< Previous8 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com Prenatal care Begin paternal postpartum depression pre- vention during prenatal care. Obtain a health history of the mother and father, including mental health. Education should include in- formation about physical changes the moth- er can expect during pregnancy, physical and hormonal changes that the father may experience, how the new parenting role will change the couple’s life, and maternal and paternal postpartum depression. Start education about paternal postpartum depression early to help remove any stigma around the condition. Simple steps, such as having posters on paternal postpartum de- pression hanging in clinical areas, can be helpful. Fathers also can be referred to fa- ther-centered education groups, where they can learn about pregnancy, birth, and par- enthood. Fathers should be encouraged to talk with other new or soon-to-be fathers about what they’re experiencing and what they can expect. Assess the father’s confidence in taking on his new role and encourage him to prac- tice childcare skills (such as diapering and bathing) before the baby comes and to par- ticipate in care as much as possible after birth. Also provide lifestyle education about sleep health, nutrition, physical activity, self- image, and postpartum sexual activity to help prevent paternal postpartum depression. Hospital care Before discharge, screen the mother and fa- ther for postpartum depression and risk fac- tors using the Edinburgh Postnatal Depres- sion Scale (EPDS) ( fresno.ucsf.edu/pediatrics/ downloads/edinburghscale.pdf ). Upon discharge, provide information and education about ma- ternal and paternal postpartum depression and resources to seek help if needed. When providing discharge instructions for the moth- er and baby, include instructions for the father and information about his role in postpartum care at home. Postpartum care Postpartum follow-up should include fa- thers. Screen them using the EDPS, provide printed materials to read at home, and en- sure posters about paternal postpartum de- pression are visible in clinical areas. Fathers can be screened by their primary care provider and in the pediatrician’s office when the mother is screened. If paternal postpartum depression is sus- pected, take action to assist the family. Based on the severity of the father’s depres- sion, providers may refer him to mental healthcare professionals for further evalua- tion and possible psychotherapy or medica- tion (such as a selective serotonin reuptake inhibitor). In cases where the parents’ rela- tionship is significantly strained, providers may make referrals for couples counseling and parenting skills classes. Educate families about the signs and symptoms of paternal postpar- tum depression throughout pregnancy, while in the hospital, and dur- ing the postpartum period. Know the signs and symptoms • Aggressiveness • Anger • Anxiety • Cynicism • Depressed mood • Fatigue and sleep problems • Feelings of worthlessness • GI symptoms • Headaches • Indecisiveness • Infidelity • Lower stress threshold • Marital conflicts • Negative parenting behaviors (for example, excessive yelling or hitting) • Partner abuse/violence • Risky behaviors (for example, drunk driving) • Self-criticism • Social withdrawal • Spending excessive time away (for example, online or at work) • Substance misuse • Suicidal ideation and/or actionCare for the whole family Mothers may experience the physical effects of childbearing, but fathers also are affected by a baby’s birth. In most cases, both par- ents will be sleep deprived as they face the challenges of becoming new parents and let- ting go of their previous life and routine. In addition, they’ll be overwhelmed at times by their baby’s needs, and they may feel a loss of control over their own lives. All of these factors can lead to postpartum depression in mothers and fathers. The stigma associated with paternal postpar- tum depression can leave fathers overlooked. However, mental health issues don’t discrimi- nate. Paternal postpartum depression is a serious condition that affects fathers and their families every day. As nurses, we need to learn more about this condition and provide the best care to the whole family after a baby’s birth. AN To view a list of references, visit myamericannurse.com /?p=63509. Nicole Altenau is the assistant clinical director of labor and delivery at Monmouth Medical Center in Long Branch, New Jersey. What are the risks? A complete history of both parents can help identify risk factors for paternal postpartum depression. • Controlling relationship by the mother or father • History of anxiety or depression • Increased stress levels • Lower socioeconomic status • Mother/father relationship less than 2 years old • Negative (flat or distant) affect • Partner depression • Poor mother/father relationship • Poor sleep quality for mother and/or father • Poor social support after birth • Preterm infant/infant in neonatal