Nurses Declaration of Solidarity and Resistance

January 30, 2017January 31, 2017 / Peggy L Chinn / 25 Comments

The 2017 U.S. Executive Branch is taking steps that will have an effect on the health and well-being of all who reside within the borders of the United States, and of all people worldwide. At this moment in history, we call upon nurses to stand together, act to resist that which harms health and well-being, protect those who are harmed, and build coalitions that move toward the ideals we seek. We stand on a long legacy of political activism by nurses that arises from our moral imperative to actively promote public policy to assure social/health equity. Our actions are grounded in the premise that health and well-being depends on healthy environments and just communities. We pledge to join with others to engage in determined action to protect health and justice for all, regardless of age, social/economic circumstance, religion, skin color, race, sexual orientation or gender identity.

1. We believe that health and well-being of mind, body and spirit is a fundamental human right.

As nurses, we are committed to provide care for all people – care that promotes and supports high level wellness, prevention and treatment of injury and disease, and restoration of health when it is compromised.

2. We believe the integrity of our environment is integral to human health and well-being.

We oppose all actions that contribute to damage and erosion of the earth’s ecosystem and the physical structures which we inhabit. We will promote, protect, and support actions toward healthy and sustainable structural and natural environments for all the earth’s inhabitants.

3. We believe that all people deserve access to affordable quality care.

As nurses, we are committed to caring for all patients and families, regardless of economic status, sexual orientation/gender Identities, current immigration status, age, ability to pay, or spiritual/religious beliefs/practices (or lack thereof).

4. We oppose all forms of oppression and discrimination.

We commit to protect and care for those whose safety and well-being is threatened based on gender, race, ethnicity, nationality, sexual identity, physical ability, economic status, or any other attribute seen as “difference.” We will take public stands opposing any attempt to weaken public policies and programs designed to protect health and well-being of those who are disadvantaged. We will fight for policies and programs that assure equality and justice.

5. We oppose intimidation and violence in our homes and communities.

We will act to protect any who are victims of intimidation and violence, particularly those who are vulnerable because of skin color, race, sexual orientation, gender identity or religion. As nurses, we nurture peaceful resolution of conflict and support those who step up to intervene peacefully in situations of threat and danger.

6. We believe that the health of women must be protected.

We will act to assure that all women receive the full range of care that assures their right to control their own reproductive choices as well as all women’s healthcare services needed to maintain their own health and the health of their families.

7. We trust scientific knowledge that supports a wholistic approach to nursing care

We examine all sources of evidence to inform the choices we make in caring for those we serve. We can assure the public that we practice from a firm foundation of sound and reliable scientific evidence. We will take all steps needed to inform the public of the science that supports our practices.

We invite all nurses, and our colleagues who support our values, to join us in declaring these values and actions by signing this declaration. You can add your signature to this document here. We invite you to use this declaration as you wish, and revise to suit your own purposes. Let us know of your actions, follow #nursesresist, and join our Facebook group.

Contributing authors:

Carey S. Clark, PhD, RN, AHN-BC
Peggy Chinn, RN, PhD, FAAN
Elizabeth Berrey, PhD, RN
Lisa Sundean, RN, MS, PhD Candidate
Adeline Falk-Rafael, PhD, FAAN
Leslie Nicoll, PhD, PhD, MBA, RN, FAAN
Sue Hagedorn, RN, PhD, FAAN

Thank you to the Cambridge Health Alliance for inspiration!

If you would like to co-sign your name to this declaration, please provide your information using this form. The list of co-signatories will be updated as frequently as possible.

SEE THE DECLARATION AND LIST OF SIGNATORIES HERE

Women, healthcare, and access issues

January 8, 2017December 20, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I have been thinking a lot lady about women’s need for healthcare and oppression of women. A lot of this thinking has been spurred on by my facebook account, which lets me know that the new administration is planning on defunding planned parenthood, cutting medicare, and possibly replace the Affordable Care Act with Health Saving’s Accounts (the last one has to be a joke…right? HSA of the average American will not pay for hospitalizations and major medical issues).

The defunding of Planned Parenthood (PP) makes little to no logical sense, as no federal money is used to support abortions (which seems to be the GOP platform reason for why PP should be de-funded). I myself used PP as a young uninsured nursing student and even when I became a nurse with no insurance. PP was in fact my primary care for many years and PP offers great care options for women.

