AMERICAN NURSE O FFICIAL J OURNAL An Publication February 2020 Volume 15 • Number 2 MyAmericanNurse.com Paternal postpartum depression Use a nursing skills bundle to prevent hospital- acquired pneumonia Strangulation and intimate partner violence Shared decision making and patient-centered care CNENOMINATE A STAR NURSE TODAY! 2020 is the Year of the Nurse and as part of this global initiative, ANA is working to advance nurses’ vital position in transforming healthcare. The Washington Post, in partnership with the American Nurses Association (ANA), proudly presents Star Nurses, a new nurse-recognition event that will honor leading registered nurses — the best of the best — in the Greater Washington (DMV) area. DO YOU KNOW A STAR NURSE? Star Nurses recognizes and celebrates registered nurses practicing in Maryland, Virginia, and the District of Columbia who are nominated by patients, patient family members, peers, or members of the community for demonstrating nursing excellence. LEARN MORE AND NOMINATE A STAR NURSE TODAY! starnurses.org Winners will be announced at a live event on May 12, 2020, the 200th anniversary of Florence Nightingale’s birth during ANA’s National Nurses Month celebration. Tickets go on sale in March. Learn more at starnurses.org SAVE THE DATEMyAmericanNurse.com February 2020 American Nurse Journal 1 Editor-in-Chief Lillee Smith Gelinas, MSN, RN, CPPS, FAAN Senior Fellow and Nurse Executive, Institute for Patient Safety University of North Texas Health Science Center, Fort Worth, Tex. Editorial Board AMERICAN NURSE O FFICIAL J OURNAL Editorial mission: American Nurse Journal is dedicated to integrating the art and science of nursing. It provides a voice for today’s nurses in all specialties and practice settings. As the official journal of the American Nurses Associ- ation, it serves as an important and influential voice for nurses across the country. The journal is committed to de- livering authoritative research translated into practical, evidence-based literature and relevant content to keep nurses up-to-date on best practices, help them maximize patient outcomes, advance their careers, and enhance their pro- fessional and personal growth and fulfillment. E DITOR E MERITUS Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN Research Associate Professor Sadie Heath Cabaniss Professor and Dean University of Virginia School of Nursing Charlottesville, VA Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN President (2018-2020), Case Management Society of America 12th President (2012-2014), National Association of Hispanic Nurses Director, Care Management, UC Irvine Health Orange, CA Danielle (Dani) Bowie, DNP, RN, NE-BC Vice President of Nursing Workforce Development Bon Secours Mercy Health Cincinnati, OH Thomas R. Clancy, PhD, MBA, RN, FAAN Clinical Professor, School of Nursing University of Minnesota Minneapolis Danette Culver, MSN, APRN, ACNS-BC, CCRN-K, RN-BC Clinical Nurse Specialist Norton Healthcare Louisville, KY Amina Dubuisson, MSN, RN, MBA/HCM, LNHA Regional Director of Clinical Operations Greystone Health Tampa, FL Michael L. Evans, PhD, RN, NEA-BC, FACHE, FAAN Dean and Professor Texas Tech University Health Sciences Center School of Nursing Lubbock, TX Margaret A. Fitzgerald, DNP, APRN, BC, NP-C, FAANP, CSP President, Fitzgerald Health Education Associates, Inc. North Andover, Mass. FNP, Adjunct Faculty, Family Practice Residency Greater Lawrence Family Health Center, Inc. Greater Lawrence, MA Melissa A. Fitzpatrick, MSN, RN, FAAN Chief Operating Officer Kirby Bates Associates Chapel Hill, NC Christine Hedges, PhD, RN, NE-BC Director of Nursing Quality and Research University of North Carolina Hospitals Chapel Hill, NC Tiffany Kelley, PhD, MBA, RN-BC DeLuca Foundation Visiting Professor for Innovation & New Knowledge UCONN School of Nursing Storrs, CT Founder/CEO Nightingale Apps & iCare Nursing Solutions Boston, MA Linda J. Knodel MHA, MSN, NE-BC, CPHQ, FACHE, FAAN Senior Vice President/Chief Nurse Executive Kaiser Permanente Oakland, CA Eileen T. Lake, PhD, RN, FAAN Jessie M. Scott Endowed Term Chair in Nursing and Health Policy Professor of Nursing and Sociology Associate Director, Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing Philadelphia Norma M. Lang, PhD, RN, FRCN, FAAN Professor and Dean Emeritus School of Nursing University of Pennsylvania, Philadelphia Wisconsin Regent Distinguished Professor and Aurora Professor of Health Care Quality and Informatics Professor Emerita College of Nursing University of Wisconsin, Milwaukee Tina Marrelli, MSN, MA, RN, FAAN Marrelli and Associates, Inc. Health Care Consultants and Publishers e-Caregiving Solutions Venice, FL Bernadette