intensive care unit • Unintended pregnancy • Witnessing a near-miss event at birth (such as postpartum hemor- rhage or infant shoulder dystocia) RN Opportunities – Labor & Delivery $5,000 Sign-on Bonus! If you’re an experienced L&D RN, take advantage of this opportunity to join our exceptional team. Monmouth Medical Center is one of New Jersey’s largest community teaching hospitals. Nursing excellence is a hallmark of Monmouth Medical Center, and we are currently on the Magnet journey. As a part of RWJBarnabas Health and backed by the latest in medical technology, Monmouth Medical Center provides its staff the resources and opportunity to deliver unparalleled methods of health care. Job Quali昀cations: BSN degree preferred. Completion of Clinical experience in NLN accredited school preferred. Additional experience required based upon speci昀c department needs. Current NJ RN Licensure required. National Certi昀cation preferred. BLS required. ACLS and NRP required within six (6) months of hire. CBC or IBCLC strongly encouraged. To apply, please visit: https://www.rwjbarnabashealthcareers.org/ant0220 Equal Employment Opportunity MyAmericanNurse.com February 2020 American Nurse Journal 9Cybersecurity awareness How to protect yourself, your coworkers, and your patients By Marti Jordan, PhD, FNP-BC C YBERSECURITY has become a pressing issue in healthcare organizations. Each year, more organizations are targeted by individuals who want to gain access to protected health infor- mation (PHI) to file false insurance claims, buy medical equipment, and order prescrip- tion drugs. Healthcare data breaches reached record levels in April 2019, with 44 attacks af- fecting nearly 687,000 people. Healthcare cybersecurity defends comput- ers, servers, wearables, medical devices, and electronic health records and other sources of PHI from malicious attacks. Nurses who learn about cybersecurity, are aware of threats, re- main alert to them, and are familiar with miti- gation and incident response can help protect patients and organizations. Consequences of cyberattacks Security breaches can lead to serious conse- quences, including complete system or net- work shutdown and life-and-death situations. For example, a hacked insulin pump could in- crease the insulin delivery rate, leading to se- vere complications or death. An experienced hacker can exploit vulnerable computer net- works in minutes, but recovery from cyberat- tacks can take years, damaging an organiza- tion’s reputation, future business, and short- and long-term finances. Patients who are vic- tims of medical theft will lose hours of work and productivity while they try to restore and secure their stolen information. Many victims suffer emotionally and financially, and fear of future attacks can result in anxiety and stress. And if the breach was internal (perpetrated by an employee), morale in the workplace could be affected. Types of attacks Hackers gain access to devices physically and virtually. Physical access is acquired by steal- LIFE AT WORK 10 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.comMyAmericanNurse.com February 2020 American Nurse Journal 11 ing portable devices or accessing computers in public areas using stolen credentials. Virtual access occurs when hackers send phishing and spear-phishing emails via net- works to seek out personal information such as usernames and passwords. The emails, many of which appear credible, may contain embedded links that recipients are asked to click on. Another form of virtual access is a ran- somware attack. Hospital operations have been shut down by these attacks, which in- vade network systems, encrypt data, take con- trol of the system and lock it down, and then demand a ransom to decrypt the data. Paying the ransom doesn’t ensure data restoration. Cyber hygiene Much like we encourage patients to practice good personal hygiene to promote health and well-being, healthcare organizations and nurs- es must practice good cyber hygiene. Think of protecting PHI as primary prevention, con- ducting risk assessments and performing reg- ular maintenance as secondary prevention, and stabilizing and restoring systems after a cyberattack as tertiary prevention. In 2018, the National Institute of Standards and Technology (NIST) developed a frame- work that can be used by any business, in- cluding healthcare organizations, to improve security and resistance against cyberattacks. The framework provides structural guidance that organizations can use to develop an indi- vidualized cybersecurity risk plan. (See Build- ing a security framework.) Organizations can use the nursing process to design compre- hensive reviews that allow nurses to collect the information necessary to complete, imple- ment, evaluate, and revise the NIST frame- work profile. Assess Formal and informal risk assessments conduct- ed by a team of nurses and members of the in- formation technology (IT) and health informat- ics staff should include an inventory of hardware (computers, connected devices, and mobile devices), software (all programs in- stalled on the network and used by everyone), applications, and data storage (onsite, off-site, and cloud storage). The assessment should review how staff are currently trained on cy- bersecurity awareness and cyber hygiene best practices. In addition, the assessment should look for vulnerabilities at all levels and include interviews with nurses about their cyberse- curity awareness, understanding of potential threats, and current knowledge, attitudes, and behaviors related to cybersecurity practices. Finally, the assessment should include a formal review of the organization’s cybersecu- rity and cyber hygiene policies and proce- dures. (See Protection review.) Diagnose After the risk assessment is completed, the chief information officer or administrative leadership team should make a determination about the risk for a cyberattack and present The National Institute of Standards and Technology (NIST) cybersecurity framework consists of three parts: core, implementation tiers, and profile. • The framework core comprises five functions that provide a set of desired cybersecurity activities and outcomes using common lan- guage that is easy to understand: •identify—develop a broad overview of how the organization would manage a cyberattack •protect—create and implement alternative systems to safeguard critical functions should a cyberattack occur •detect—put activities in place for early identification of a cyber- security event •respond—develop mitigation and incident response and imple- mentation plans •recover—determine actions that may be required if a cyberat- tack occurs, including restoring systems. • The framework implementation tiers provide organizations with an overall view of their cybersecurity risk and the plan they have in place to manage it. • The framework profile helps organizations evaluate their plan and risk considerations against the desired outcomes described in the core. The profile can be used to identify areas for improvement. Source: nist.gov/cyberframework/new-framework Building a security framework 12 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com recommendations. Based on these recom- mendations, changes may include removing outdated hardware, patching or removing software programs, writing policies and pro- cedures, improving the current education program, developing a mitigation plan, con- sistently backing up data, and increasing an- nual employee training. An organization also may want to consider purchasing cybersecu- rity insurance. HealthITSecurity.com reported that on average it takes $1.4 million to recov- er from a cyberattack. Cyber insurance can help organizations cover some of the costs in- curred during a breach; however, policies may not cover all expenses, including replacing or repairing equipment damaged during attacks or subsequent litigation. Helpful training includes recognizing and avoiding phishing scams, practicing good password management, following safe inter- net practices, and increasing device safety. Mitigate Even an initially small breach can eventually involve thousands of patients, making a miti- gation plan important. Sometimes a breach can be solved easily by shutting down a group of computers on one unit, but other times a more complicated solution—such as turning away patients and temporarily clos- ing—may be required. The quicker a problem is reported, the less damage will occur to the organization, so most mitigation plans require staff to immediately report an incident to the IT department. Miti- gation plans should be followed exactly, and they require educating staff about the Health Insurance Portability and Accountability Act breach notification rule, 45 CFR §§ 164.400-414, which requires that healthcare organizations notify individuals who are affected by a breach no later than 60 days after the occurrence. In some cases (for example, if more than 500 res- idents of one state are affected by a breach), organizations are required to notify media out- lets and the secretary of the Department of Health and Human Services. Organizations al- so need to be aware of and follow any state requirements for reporting breaches. Implement The goal of implementing a cybersecurity plan is to protect PHI. Similar to event drills for bioterrorism, active shooter, or mass casu- alties, mock cybersecurity exercises help or- ganizations conduct a variety of scenarios and evaluate their preparedness for an attack. Dur- ing the mock exercise, participants follow the incident response plan to understand their roles in the event of an attack and practice their response. The organization also will be able to determine how well it responds to a crisis and secures information. Evaluate A formal evaluation should be conducted im- mediately after a mock exercise or an actual cyberattack to determine what parts of the plan worked and what parts didn’t. The eval- uation may reveal areas of