This year when it came to my yearly exam, instead of literally waiting 8-12 weeks for an “annual” appointment with an MD or DO, I decided to have my basic needs met through PP. They take my insurance (which I am ever so grateful for) and I could make an appointment for a few days from when I went online. I could cancel my appointment online.

When I arrived, I was pleased to see a bowl full of condoms sitting out. I was in the waiting room with one other male in his mid-20’s, it was mid-day on a Monday. When I went back to the exam room, after only waiting about 10 minutes, the MA took my weight, BP, and did a brief health history with me. An NP was with me shortly after this, and we discussed many of prohormones and my overall health concerns. She did a breast exam, gynecological exam and pap smear, discussed peri-menapause with me, and she even spent a few minutes talking with me about my tween and what the latest approaches were for sexually active teens (including answering my questions about HPV and what my daughters’ experience might be like should she come to a PP for birth control when she is a teen).

I have to admit I was more comfortable here then visiting my primary care doctor, the one who is listed on my insurance. I like getting care from NPs, I trust them and appreciate the time they devote to prevention. The routine felt comfortable and I was at ease. I left with a plan to address some of my health concerns with other healthcare professionals and with an increased knowledge base around my own health and even my daughters’ future sexual health. Although my insurance paid for this health prevention visit, I made a donation to PP on the spot before I left the building. Omeprazole is used to treat conditions where reduction in acid secretion is required for proper healing, including stomach and intestinal ulcers (gastric and duodenal ulcers), the prevention and treatment of ulcers associated with medications known as NSAIDs, reflux esophagitis, Zollinger-Ellison syndrome, heartburn, and gastroesophageal reflux disease (GERD). You can get losec prescription medicine online at https://www.ukmeds.co.uk/treatments/acid-reflux/losec-20mg/.

I want PP to be around when my daughters’ might need them in the next few years. If you feel the same, I hope you will join me in contacting your legislative body and your local PP to see how you might be of assistance. To learn more about how to contact your representative in Washington DC, please visit: http://www.house.gov/representatives/find/

Healthy Holidays for Nurses

November 23, 2016November 21, 2016 / Jane K. Dickinson / Leave a comment

As nurses we often focus on taking care of others. At the holidays it’s important to take a few moments to also think about how we can take care of ourselves.

I’m a diabetes educator, so “surviving the holidays,” as you might imagine, is a common conversation. What about nurses? Holiday time is stressful for nurses as well. Like diabetes, nurses’ work doesn’t let up no matter what day it is.

Some ideas for self-care at the holidays include getting some physical activity. Going for a walk can do wonders for clearing the mind, helping with stress, and balancing out any extra holiday calories!

Speaking of calories, many patients/families give nurses food platters during the holiday season. While this is a very kind and thoughtful gesture, another idea is to ask patients and their families to consider a donation to a chosen charity. Perhaps nurses could decide on a charity and post a sign on the unit about making a contribution rather than giving gifts or food to the nurses.

Another strategy is taking time for gratitude. Starting our day with gratitude can help us focus and stay positive. Many people find giving back at this time of year very rewarding. Ways to do that may include serving food to those in need; donating to groups that collect holiday gifts for children, families and the elderly; coat drives; and many other opportunities.

Taking care of ourselves also means accepting ourselves – our strengths and weaknesses, successes and areas for improvement. If we do indulge in high calorie treats, or if we don’t make time for exercise, it doesn’t help to beat ourselves up or say “if only” or worse yet, to “should” on ourselves. Instead, we can say “next time,” and move on.

Let’s enjoy the special moments – with patients, with family and friends, and with ourselves. I hope nurses everywhere have a joyous holiday season. At this time of year (and always) I am grateful to be a nurse and to count all of you as colleagues in this important work we do.

Grieving for my country

November 15, 2016 / Peggy L Chinn / 24 Comments

There is no other way to say this – the U.S. election of Donald Trump as President has gripped me with grief, and fear. As each day passes, further news of the dys-function of this man, and what it portends for our county and the world, only intensifies my grief, as he surrounds himself with people who have already demonstrated that they bring no good will in exercising their new-found power. I understand the intentions of our current political leaders in expressing their desire to hold fast to the democratic principle of smooth transition of leadership, and the sound principles that they are modeling for all of us. But at the same time, I am convinced that this is not a time to remain resigned, or to accept what is to come. It is true that we do not know exactly what is to come, but because of the demonstrated words and deeds of all of the major players now coming into office, we have every good reason to remain vigilant and prepared to act at a moment’s notice.

