacn.org/wd/chapters/content/nti-chapter-rebate.pcms?menu=chapters
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It’s All In Your Head:
Getting AHEAD In
Neuroscience Nursing
Featuring:
SCHEDULE:
7:30 - Registration/Continental
Breakfast
8:00 – Navigating the Brain/Spine:
Mary Kay Bader
Integrating Neuroanatomy and
RN MSN CCNS CCRN CNRN
Neuroassessment
9:15 – Break
April 23, 2013
9:45 – Time is Brain: Care of the
Ischemic Stroke Patient
8:00 AM – 4:00 PM
11:00 – It’s Complicated:
Westford Regency
Hemorrhagic Stroke
Inn & Conference Center
12:00 - Lunch (buffet lunch included)
219 Littleton Road
Westford, MA
1:00 – Cold as Ice: Therapeutic
Temperature Management in
HACA and Neurologic Disorders
2:30 – Break
FOR MORE INFORMATION:
2:45 – Head Injuries in the Emergency
Diane Meagher 978-455-4167 or
Department: Wrapping Your
Email: dianemeagher@comcast.net
Brain Around It
3:45 - Questions, wrap-up, evaluations
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and suicide. She described trauma as the
killer of the future, as ages 15-24 are at the
greatest risk, and more than 75% are male.
She referred to this loss of productivity in
terms of economic loss.
Next she discussed trauma systems
beginning with a historical perspective. In
1966, the National Academy of Sciences
published Accidental Death and Disability:
Program Review
Trauma: At the Scene & Beyond
by Diane Meagher BSN, RN, CCRN
The Neglected Disease of Modern
Society (http://www.ems.gov/pdf/1997ReproductionAccidentalDeathDissability.pdf). This
publication recognized trauma as a disease
entity worthy of specialized study and
On November 13, 2012 we held our fall
program, Trauma: At the Scene & Beyond at
the Westford Regency Inn & Conference
Center. Trauma has been a frequently
requested topic by previous program
participants, who have also expressed that
they enjoy multiple speakers presenting a
development of trauma specific treatment,
rehabilitation, and prevention measures. It
“resulted in the implementation of a system
of care for the seriously injured in most
states and within the US military”
(http://www.ncbi.nlm.nih.gov/pubmed/2285
0159).
variety of content. So that is how we
In 1973 Dr. Cowley coined the phrase,
planned this program.
“golden hour,” when the initiation of care
The first speaker of the day was Vanessa
Barrett RN BSN CEN, Trauma Program
Coordinator at Lowell General Hospital.
Vanessa began her presentation by stating
that trauma is preventable. She described
the magnitude of the problem –
unintentional injury is the leading cause of
death in the U.S. for ages 1-44
(www.cdc.gov/traumacare). Unintentional
injury includes motor vehicle accidents, falls
burns, sport related injury and drowning.
Intentional injury includes homicide, assault
within the first hour post injury gave
patients the best chance for an optimal
outcome and increased probability of
survival. “It is well established that the
patient's chances of survival are greatest if
they receive care within a short period of
time after a severe injury; however, there is
no evidence to suggest that survival rates
drop off after 60 minutes. Some have come
to use the term to refer to the core principle
of rapid intervention in trauma cases, rather
than the narrow meaning of a critical onehour time period”
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(http://en.wikipedia.org/wiki/Golden_hour_(
medicine)). In fact, “the pressure to arrive at
the hospital within the Golden Hour may
increase the number of emergent
transports, which have been demonstrated
to increase the risk for collisions resulting in
injury and fatality”
(http://www.emsworld.com/article/1073233
7/rethinking-the-golden-hour-oftrauma?page=2). Vanessa further described
trauma care within a trauma system,
including the EMS system and trauma
center level designations, as well as specifics
about the Massachusetts trauma system.
D-isability (neurologic status)
E-xposure/environment control
F-ull set of vital signs/focused adjuncts
G-ive comfort measures
H-istory and Head to toe
I-nspect posterior surfaces
The primary assessment consists of A
through E and interventions to correct any
life threatening conditions must be
performed before further assessment is
continued. The secondary assessment
Next she described the role and
consists of F through I. Finally she shared a
responsibility of the trauma nurse, and the
few case studies and points to ponder. She
education and skills required including
ended her presentation as she began it, “the
certifications in: TNCC (Trauma Nurse Core
cycle begins and ends with PREVENTION!!!!”