Mazurek Melnyk, PhD, RN, CRNP, FAANP, FNAP, FAAN Vice President for Health Promotion University Chief Wellness Officer Dean and Professor, College of Nursing Professor of Pediatrics & Psychiatry, College of Medicine The Ohio State University Columbus Sally Miller, PhD, APRN, FNP-BC, AGACNP-BC, AGPCNP- BC, PMHNP-BC, FAANP Associate Professor, Associate Dean for Graduate Affairs University of Nevada Las Vegas Las Vegas, NV Jack Needleman, PhD, FAAN Fred W. and Pamela K. Wasserman Professor Chair, Department of Health Policy and Management UCLA Fielding School of Public Health Los Angeles Christine Pabico, MSN, RN, NE-BC Director, Pathway to Excellence Program American Nurses Credentialing Center Silver Spring, MD Rebecca M. Patton, DNP, RN, CNOR, FAAN Former President, American Nurses Association Lucy Jo Atkinson Professorship in Perioperative Nursing Frances Payne Bolton School of Nursing at Case Western Reserve University Cleveland, OH Mark Pelletier MS, RN Chief Operating Officer Chief Nurse Executive The Joint Commission Oakbrook Terrace, IL Joseph Potts, MSN, RN Assistant Nurse Manager, Resource Pool Northeast Georgia Medical Center Gainesville, GA Staci Reynolds PhD, RN, ACNS-BC, CCRN, CNRN, SCRN Assistant Clinical Professor/DANCE Coordinator Duke University School of Nursing Infection Prevention Clinical Nurse Specialist Duke University Hospital Durham, NC Stephanie Schulte, MLIS Associate Professor, Health Sciences Library The Ohio State University, Health Sciences Library Columbus Franklin A. Shaffer, EdD, RN, FAAN Chief Executive Officer CGFNS International Philadelphia, PA Roy L. Simpson, DNP, RN, DPNAP, FAAN, FACMI Clinical Professor, Assistant Dean for Technology Management Nell Hodgson Woodruff School of Nursing Emory University Atlanta, GA Marla J. Weston, PhD, RN, FAAN CEO Weston Consulting, LLC Washington, DC February 2020 • Volume 15 • Number 2 MyAmericanNurse.com Editorial Staff Editor-in-Chief Lillee Smith Gelinas, MSN, RN, FAAN Executive Editor, Professional Outreach Leah Curtin, RN, ScD(h), FAAN Editorial Director Cynthia Saver, MS, RN Managing Editor Julie Cullen Copy Editor Jane Benner Publishing Staff Group Publisher Gregory P. Osborne Executive Vice President Steve Ennen Director of Professional Partnerships Tyra London Account Managers Mary Chris Schueren, Cara Sosnoski, John J. Travaline 215-489-7000 Production Director Christian Evans Gartley Art Director David Beverage Designer Christy Carmody American Nurses Association Staff Joan Hurwitz Vice President, Communications Susa McCutcheon Editorial Director, Communications Susan Trossman, RN Writer-Editor, Communications P UBLISHED BY HealthCom Media 259 Veterans Lane, Doylestown, PA 18901 Telephone: 215-489-7000 www.healthcommedia.com Chief Executive Officer Gregory P. Osborne Executive Vice President Steve Ennen Finance Director/Operations MaryAnn Fosbenner Business Manager Jennifer Felzer Marketing Manager Jessica Lockhart Project Manager Meredith Haywood Website Developer Brian Jones Digital Content Editor Lydia L. Kim Audience Engagement Manager Michelle Welliver Database Administrator Parvathi Bellamkonda American Nurse Journal is the official journal of the American Nurses Association, 8515 Georgia Avenue, Suite 400, Silver Spring, MD 20910-3492; 800-274-4ANA. The journal is owned and published by HealthCom Media. American Nurse Journal is peer reviewed. The views and opinions expressed in the editorial and advertising material in this issue are those of the authors and advertisers and do not necessarily reflect the opinions or recommendations of the ANA, the Editorial Advi- sory Board members, or the Publisher, Editors, and staff of American Nurse Journal. American Nurse Journal attempts to select authors who are knowledgeable in their fields. However, it does not warrant the expertise of any author, nor is it responsible for any statements made by any author. Certain statements about the uses, dosages, efficacy, and characteristics of some drugs mentioned here reflect the opinions or investigational experience of the au- thors. Nurses should not use any procedures, medications, or other courses of diagnosis or treatment discussed or suggested by authors without evaluating the patient’s conditions and pos- sible contraindications or dangers in use, reviewing any appli- cable manufacturer’s prescribing or usage information, and comparing these with recommendations of other authorities. Edited, designed, & printed in the USA AMERICAN NURSE O FFICIAL J OURNAL 2 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com 4 Editorial By Lillee Gelinas, Editor-in-Chief Why are nurse practitioners still referred to as “mid- level”? The term is outdated and misleading. 