So at this early stage in what is happening, my focus turns to one of the most important things that we all need to nurture – our sense of unity and community in speaking truth to power, in holding dear the values that form our words and actions, and in support for whatever paths we can take to assure a safe and secure future for each and every person in this country and in the world. This is not a time to turn against one another and let our petty differences tear us apart. I have been dismayed at posts on social media that criticize and demean those who wear the safety pin as a signal of solidarity with those whose safety is threatened, or in a search for answers focus on criticizing those who are only now speaking up, when they could have done much more to prevent what has happened. The fact is that any signal, any symbol, or any action at any time – these are all necessary at this moment, and our focus needs to be on creating communities that honor whatever can be done to strengthen those who seek justice and health for all. It may not be what another person prefers in substance or in timing, but it is what can be given at this moment. I call on all of us to turn away from blame and in-fighting, and to turn toward one another as allies and friends in the struggles that are now part of our future – to secure health and equality and justice for all.

If we seek to heal the divisions and the animosity that is now all-too prevalent in this and other countries, then the one thing that we can all do now is to start on a path of healing the divisions and the hurts in our own families first, and in our own communities. Our children, most of all, need to see us taking concrete actions to heal animosities, to address difference constructively and without demeaning another person for their ideas or beliefs. Our children need to learn to honor other people who are different, to value the richness that comes from diversity.

I invite you, as someone manifesting nursing, to contribute your ideas for healing in our relationships, and your ideas for building and strengthening the connections that we will surely need in the months and years ahead.

A Nurse’s Perspective on Cannabis (Marijuana), Legalization, and Safety.

October 16, 2016December 21, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

I am a Registered Nurse with 22 years of experience, and I have had an anti-prohibition stance in regards to marijuana (cannabis) for 30 years. I was fortunate that when I moved from California to Maine 6 years ago, I was introduced to Maine’s amazing medical cannabis program. I have also been able to study and learn more about the medicinal benefits of this sacred herb through my involvement with the American Cannabis Nurses Association (I now sit on ACNA’s board of directors) and by going to cannabis clinician conferences, such as Patients Out of Time.

Cannabis is on the ballot in 9 states this November, for either legalization for adult use or medicinal consideration. As nurses, we are often concerned with safety, so the following are my thoughts on safety issues and the end of prohibition of cannabis. If you are unfamiliar with how cannabis works in the body and why it such a safe herbal medicine, I suggest you first visit my blog posting on what nurses need to know about cannabis: https://nursemanifest.com/2015/07/14/the-endocannabinoid-system-what-nurses-need-to-know-an-introduction/.

Let’s consider the following issues:

Access: The idea of increased access for adults over age 21 is compelling on many levels. As many have stated before me, all cannabis use is medicinal due to the way the herb interacts with the body’s own endocannabinoid system. (http://thejointblog.com/all-marijuana-use-is-medicinal/; https://halcyonorganics.com/all-cannabis-use-is-medical/). Patients who cannot access cannabis legally to support their healing because they did not have a documented qualifying condition may now have access to this safe effective herbal medicine. Sites like http://www.drugguardians.com are being created with impunity and are helping the population become informed by third parties, decentralizing the source of knowledge about drugs. As legal access increases, black market issues will likely dissipate which creates a safer environment for all citizens. Meanwhile, we know that in legalized states, teen cannabis use drops significantly, effectively decreasing access for younger folks, which is often a concern for those who are considering legalization or medicinal programs (http://www.usnews.com/news/articles/2014/08/07/pot-use-among-colorado-teens-appears-to-drop-after-legalization).

Quality: In Maine, our ballot calls for testing and proper labeling of cannabis products sold at both recreational stores and recreational cafes. This is a major step forward to ensuring safe use of quality cannabis products for both patients and recreational users. Many patients now are being encouraged to start low and go slow with their dosing of their medication, and proper labeling will help to ensure that people can use cannabis with comfort knowing the relative psychoactive effects increase as THC levels of the cannabis products increase. Additionally, products will be tested for pesticides and contaminants, further ensuring the medicine and products people are accessing is safe.

