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Burning Questions About Smoking Cessation

harnessg — Fri, 03 Jun 2022 18:14:41 +0000

Burning Questions About Smoking Cessation

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 06/03/2022 - 13:14 RSS:

Occupational Health Clinic

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Ms. Lesa Abney, RN and Tobacco Treatment Specialist for Vanderbilt, Tobacco, Addiction, and Lifestyle (ViTAL), discusses smoking cessation and resources for treatment.

Additional Resources

Occupational Health Quit Rx Program

ViTAL

Tennessee Tobacco Quitline

https://smokefree.gov/

Begin Transcript

Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness WellCast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Mr. Lesa Abney, a registered nurse and tobacco treatment specialist for the Vanderbilt Center for Tobacco Addiction and Lifestyle, also known as ViTAL. Thanks for being with us today, Lesa.

Lesa Abney, R.N.: Oh, you are welcome.

Shaina Farfel: We all know that smoking is bad for our health, and I am sure a lot of our listeners who are also smokers have been advised to quit by friends, family members, healthcare providers, but we also all know that quitting smoking is an incredibly challenging endeavor and certainly not one to embark on lightly and without a plan. As an expert in the field, I wanted to pose a few questions for you today that I think will help our listeners to contemplate and prepare for quitting smoking in a realistic way. Can you start by telling us what are the health benefits of quitting smoking and if I have been a smoker for let's say lots of decades is the damage already done or can it be reversed in terms of my health?

Lesa Abney, R.N.: Well, a lot of it depends on the exposure, but the bottom line for everybody to remember is that anyone at any age can benefit by quitting smoking and here is just a few of the time points that you can think about. After you have had your last cigarette, in 20 minutes, your heart rate and blood pressure will begin to drop. In about 12 hours, the carbon monoxide level in your blood begins to drop back toward normal. In 48 hours, the damage nerve endings will begin to regenerate, and your sense of smell and taste will begin to return to normal. In about two weeks to three months, your risk of heart attack will begin to decrease. Your circulation improves and your lung function increases. Also, something you probably do not think about is that your HDL cholesterol will improve. In the timeframe of like one month to nine months, the coughing and shortness of breath will improve. The cilia, or those tiny hair-like structures that help us keep our lungs clean, will begin to regain their normal function and help us reduce the risk of infections. A year after quitting, the excess risk of coronary heart disease is half of that of a continued smoker. After five years, the risk of lung cancer is about 40% lower than those of continued smokers. In that five-year period, your risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Most people do not think about bladder cancer as being related to smoking, but it is. Cervical cancer and stroke risk start falling to that of a nonsmoker at about five years. Ten years after you quit, the risk of cancer of the voice box or your larynx and your pancreas will decrease. You have probably also heard that smoking impacts the wrinkles around your face. If you quit smoking, the collagen will get better. You will have fewer wrinkles, meaning a more youthful appearance. One thing that people don’t really think about when they think about quitting smoking is cost. When you quit smoking, you reduce your own financial burden, the burden on the healthcare system and on society as a whole. You also are ill more often. You miss more work which impacts your bottom line. You expose your children and other relatives to risks of illness which means you may have more sick days taking care of sick children. Your pets are even impacted by smoke, so that is something to think about. Even if you go outside to smoke, you come back in and you have third-hand smoke on you which then still impacts your family. I do not know if you have heard this very much, but I have had patients tell me that you know I only smoke organic cigarettes. They are much more healthy. There is not a problem with those. Well, then we do a little bit of education because the chemicals are released from the tobacco set on fire. So, organic cigarettes, as well as regular cigarettes, are going to have the same 7000 chemicals because they are set on fire when you smoke it. So, you are still getting the same damage whether you have organic tobacco or not. Studies that looked at people who quit smoking versus people who continued to smoke noticed that people who had quit had lower scores of depression, lower scores of anxiety, and higher scores of wellbeing. Remember, when you do quit, you do need to use the three months of medication as well as the counseling to help you manage that nicotine withdraw and the coping skills.

Shaina Farfel: So, just huge spectrum of benefits from physical health to mental health to financial health and I did not know a lot of those numbers. That’s really significant. One of the questions I get a lot from patients is, okay, so let's say I am smoking a pack a day and I am able to cut back significantly to a half-pack or less, but I am still smoking, is this better than smoking a pack a day or do I only get the health benefits by stopping completely? Any thoughts about that?

Lesa Abney, R.N.: Actually, there was an article written and published in the British Medical Journal in 2018 that really helps answer this question. They report there is no safe number of smoked cigarettes. Smoking one cigarette a day, carries 40% to 50% of the risk of cardiovascular disease and stroke as smoking 20 cigarettes per day. So, think about it like this, it is just like asbestos. There is no safe level.

Shaina Farfel: Just sticking with it to get down to zero is the goal.

Lesa Abney, R.N.: As you said, if they are in the process of cutting down to quit, I have cut down to a half-pack and I am on my way to quitting, that is something that we encourage because you are cutting down to quit but have that quit as the end goal.

Shaina Farfel: Yes. Absolutely. This is a loaded question and I know you could probably answer this for days. If someone has tried and failed to quit in the past, how can they remain motivated to quit in the future and what might they consider doing differently next time that may be more successful?