6 Paternal postpartum depression By Nicole Altenau Depression in men after the birth of a child is more common than you may realize. Learn how to assess for, treat, and prevent the condition. 16 CNE Preventing hospital-acquired pneumonia By Carolyn D. Meehan and Catherine McKenna A nursing skills bundle can reduce the incidence of hospital-acquired pneumonia. 24 Strangulation: A silent but deadly form of intimate partner violence By Jessica McCarthy and Denise Stagg Do you know how to identify strangulation in a victim of intimate partner violence when there are no visible signs or symptoms? R APID R ESPONSE 22 Wound dehiscence By Wendy R. Downey When you detect and report warning signs you can save a life. 42 Ultrasound-guided I.V. catheter insertion By Carrie A. Cromwell and Alice L. March Using ultrasound for short peripheral catheter insertion can reduce discomfort for patients with difficult venous access and ease nurse frustration. W EB EXCLUSIVE ! Drugs and devices today An update of drug news, including alerts, approvals, and removals, at myamericannurse.com/article-type/ drugs-and-devices/ . 14 Engaging and advocating By Ernest J. Grant Your political engagement can help ensure quality patient care and advance the nursing profession. 41 Key components for optimal staffing By Kendra McMillan Appropriate staffing is integral to patient and nurse safety. 45 Shared decision making and patient- centered care By Christy L. Skelly, Carrie Ann Hall, and Carrie R. Risher Engage patients in healthcare decisions to improve outcomes, care quality, and patient satisfaction. W EB EXCLUSIVE ! What works: Developing a mentor program to improve support and retention By Emily Glassman An informal mentor program can help ease novice nurses’ transition into practice. myamericannurse.com/?p=64426 F ROM W HERE I S TAND 48 Moral space By Leah Curtin The real discussions of living and dying are happening on hospital units by those who are most familiar with the ramifications. American Nurse Journal (ISSN 1930-5583 [print], ISSN 2162-8629 [online]) is published monthly by HealthCom Media, Lantern Hill Business Park, 259 Veterans Lane, Suite 201, Doylestown, PA 18901. Printed in the U.S.A. Copyright © 2020 by HealthCom Media. All rights re- served. No part of this publication may be reproduced, stored, or transmitted in any form or by any means, elec- tronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without per- mission in writing from the copyright holder. Periodicals Postage paid at Doylestown, PA and additional offices. Postmaster: Send address changes to American Nurse Journal, Lantern Hill Business Park, 259 Veterans Lane, Suite 201, Doylestown, PA 18901. Subscription information: Annual subscriptions: $49.00 U.S.; $59.00 Canada; $71.00 outside U.S./Canada. Single copies: $7 U.S.; $15 outside U.S. Institutional subscriptions available by request. Digital-only subscription: $14.97. Reprints and back issues: Contact Chris Evans Gartley (Pro- duction Director) at 215-489-7000 or production@healthcom media.com. Availability may be limited. February 2020 • Volume 15 • Number 2 MyAmericanNurse.com STRICTLY CLINICAL PRACTICE MATTERS FEATURES EDITORIAL W EB EXCLUSIVE ! Take note A round-up of clinical and practice news and alerts at myamericannurse.com/article-type/take-note-practice- updates/. 33 Learn about the top issues facing ANA member nurses, how ANA is working for you, and what ANA is doing to advance nursing. F EATURE ARTICLE : Innovation 10 Cybersecurity awareness By Marti Jordan Learn now to protect yourself, your coworkers, and your patients from the theft of personal health and financial information. 28 Leading the way to professional well-being By Sharon Pappas and Cynda Rushton When a work system is out of balance, the result can be nurse burnout and diminished well-being. 32 Caring Counts By Wanda Montalvo Overcome awkwardness and social taboos about suicide to have conversations that can save lives. W EB EXCLUSIVE ! Being the nurse in the family By Roberta Young and Teresa (Terry) Anderson When a family member is ill, nurses must define their role and set expectations. myamericannurse.com/?p=64428 MyAmericanNurse.com February 2020 American Nurse Journal 3 Subscription Questions? Christian Evans Gartley, Production Director 215.489.7004 cevansgartley@healthcommedia.com Change in Mailing Information? To change your subscription information online, send re- quest to Christian Evans Gartley, Production Director, at cevansgartley@healthcommedia.com Indexing American Nurse Journal is indexed in the Cumulative Index to Nursing and Allied Health Literature. Submit an Article Please email Cynthia