Smoking: I often hear that medical providers are very concerned with the idea that smoking cannabis may be harmful to the person. While there may be some minimal changes to lung structures, there is no strong correlation with COPD and lung cancer in cannabis smokers (http://www.ncbi.nlm.nih.gov/pubmed/23802821; http://www.ncbi.nlm.nih.gov/pubmed/21859273). However, there are many ways to ingest cannabis, and vaporizing cannabis is a way to inhale the medicine without having contact with some of the combustive byproducts that are related to any perceived risk of smoking cannabis. For more therapeutic effects, regular users of cannabis and those seeking its healing properties are generally encouraged to use edibles and tinctures, as they target whole body homeostasis more effectively.

OUI/ DUI: Driving under the influence of any psychoactive medication is obviously an issue. However, levels of THC in the body do not directly equate to impaired driving in the same way that alcohol does, secondary to the way THC is metabolized in the body and how it remains in the body due to it being a fat soluble substance (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456923/). “Stoned drivers” do not pose the same risk to the public’s well-being as “drunken drivers” do; indeed “stoned” drivers tend to drive more slowly. Researchers from UCLA have called for more efforts to be made around lowering acceptable blood alcohol levels to truly curb issues around impaired driving (http://www.nytimes.com/2014/02/18/health/driving-under-the-influence-of-marijuana.html?_r=0), as being at .08 BAL leads to an eleven fold increase in the risk for being in a car accident, while driving under the influence of cannabis leads to a two-fold increase of being in an accident (texting while driving has a two fold increase and talking on the phone while driving has a 3 fold increase in risk for car accidents) (http://www.huffingtonpost.com/sam-tracy/putting-marijuana-dui-in-_b_6023136.html). Driving or operating machinery while under the influence of cannabis is unacceptable and indicates a risk, however in Colorado since legalization of recreational use of cannabis was initiated, DUI fatalities have decreased (https://www.washingtonpost.com/news/the-watch/wp/2014/08/05/since-marijuana-legalization-highway-fatalities-in-colorado-are-at-near-historic-lows/?utm_term=.64fa02a0cc5e). It should be noted that Colorado made a concerted effort to promote safer driving conditions and decreasing driving while intoxicated once they ended cannabis prohibition. all states should be making efforts to combat intoxicated and unsafe driving practices.

Children: When cannabis was made recreationally available in Colorado, it appeared that more children were being accidentally exposed to cannabis (http://www.usatoday.com/story/news/nation/2014/04/02/marijuana-pot-edibles-colorado/7154651/). I would posit however that once the plant became legal, more parents were willing to seek medical attention if their child had accidentally ingested cannabis infused edibles or other cannabis products. Additionally, the relative number of cannabis ingestion issues versus other toxic substances truly remains quite low in Colorado at 6.4% of all “poisoning” cases treated within the pediatric population (http://www.cnn.com/2016/07/27/health/colorado-marijuana-children/index.html). There has not been a single reported death from a child (or any person) ingesting cannabis (unlike other ingested toxins, such as laundry pods: http://www.cnn.com/2014/11/10/health/laundry-pod-poisonings/index.html). So while we will need to educate consumers about the risks of pediatric access and ingestion of cannabis, the risks remain relatively low. In most cases, children recover quickly from cannabis intoxication, with hospitalization for supportive care only, which generally lasts 1-2 days and generally leads to no lasting side effects (http://health.usnews.com/health-news/news/articles/2013/05/27/kids-poisoned-by-medical-marijuana-study-finds
). Both the states and the individual companies who will be selling cannabis should be responsible for educating the public around ensuring pediatric safety should a state chose to legalize. Ideally some of the tax dollars generated from cannabis sales would be geared toward education of the public on safe cannabis consumption and storage.

Teen Use: Teen cannabis use has actually declined as more states legalize or become medicinal cannabis states (https://www.washingtonpost.com/news/wonk/wp/2014/12/16/teen-marijuana-use-falls-as-more-states-legalize/). This in part may be due to tougher regulations making it harder for teens to access cannabis, and a decrease in black market availability of cannabis.

Pregnancy: Dr. Melanie Dreher, the Former Dean of Rush University school of nursing, is a nurse who researched the Ganga culture in Jamaica for over ten years, and determined that there were no adverse outcomes to the fetuses who were exposed to cannabis (https://www.youtube.com/watch?v=K9WorIM0RhA; https://www.youtube.com/watch?v=RDV5HhmP4UI). A recent study also reported that cannabis use is safe during pregnancy (though caution may still be advised)(http://www.scienceworldreport.com/articles/47194/20160910/marijuana-safe-during-pregnancy-experts-encourage.htm) and breast feeding while using cannabis also appears to have minimal risks (http://cannabisclinicians.org/breastfeeding-and-cannabis/).