strength and weak- ness, as well as lessons learned. Ultimately, the organization should incorporate changes Healthcare organizations should have formal cybersecurity policies and procedures related to acceptable use, security awareness, information security, disaster recovery, change management, incident response, re- mote access, personal devices, vendor access, and data backup. • Acceptable use details the purpose of work computers and em- ployee networks. • Security awareness describes how an employee’s actions on the network may affect security and the privacy of others, as well as the personal health information housed in the network. • Information security provides information about data risk manage- ment and whom to contact for information technology security issues. • Disaster recovery provides step-by-step details of the mitigation plan to reduce the severity of the impact of a threat or attack. • Change management informs employees about who will install updates and how they’ll be notified about scheduled maintenance. • Incident response contains step-by-step details about how the or- ganization responds to a cybersecurity breach, including information about preparation, detection, analysis, containment, eradication, re- covery, and postincident activity (for example, how well the team re- sponded to the crisis and how quickly it secured the organization). • Remote access explains the necessary safeguards required if the network must be accessed remotely, including virtual private net- work use and two-factor authorization. • Personal device provides explicit guidelines for employees’ person- al devices—laptops, tablets, smartphones, and USB drives—that are used for work. • Vendor access determines how much access to the network vendors will be permitted and how they must access it. • Data backup clarifies where data is stored, who has privileges to back up data, and how often data should be backed up. Protection reviewto ensure it’s always prepared and remains aware of and follows security best practices. Be prepared Cyberattacks are increasing in frequency and severity. Being aware of the most common at- tacks will improve nurses’ abilities to recog- nize, avoid, and respond to them. And a framework that guides developing a cyberse- curity risk plan specific to nursing will give nurses a better understanding of how to pro- tect themselves, their coworkers, the organiza- tion, and their patients. AN Marti Jordan is a visiting assistant professor at the University of Southern Mississippi School of Leadership and Advanced Nursing Practice in Hattiesburg, Mississippi. References Cohen JK. Healthcare data breaches reach record high in April. Modern Healthcare. May 10, 2019. modern- healthcare.com/cybersecurity/healthcare-data-breaches- reach-record-high-april Davis J. What is cyber insurance for healthcare organiza- tions? HealthITSecurity.com. February 5, 2019. healthit - security.com/features/what-is-cyber-insurance-for-health- care-organizations Gupta BB, Tewari A, Jain AK, Agrawal DP. Fighting against phishing attacks: State of the art and future chal- lenges. Neural Comput Appl . 2017;28(12):3629-54. Kruse CS, Frederick B, Jacobson T, Monticone DK. Cy - ber security in healthcare: A systematic review of mod- ern threats and trends. Technol Health Care. 2017; 25(1):1-10. Lötter A, Futcher LA. A framework to assist email users in the identification of phishing attacks. Information & Computer Security. 2015;23(4):370-81. National Institute of Standards and Technology. Frame- work for Improving Critical Infrastructure Cybersecurity. Version 1.1. April 16, 2018. nvlpubs.nist.gov/nistpubs/ CSWP/NIST.CSWP.04162018.pdf Spence N, Bhardwaj N, Paul DP, Coustasse A. Ransom - ware in healthcare facilities: A harbinger of the future? Perspect Health Inf Manag. 2018;Summer:1-22. perspec- tives.ahima.org/ransomwareinhealthcarefacilities Stafford T. Tackling healthcare cybersecurity with risk identity, assessment [webinar]. Xtelligent Healthcare Me- dia. vimeo.com/359520062 U.S. Department of Health and Human Services. Health information privacy: Breach notification rule. July 26, 2013. hhs.gov/hipaa/for-professionals/breach-notification/ index.html Visit www.proliability.com/89590 or Call 1-800-375-2764 Program Administered by Mercer Health & Benefits Administration LLC In CA d/b/a Mercer Health & Benefits Insurance Services LLC • AR Insurance License #100102691 • CA Insurance License #0G39709 Underwritten by Liberty Insurance Underwriters Inc. *This literature is a summary only and does not include all terms, conditions, or exclusions of the coverage described. Please refer to the actual policy issued for complete details of coverages and exclusions. **Actual rate may vary based on state of practice and professional designation. A premium credit of 10% is available only to members of nursing associations that sponsor the Proliability program and satisfy the risk management requirement — look for your association when securing a quote. 