Course), ENPC (Emergency Nurse Pediatric
Course), PALS (Pediatric Advanced Life
Support), and ACLS (Advanced Cardiac Life
Support). She described a multidisciplinary
trauma team, including ancillary department
notification in advance of patient arrival and
potential need for services to facilitate
response time. Resource and equipment
needs should be anticipated based on the
mechanism of injury. She described a
systematic, standardized approach to the
assessment and management of the trauma
patient:
The second speaker was Sandi Mackey RN
BSN, Trauma Program Coordinator at Lahey
Clinic, and she presented, “Geriatric Trauma:
The New Older Face of Trauma.” She offered
several definitions of elderly: greater than 65
years according to the CDC (Centers for
Disease Control); chronological age as the
actual number of years lived; and
physiologic age as the actual functional
capacity of patient’s organ systems. Trauma
is the seventh leading cause of death in
persons >65 years. Falls are the leading
cause of “accidental” trauma in the geriatric
A-irway w/ simultaneous cervical spine
population. More than one-third of all
protection
health care dollars go to care for the elderly.
B-reathing
C-irculation
Older adults are less likely to be injured than
young adults but more likely to die as a
result of their injuries combined with their
preexisting conditions. The leading
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mechanisms of injury in the geriatric patient
despite worse outcomes in geriatric trauma
are falls (falls from standing, stairs,
patients compared to their younger
commode, furniture), motor vehicle crashes
counterparts (likely due to a higher
(driver and passenger), motor vehicle vs
preponderance of co-morbidities as well as
pedestrian, assault, burns and suicide.
reduced physiologic reserve), age should
Sandi went on to identify age related
physiologic changes, system by system, that
impact mortality and morbidity in the
geriatric trauma population. Nursing
management of the geriatric trauma patient
should include DVT (deep vein thrombosis)
prophylaxis, prevention of common
not be used as the sole criteria for limiting
care as the majority of geriatric patients will
return home and as many as 63-85% will
return to independent function. Injury
prevention is as important as any
resuscitative effort we provide. And finally –
we will all be there someday…
complications (pneumonia, catheter-
Our next speaker after lunch was Partick
associated urinary tract infection, decubitus
Brophy MD, a colonel in the U.S. Army
ulcers, delirium), stress ulcer prophylaxis,
Reserve Medical Corps, and
early mobilization with PT/OT, and
general/oncology surgeon at Winchester
anticipation of age related complications.
Hospital, and he presented, “Health Care in
Next she focused on injury prevention, and
much like the first speaker, she stated,
“PREVENTION is key.” Opportunities for
injury prevention include safe environment
(rugs, cords, lighting, etc.), home
modifications (tubs, rails, etc.), hearing and
vision check-ups, medications, alcohol,
driving safety, not driving, and strength and
balance therapy. The driving issue is a hot
topic and she offered the following options:
driver rehabilitation programs; Mass RMV:
Request for Medical Evaluation form; backup plan for transportation; access to
public/private transportation.
Sandi also identified other considerations:
Health Care Proxy; DNR/DNI/CMO; futile
care; palliative care; early and often family
meetings; and discharge planning: home,
SNF, LTAC, acute rehab. She concluded that,
Areas of Conflict.” Dr. Brophy described
deployment experiences in multiple areas of
conflict, including the Balkans, Kuwait,
Africa, Iraq and Afghanistan. He described
the local health care systems and the
breakdown of these systems during conflict.
He identified the systems in each area in
terms of First, Second or Third World levels
– even Stone Age level for Afghanistan,
which was Second World level prior. Some
systems remained intact, but were limited or
antiquated to begin with; others were
minimally intact.
Providers were present in some areas, but
limited in experience or out of date; others
had current training but were displaced,
dispersed or transient. Care was limited in
all areas. Reconstruction varied from area to
area. He identified security as an issue in
Iraq, and a huge issue in Afghanistan.
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Cultural issues are also significant. Health
health care education for the registered
care isn’t just about humans – animals are a
nurse in the scientific investigation and
symbol of wealth and a basic need for
treatment of trauma and/or death related
survival.
medico-legal issues.” Elizabeth reviewed the
Acute interventions are the only feasible
techniques available in most cases, as longterm management is limited by access to
providers and treatments, including
medications. Also the societies involved may
not want to devote resources to chronic
care.