Harm Reduction: Cannabis has been studied as a harm reduction tool, particularly when it comes to addiction and treating folks for pain related issues. Physicians have called for neuropathic pain to be treated with cannabis instead of opioids (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/). We also know that cannabis can decrease the need for escalating doses of opioids, and assist people who are opioid dependent in either decreasing thier doses of opiates or completely overcoming their addiction (http://nationalaccesscannabis.com/press-release/opiate-study-press-release/).
For an overview of the body’s endocannabinoid system and the issue of biological harm reduction, please see here: http://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-2-17

Overdoses with opioids have fallen in states where medicinal and legal cannabis are available (http://www.nytimes.com/roomfordebate/2016/04/26/is-marijuana-a-gateway-drug/overdoses-fell-with-medical-marijuana-legalization; and https://www.drugabuse.gov/news-events/nida-notes/2016/05/study-links-medical-marijuana-dispensaries-to-reduced-mortality-opioid-overdose). With high rates of opioid addiction plaguing our country, it makes sense to legalize cannabis now to help address this issue.

Self-Medicating: People self-medicate with substances on a daily basis; from alcohol to caffeine to tobacco. People self-medicate with herbs as well from turmeric to Echinacea, to vitamins and natural thyroid supplements. With legalization and regulation, people have a better chance of using safe, monitored, quality herbal cannabis medicine. For most of our recorded human history, cannabis was used as a healing herb. This came to a halt when cannabis prohibition became a global stance. Additionally, legalization opens the door for more open discussions between healthcare providers and patients. Healthcare providers such as nurses and doctors must become educated around the body’s endocannabinoid system and the therapeutic use of cannabis to create homeostasis and support healing.

Pathways for New Healing Products: Currently, many new cannabis products that are available in legal states are not available to medicinal patients in states where only medicinal cannabis is legal. For instance, various teas, salves, edibles and patches that are available in Colorado, Washington, or Oregon are not yet always available for medicinal patients in other states. Once states have a legalized cannabis regulation processes in place, it may be that people can access items such as a topical sub-dermal patches to deliver cannabis medicine or specific cannabinoids. A person may be able to use a CBD (a non-psychoactive cannabinoid) only patch during the day to help with issues like, pain, anxiety, nausea, and depression, and a CBN patch (another non-psychoactive cannabinoid) at night to help with sleep. In this example, the person would have minimal if any exposure to the psychoactive effects of THC in cannabis, and yet they may experience a greater quality of life. From a justice perspective, people deserve to make choice around the medicines they would like to utilize for their own healing, particularly when the medicines are safe.

Social Justice Issues and Policing: Recently, the chiefs of police in Maine came out against the yes on 1 ballot initiative to legalize marijuana in Maine. It is interesting to me that this organization stated they are “unprepared to address legalization issues,” when certainly looking at the legalization issues in Colorado and Washington should provide plenty of data and solutions to common issues. I would posit that there would be fewer marijuana trafficking issues and convictions, and the police could turn greater attention to bigger and more harmful issues in Maine, such as the opioid crisis and OUI related to alcohol ingestion. Additionally, cannabis legalization is a step toward social justice given the illogical, irrational, and unsuccessful war on drugs (http://www.sfgate.com/opinion/article/Marijuana-legalization-a-step-toward-social-5848468.php, http://theweek.com/articles/542678/why-pot-legalization-also-fight-social-justice). Legalizing cannabis should free up our law enforcement agencies to fight crimes that cause greater damage, even as it lowers the need for them to be addressing black market cannabis issues.

I would like to close with my final thought:

All cannabis is medicinal. Our bodies have our own endocannabinoid systems; we make our own endogenous cannabinoids. However when we become deficient in these cannabinoids, we may become ill and need to seek exogenous sources of cannabinoids, or support our own bodies in creating more endocannabinoids. Cannabis is a safe effective medicine with a low rate of addiction and minimal if any withdrawal symptoms, similar to caffeine. Ingestion of cannabis itself has never lead to a death (unlike many prescription and OTC drugs, alcohol, and nicotine products), and it is time we begin to move beyond the government’s ineffective “prohibition of marijuana” stance and take steps toward effective access for all adults.

In the states where cannabis is a ballot initiative, I urge us as nurses and other healthcare providers to explore the data around cannabis as a medicine and consider our roles as advocates for patient access to the healing support this medicine can provide.