Dear Parish Nurse - fall is upon us with the promise of school and football! It is mind boggling how fast my grandchildren are growing up - I don't remember that is was this fast when I was 13! Mental health is an issue that ELPNA has been concerned about this year. Resources have been added to our web site to keep you up-to-date, There have been several studies published recently that have focused on mental health.
1. Suicide and self-harm by youth are on the rise as indicated by two research studies. In one study by the CDC, non-fatal self-inflicted injuries coming to the emergency room were investigated. The subjects were placed in three age groups, 10-14, 15-19, 20-24. Results indicated that although the trends for such injuries among boys remained relatively stable, the age-adjusted rated for girls increased 8.4% from 2009 to 2015. But in the youngest group of girls, the increase was 18.8% per year from 109.9 per 100,000 population in 2009 to 317.7% in 2015. The increases for girls in the two older age groups were much less. The other study examined changes over time in the rates of suicidal ideation and suicide attempts seen in the EDs. Information came from 49 US Children's hospitals and included ED visits/encounters, "observation stays" and in-patient hospitalizations in children and adolescents ages 5 to 17 over a 7 year period. The annual percentage of all visits for suicidal ideation and suicide attempts nearly tripled, increasing from 0.66% in 2008 to 1.82% in 2015. Significant increases were seen in all age groups but were higher in adolescents 15-17, 12-14 years of age. While increases were significant for both genders, girls has a greater increase.
These two studies provide parish nurses much need information for their practice. The findings of both indicate that mental health disorders in youth have an increasing impact on children's hospital services and community programs. Both articles underscored the need for evidence-based, comprehensive suicide/self-harm preventions for youth - So how can congregations help? What about educational programs for teens that teach coping and problem solving skills? Programs for parents in identifying and supporting at risk children/teens? Community discussions about meeting all children's mental health needs? Encouraging school programs addressing bullying? Teaching parents listening skills? The list could go on . . . Think about what you can do this fall to help the at-risk youth in your congregation.
2. Fischer-Cartlidge, E., et al. (2018). Breast cancer screening: A review of current guidelines. AJN, 118 (7), 34-41. While this article is not totally research, the authors provide updates on breast cancer screening that may impact members of your congregation. The recommendations from three different entities were compared, American Cancer Society, the US Preventive Services Task Force, and the National Comprehensive Cancer Network. The authors discuss the controversies surrounding mammography. While the three entities differ on their recommendation for mammography screening in women at average risk, they are consistent on their suggestions for women at moderate or high risk for breast cancer. This article is well written and provides information to health care professionals involved in supporting and educating women.
Parish nurses, this would be an excellent article to read for updating your own knowledge and in educating women in your congregation who may be at high risk of breast cancer.
3. Three articles were reviewed in the AJN dealing with medications and older adults. The authors of the first article (July, 2018) on fall risk in older adults pointed out that medication use is prevalent in older adults with over 1/3 of this age group taking five or more medications daily. In this mix, more than 1/2 of all older adults use at least one medication whose adverse effects are linked to falls. As a result of this, the CDC has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to guide nurses in the screening, assessing, and intervening aimed as reducing falls in the elderly. This guide is available from the CDC web page (www.cdc.gov/steadi). The authors suggest that nurses play an important role in reducing older adults fall risk by identifying medications that are associated with increase fall risk. The second article (May, 2018) reported that nursing homes are overmedicating people with dementia. The authors suggest that the laws against "chemical restraints" are not being enforced. The report is based on visits by researchers to 109 nursing facilities in six states during 2016 and 2017; interviews with residents, families, staff, and advocates; and review of studies, regulations, and government reports. Reasons given for this finding are inadequately trained and insufficient staff. The authors point out that referenced studies show that use of antipsychotic drugs almost double the risk of death in older patiens with dementia and suggest that non-pharmacological behavior modifications should be used before adding antipsychotic medications. The third article (July, 2018) suggests that nurses play a key role in confirming that people are prescribed the appropriate medications. The authors focus on the Beers Criteria for Potentially Inappropriate Medications Use in Older Adults, which is an evidence-based list of medications generally considered inappropriate for use in older patients. The assessment conducted by nurses is key to recognizing potential medications that might not be appropriate for the person. In addition to checking that the drug matches the person's diagnosis, the nurse looks at the person's age, height and weight, comorbidities, and other medications both prescription and over the counter. This assessment guides the nurse in providing education to the person on drug therapy. The Beers Criteria is available free of charge on the American Geriatrics Society website at www.americangeriatrics.org.
These studies provide excellent information for the parish nurse who works in a congregation with numerous older adults. Medications are important for the health of the individual but may also be the source of harm. Those of you who conduct "Medication Sunday" may want to obtain a copy of the Beers Criteria.
If you have specific questions about research, I would be happy to help you explore the answers. Research helps us move forward in providing the best possible care to those whose lives we impact.
Andrea West, FCN