89590 (2/20) Copyright 2020 Mercer LLC. All rights reserved. W ith your busy schedule, finding the right professional liability insurance policy to meet your needs can be challenging. Proliability® powered by Mercer makes it easy and affordable! Through Proliability, you’ll have access to: * • Premium discounts, which can reduce your annual cost • Limits of Liability of $1 million per incident/$6 million annual aggregate • Coverage for licensing board matters, HIPAA fines, deposition expense reimbursement and more! • Risk management information and Helpline Looking for Affordable Professional Liability Insurance? Compare Proliability rates today! As an employed nurse your premium can be as low as $101/year for $1 million per incident/ $6 million annual aggregate. Additional discounts may apply.** AN A’s authorized provider for Professional Liability Insurance MyAmericanNurse.com February 2020 American Nurse Journal 1314 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com Engaging and advocating Election year offers opportunities to influence. From your ANA President N URSES MAKE A DIFFERENCE . Those four words succinctly and accurately capture what our pro- fession is all about and what each and every one of us is capable of achieving. Through out 2020, you’ll be hearing that phrase even more as we highlight nurses’ positive contributions to the health and well-being of individuals, communities, and the nation as a part of the Year of the Nurse campaign and during Nurs- es Month in May. Because 2020 is a major election year, nurses have an even greater opportunity to make a difference through our political advo- cacy, a critical component of our profession- al practice. Nurses can help shape healthcare and influence local, state, and national agen- das through our voices and our votes. At more than 4 million strong, we’re a powerful constituency. I understand how precious nurses’ time is, as many of you juggle work, family, and even school and community responsibilities. But as you know, political advocacy, including par- ticipation in elections at every level, matters. Issues that come before elected officials can include everything from determining whether your communities have enough school nurses to addressing vaccine-preventable diseases and ensuring access to safe, affordable healthcare. So a great deal is at stake—first in primary elections and caucuses taking place across the country in the coming months and then the general election in November. Beyond the of- fice of president of the United States, candi- dates are vying for 435 seats in the U.S. House of Representatives and 35 in the Senate. Nurs- es also can have an impact on outcomes clos- er to home, whether it’s determining gover- norships, state legislators or other officials or ballot initiatives. Keep in mind that public polling indicates healthcare once again has emerged as a significant election issue. Although the American Nurses Association (ANA) no longer endorses presidential candi- dates, we developed an online resource, nurses vote.org , to support and encourage nurses in their political engagement. The site provides information on voter registration and other election-related resources, where presidential candidates stand on issues important to nurses and patients, and how to volunteer on cam- paigns. The latter is a great way to share your expertise and provide consumers and candi- dates with accurate information. When it comes to engaging in political ad- vocacy beyond voting, you can be involved at any level. For some of you, that may mean helping on campaigns with phone banking or hosting a fundraiser. For others, it may be posting pictures of your involvement on social media with the #NursesVote hashtag. Also, each election cycle, ANA’s political action committee (PAC) endorses congressional can- didates who show a commitment to advanc- ing the nursing profession and advocating on healthcare issues, both on Capitol Hill and in their congressional districts. (Learn more at anapac.org .) Another way to engage in political advoca- cy is to participate in your state or constituent nurses association’s Legislative Day and ANA’s Hill Day in June. These annual events provide the opportunity for nurses to share informa- tion with elected officials from both sides of the aisle and gain their support for crucial leg- islation. Last year, for example, participants in ANA’s Hill Day helped gain bipartisan support from congressional members and their staffs for proposed measures on workplace violence prevention, home healthcare, workforce de- velopment, and safe staffing, among others. Legislative and Hill Days also help nursing stu- dents—our next generation of advocates— gain the skills they need. Finally, if we’re truly to be good advocates and good citizens, I urge you to stay current on the candidates and key issues—and then vote. You will make a difference. Ernest J. Grant, PhD, RN, FAAN President, American Nurses Association PRACTICE MATTERS If we’re truly to be good advocates and good citizens, I urge you to stay current on the candidates and key issues—and then vote.16 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com Implementing a fundamental nursing skills bundle can reduce risk. By Carolyn D. Meehan, PhD, RN, and Catherine McKenna, MSN, RN L EARNING O BJECTIVES 1.Identify risk factors for hospital-acquired pneumonia (HAP). 