The US military takes care of its own;
provides medical support to Coalition
Forces, provides care to anyone we
injure/detain; provide “life, limb or eyesight
saving” care; and support NGOs in
providing care. He described many medical
threats in these areas, including malaria, TB,
snake bites, and anthrax, as well as the
threat of weapons. Ultimately, Dr. Brophy
illustrated the medical capabilities of our
military to deliver state of the art care in
austere environments.
Our next speaker was Yvonne Michaud RN
MS, Trauma Program Manager at Brigham
and Women’s Hospital, and she presented,
“Post Resuscitation Care for Nurses.” Yvonne
used a case study of Abraham Lincoln to
history of forensic nursing, recognized in the
U.S. as a nursing specialty in 1995. She
identified various roles of a forensic nurse,
including medico-legal consultant, nurse
attorney and expert witness, and she
described the scope of forensic nursing
practice. She discussed legislative issues that
impact forensic nurses, e.g. the Violence
Against Women Act. She described various
academic avenues to expanding knowledge
in a forensic arena – Masters level forensic
science degree, post-masters certificate
programs, SANE (Sexual Assault Nurse
Examiner) certification, Nurse Death
Investigator course, and nurse legal
consultant certification.
Next she described the living forensic
population – “survivors of criminal or
liability-related injuries that result in an
investigation by a legal agency” (Lynch,
1995). This population includes sexual
assault victims, victims of domestic violence,
child abuse victims, elder abuse victims,
victims of workplace violence, refugees
seeking asylum from violence, and
elucidate her objectives.
individuals with disabilities. “There is no one
Last, but not least, the final speaker of the
patient – it could be anyone!” Clinical
day was Elizabeth Henderson RN MSN,
Staff/Access Nurse in the Emergency
Department at Mass. General Hospital, and
she presented “Clinical Forensic Nursing.”
Forensic pertains to law; forensic nursing is
“the application of the forensic aspects of
definition of what constitutes a forensic
practice issues include physical evidence
collection as well as non-physical evidence
collection (photographs, narrative of
assault), meticulous documentation, and
crisis intervention support. Physical evidence
includes “anything that has been used, left,
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removed, altered or contaminated during
the commission of a crime by either the
suspect or victim” (Mund, 1996) – clothing,
The Chapter Christmas
Party at the Nesmith House
duct tape, hair, fibers, jewelry, fingerprints.
in December was a Big
She described the rigorous process of
Success! Fun was had by all
collecting and preserving evidence, and
maintaining the chain of custody.
Documentation provides: evidence that
who attended! There was
good food and good friends,
something is done or not done, exists or
along with many toys
doesn’t exist; protection for the nurse
collected for Toys for Tots!
(breach in standard of care); evidence for
the client; and testimony for the court.
Documentation might be the only tangible
Some of the photos of the
event are included here:
item the jury has for evaluation! Elizabeth
ended her presentation with a discussion of
crisis intervention.
All in all it was a good day. The
amphitheater is always a great venue for our
programs, and the food is always excellent.
We also had nine exhibitors sharing
information about their products with
participants, and providing financial support
for the program.
Chapter President Eileen S. with Toys
for Tots donations
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More Christmas Party Photos!
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Newsletter Information:
Chapter Newsletters are produced twice a
year (spring and fall) and are e-mailed to all
Chapter members who have provided a valid
e-mail address. If you know a Chapter
member who has not received this
newsletter please e-mail Valerie at the
address below with the correct e-mail
information and one will be sent.
Be sure to enjoy NTI in
Boston!
Also if anyone has requests for future
newsletter topics or if you would like to
submit an article for the next Chapter
Newsletter please e-mail Valerie at the email address below.
Chapter Newsletter design by:
Valerie.fernald@lowellgeneral.org.
(Photo courtesy of aacn.org)
Feel free to contact any of the Chapter
Board Members with ideas or suggestions as
well –
President – Eileen Scondras
President-Elect – Chrissy Cebollero
Past President – Judi Gettings
For more information on NTI be sure to
go to:
http://www.aacn.org/dm/nti/ntihome.asp
x?selnti=nti2013&menu=nti2013
Or download the NTI brochure at:
http://www.aacn.org/wd/nti/nti2013/docs/
nti-2013-brochure.pdf
Treasurer – Sue Ouellette
Secretary – Sue Wheeler
Scholarship – Sue Sadowski
Membership – Ellen Stokinger
Horizons – Michele Woonton
Website – Chrissy Cebollero
Programs – Diane Meagher
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