Saver, MS, RN, at csaver@health commedia.com . In the email, describe the topic of your proposed article and why it would be of interest to the readers of American Nurse Journal; include your name, credentials, employer, and phone number. We’ll let you know if we’re interested in the article you’ve proposed and can advise you on how to focus it. For more infor- mation, please refer to the Author Guidelines (MyAmerican Nurse.com/author-guidelines). Send a Letter to the Editor Your input is vital in assuring that American Nurse Journal is a valuable resource to your practice. You can email a Letter to the Editor at MyAmericanNurse.com/ send-letter-editor . February 2020 American Nurse Journal 33 ANA ON THE FRONTLINE NEWS FROM THE AMERICAN NURSES ASSOCIATION nn Creating space for innovation C OMING NEXT MONTH •Avoiding antipsychotic medications in nursing home residents with dementia •Adults with chronic kidney disease: Overview and nursing care goals •The changing face of cystic fibrosis ANA ON THE FRONTLINE LIFE AT WORK LEADING THE WAY HEALTHY NURSE4 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com What’s in a name? Everything! Outdated jargon undermines nurse practitioner role. N URSE PRACTITIONERS (NPs) expand care delivery to address exploding patient de- mand, mitigate physician shortages, and en- hance the effectiveness of interprofessional teams. However, the words used to describe these healthcare professionals vary and fre- quently are incorrect. Take, for example, “mid-level.” Why this term? And why has it been used for decades? Words matter. Differ- ent words trigger very different responses and can shift how you view an issue. Think about your response when someone says “death tax” instead of “estate tax” or “global warming” instead of “climate change.” Why do we use slang to describe a li- censed advanced practitioner? “Mid-level” is outdated, and it misleads the public into thinking the care provided isn’t “high-level.” Imagine what “mid-level” must sound like to a patient or family member. I did a literature search to discover the ori- gin of the term, but I didn’t find much other than its frequent use in articles and research. However, I did learn that the U.S. govern- ment doesn’t use the term. Payers and regu- lators have terms known as “identifiers” for NPs and physician assistants (PAs) that are used for billing and monitoring. For example, the U.S. Department of Health and Human Services Medicare program uses “nonphysician practitioner” to describe advanced practice RNs (APRNs) and PAs. Some physician groups criticize hiring NPs instead of medical doctors, asserting that cost is becoming a priority over patient care and safety. Suggesting that NP care is dangerous and less than the care provided by physicians is unacceptable. All NPs have advanced clinical training and competency to provide healthcare be- yond their initial RN preparation. NPs have graduate education, with master’s or doctor- al degrees. The high quality of care they provide, which has been well-documented by research, should be without debate. The American Nurses Association repre- sents the interests of all APRNs and is a founding member of the Coalition for Pa- tients’ Rights, which was formed to address the American Medical Association’s scope of practice campaign dedicated to limiting the scope of practice for APRNs and other li- censed professionals. What can you do? Support change with two important actions: 1. Never use the term “mid-level”—spoken or in print—to describe an NP. Correct others “in the moment” by asking them to use the term nurse practitioner. 2. Request that your organization stop using “mid-level” in reference to NPs. Nothing about NPs is “mid.” Let’s educate our organizations, our patients, and our communities about that fact. Americans make more than 1.06 billion visits to NPs a year, so let’s ensure that they worry only about their illness, not the competency of those providing care. Lillee Gelinas, MSN, RN, CPPS, FAAN Editor-in-Chief References American Association of Nurse Practitioners. Quality of nurse practitioner practice. 