2.Discuss bundled strategies for prevent- ing HAP. The authors and planners of this CNE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. See the last page of the article to learn how to earn CNE credit. Expiration: 2/1/23 CNE 1.36 contact hours Preventing hospital-acquired pneumoniaMyAmericanNurse.com February 2020 American Nurse Journal 17 H OSPITAL - ACQUIRED PNEUMONIA (HAP), which includes ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumo- nia (NVHAP), is a well-documented hospital complication that’s diagnosed when patients demonstrate signs and symptoms of pneumo- nia 48 or more hours after hospital admission; VAP is diagnosed when signs and symptoms of pneumonia appear 48 hours after intubation. HAP, an inflammatory condition of the lung parenchyma, has the highest mortality rate of any hospital-acquired infection (HAI) in the United States. VAP comprises about 38% of HAP cases; NVHAP is underreport- ed as a hospital complication. Consequences of HAP include pro- longed lengths of stay in the hospital, expensive medical treatments, and discharge to a long-term care facil- ity. Avoiding these consequences depends on nursing care that is based on a fundamental nurs ing skills bundle and de- livered in conjunction with an interprofessional team. Causes and risk factors The most common cause of HAP is aspiration of mi- croorganisms that originate in the patient’s nasal, oro - pharyngeal, and gastric flora. Several factors place patients at risk for aspiration, including dysphagia, coughing, and al- tered mental status as a result of stroke, seizures, or substance use disorder. For patients who’ve had a stroke, pneumonia resulting from as- piration is a leading cause of death. Other patients at risk for aspiration in- clude those with neuromuscular diseases (such as Parkinson’s disease and muscular dystrophy), mouth sores, esophageal block- ages due to tumor or radiation treatment, neu- rologic changes (for example, alteration of the glossopharyngeal nerve after a stroke), chron- ic pulmonary disease (which can result in poor cough or inspiratory effort), and GI con- ditions that cause severe nausea and vomiting. In addition, patients receiving proton pump inhibitors or histamine H2 antagonists to raise the pH of gastric secretions have an increased incidence of HAP. The reduction of the acidity of gastric secretions may allow microorgan- isms in the gut to proliferate, potentially caus- ing HAP if vomit is aspirated. Even healthy patients may experience aspi- ration. Almost half of healthy individuals have episodes of silent aspiration during sleep, which they tolerate without significant disease progression. But when they’re hospitalized and their health status is compromised, their risk for developing pneumonia increases. HAP also can be acquired from pathogens transmitted via healthcare workers and hospi- tal equipment. For this reason, all healthcare workers must strictly adhere to infection pre- vention standards, especially when caring for patients in the acute care setting, who are at a greater risk for developing pneumonia be- cause they may be immunocompro- mised or malnourished, at an advanced age, or have multiple comorbidities. Assessment and diagnosis HAP is the second most common HAI after catheter-associated urinary tract infections. Patients on any unit in the hospital can develop NVHAP, which can result in transfer to intensive care. To prevent HAP, nurses should be alert for aspiration symptoms and inter- vene quickly and appropriately. Signs of respiratory distress—such as stridor, tachypnea, tachycardia, and drop in oxygen saturation—warrant immediate nursing interventions. Pain when swal- lowing, a feeling that food is getting stuck in the throat, and difficulty swallowing should alert nurses to possible dysphagia. Early HAP diagnosis can be achieved with pulse oxime- try, chest x-ray, complete blood count with differential, and sputum culture. Management Several fundamental therapeutic nursing inter- ventions—adhering to infection prevention standards, elevating the head of the bed 30 to 45 degrees to prevent aspiration, ensuring good oral hygiene (cleaning teeth, gums, tongue, dentures), increasing patient mobility with ambulation to three times a day as ap- propriate, encouraging coughing and deep breathing, and instructing patients in the use of incentive spirometry—are associated with reducing HAP risk. Most hospitals don’t rou- tinely monitor this fundamental nursing inter- HAP also can be acquired from pathogens transmitted via healthcare workers and hospital equipment.Next >