2015. aanp.org/advocacy/ advocacy-resource/position-statements/quality-of-nurse- practitioner-practice American Nurses Association. Advanced practice regis- tered nurses (APRN). nursingworld.org/practice-policy/ aprn/ U.S. Department of Health and Human Services: Office of Inspector General. Medicare Coverage of Non-physi- cian Practitioner Services. June 2001. oig.hhs.gov/oei/re- ports/oei-02-00-00290.pdf EDITORIAL “Mid-level” is outdated. Nothing about NPs is “mid.”REGISTER TODAY! Visit pages.nursingworld.org/ncpdsummit Leading. Learning. Preconference Event at AONL 2020 March 18, 2020 | Nashville, TN © American Nurses Credentialing Center (ANCC). ANCC is a subsidiary of the American Nurses Association.6 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com Paternal postpartum depression Prevent and screen for depression in new fathers. By Nicole Altenau, MSN, RNC-OB, CBC MyAmericanNurse.com February 2020 American Nurse Journal 7 A PREGNANT WOMAN is coping well with her labor—just as she dreamed she would—when suddenly her water breaks and with the fluid comes an umbilical cord prolapse. What was a happy day quickly turns into the controlled chaos a labor nurse knows well but a soon-to- be mother never imagined. The woman is whisked to the operating room (OR), where her baby is delivered and taken to the neona- tal intensive care unit (NICU). After the deliv- ery, the new mother experiences significant bleeding in the postanesthesia care unit (PACU) and is rushed back to the OR, where more nurses and physicians rush to stabilize her. After 4 eventful days in the hospital, mother and baby are discharged and the family goes home. Most nurses involved in prenatal, ante- natal, labor and delivery, and postpartum care who hear this story will appropriately think about the mother and how this situa- tion will complicate her postpartum period and increase her risk for postpartum de- pression and anxiety. But what most won’t consider is the new father, who was left in the labor room with little understanding of what was happening to his wife and un- born child in the OR, who watched his ba- by taken to the NICU, and who was left in the PACU after his wife was taken back to the OR. In other words, pregnancy, birth, and postpartum care don’t affect only mother and baby. Paternal postpartum depression Postpartum depression is finally getting the attention it deserves in the media, hospitals, and healthcare in general, but fathers gen- erally aren’t mentioned. Paternal postpar- tum depression affects men all over the world, but it’s rarely discussed, and few— including fathers who are at risk and nurses who care for families—are educated about it. Studies show that about one in 10 fathers develop paternal postpartum depression; according to the Centers for Disease Con- trol and Prevention (CDC), about one in nine mothers will experience postpartum depression symptoms. Paternal postpartum depression typically begins in the first 12 months after a baby’s birth, with the highest number of cases be- ginning between 3 and 6 months after birth— later than when postpartum depression gen- erally develops in women. A study by Paul- son and colleagues comparing women’s and men’s depression symptoms prenatally and at 1, 3, and 6 months postpartum found that of those who were depressed prenatally, symptoms began to decline at 1 month post- partum, but men’s symptoms then increased at 3 and 6 months while women’s declined; 86% of these men remained depressed at 6 months postpartum, and 79% of these were depressed at each stage of evaluation. Signs, symptoms, and risk factors Signs and symptoms of paternal postpartum depression are similar to maternal postpar- tum depression, but men may experience additional symptoms, such as aggressive- ness, substance misuse, risk-taking behav- ior, partner violence, and infidelity. (See Know the signs and symptoms.) Paternal postpartum depression also can affect both parents’ ability to bond with a new baby. A study by Kerstis and colleagues of how fa- thers’ depressive symptoms affect bonding showed that fathers with depressive symp- toms 6 weeks postpartum have impaired bonding with their baby at 6 months. This same study found that a father’s depression symptoms can decrease a mother’s bonding ability. Many of the risk factors for maternal and paternal postpartum depression are similar; however, some differences exist. One risk factor more commonly seen with fathers is witnessing a life-threatening obstetric event or poor outcome during delivery. (See What are the risks?) One of the more significant risk factors for paternal postpartum depres- sion is a partner’s postpartum depression. A father’s postpartum depression also can af- fect the mother. A woman with postpartum depression whose partner also has postpar- tum depression is 4.2 times more likely to show a worsening of her symptoms over time; however, a woman whose partner doesn’t have paternal postpartum depression shows symptom improvement. Treatment, prevention, and nursing implications Preventing and treating paternal postpartum depression should begin before the baby is born and continue in the hospital and after the baby is delivered. Studies show that about one in 10 fathers develop paternal postpartum depression.Next >