Lesa Abney, R.N.: One thing to remember is this statistic, only 5% of the people who are trying to quit use medication and counseling. We need to remember to use the tools that are proven to be successful. Those are the FDA approved medications as well as getting into a structured counseling program. This counseling program can be used through the State QuitLine which is free. You can go to smokefree.gov and sign up and get text messages or they can contact you guys at the Occupational Health Clinic because you guys have got a really good program. So, using these helps improves your odds of quitting, but the most important thing is do not get discouraged. If you think back to a time where maybe you were trying to learn a new skill, that new skill could be something to do with work, maybe learning how to type, maybe learning a new exercise or trying to learn a craft, something that might even be fun, when you learned this new skill how did your first attempts go with this? How did that attempt go? Did you do perfect the first time you did it? Did you get frustrated or discouraged because I just cannot get this typing down? I know it took me quite a while to get the skills down to where I can type and do so with very few errors and that is the way it is with smoking. Always think back to a time in your past. What did I do to be successful then? Maybe I practiced. Maybe I got help from friends. So, always remember, we learn from the challenges. As you are going through this process, you are going to have some ups and downs, but you learn from them and just keep on going.

Shaina Farfel: Absolutely. I think that is a really good way to think about that. I like the analogy of learning a new skill because it is something you have to relearn and retrain your body.

Lesa Abney, R.N.: Exactly. Because you learned how to smoke. You have got to learn how to quit.

Shaina Farfel: Right. Right. Exactly. Unfortunately, that part is harder.

Lesa Abney, R.N.: Yes, it is.

Shaina Farfel: Again, this is another thing that I hear a lot from patients who are ready to quit smoking, but one of the biggest hindrances that I think they face is when they have family and friends around them or even in their household who are still smoking. If someone is ready to quit, how might they be able to overcome a hurdle like that?

Lesa Abney, R.N.: And that is a really, really big challenge for a lot of the people that I speak with as well. One thing we usually start with is you will call a family meeting. Say okay guys, I am quitting smoking. I have this reason, this reason, and this reason. I am quitting smoking. I would like your help and support. Make your home a no smoking area. Say I understand we all smoke, we are all going to start smoking outside. We are not going to smoke inside the house anymore. Because if you have to get up and go outside, it usually makes you look at it a different way. I don't want to go outside. I will just wait. It is too hot. It is too cold. If you are an outside smoker, most everybody has a little smoking area setup outside, chair, table, ashtrays, you want that to look different inside and out. Clean away all your smoking paraphernalia. Put something different on the table. Make it look different. You want to have a different visual for that trigger when you see it. It is also really important that you have props in your hands. Something as silly as a pen or pencil that you can mess around with, you can hold. The spice cinnamon we use in cooking comes in a form of cinnamon sticks. Those cinnamon sticks are rolled up bark. They feel like a cigarette. Hold that in your hand and breath in and out through it. A straw, breathe in and out through it. Hold it in your hand. Works great in a car. Flavored toothpicks are another good prop. You can get those on Amazon and find recipes to make them yourself, especially if you are a menthol smoker. Menthol is another layer in quitting because people are addicted to the nicotine and the hit of the methanol going down their throats. Using things like that and oral nicotine replacement when you are around other smokers can also be very beneficial.

Shaina Farfel: Those are great ideas. We do not have to get into this kind of exhaustively, but you know you mentioned that there are medications available for treatment. What’s sort of the overview of what those medications are just so people have an idea?

Lesa Abney, R.N.: Well, there are seven FDA approved medications. Five of them are nicotine replacement and two of them are oral medications. The big picture is patches are long acting and they can be purchased over the counter or as a prescription depending on your insurance. Short acting is the gum and the lozenges that also be purchased over the counter or prescription. They are dosed according to how much you smoke. It is important to have strong enough patches. So, if you smoke 10 cigarettes a day, you really need to start with a 21 mg patch to be sure you are covered. The important thing that a lot of people do not know about the short-acting nicotine replacement lozenges and gum is they have got to be used the right way. They absorb through the lining of your cheek, not your stomach. Read the directions very carefully. You want to make sure you are using these the right way so that you are getting the best benefits. Using patches which are long acting with the oral, which is short-acting, using those together covers breakthrough cravings and is much more affective. The two-prescription nicotine replacements are a nicotine inhaler and nasal spray. I do not see nasal spray used very often. A lot of people do not like to use nasal sprays. The inhaler is almost cost prohibitive because a lot of insurances do not cover it. It is not an inhaler like you think about using for asthma. It is a plastic piece shaped as a cigarette with a vial of FDA approved clean nicotine in it that you can do this with.

Shaina Farfel: That is a new one for me.

Lesa Abney, R.N.: Yes, and our insurance does not cover it. We have the oral medication which is called Wellbutrin or Zyban. Be aware that this is not used as often as it was in the past because there is multiple medication to mediation interactions. Chantix or varenicline is used quite frequently. There are now two genetics, one of them is called apo-varenicline and the other one is varenicline. They are very effective. The EAGLES trial published in 2016 showed the efficacy of varenicline as well as its safety profile. It did show also that you have a 50% chance of quitting over patches alone. Also, studies are showing using nicotine replacement short and long acting together are kind of on the same level as varenicline. Both of those are very, very good ways to quit. Always remember that whatever medication you choose you need to use it for three months. The general timeframe is 6 to 12 weeks that it takes the nicotine receptors in your brain to return to normal of presmoking levels. Let your brain heal. Once it heals, you are less likely to have issues with the nicotine withdraw, the irritability, the anxiousness, and those strong cravings and such. That is why they are always recommended for three months.

Shaina Farfel: Wonderful. Thank you for going through that. That was very helpful. Lastly, what smoking cessation resources are available here at Vanderbilt for folks if they are contemplating quitting?

Lesa Abney, R.N.: Well, you guys actually have an amazing program for all of our employees which is so amazing, and I wish more people knew about it. Also, there are free services such as the Tobacco QuitLine which is 1-800-quit-now. Each state has their own QuitLine funded by the state, giving some free medications depending on the state. You can also go to smokefree.gov which is a testing service that can kind of help give you assistance and that is sponsored through the National Cancer Institute. Tell me a little bit more about your program.

Shaina Farfel: Yeah, thank you. We at Occupational Health have a program that is called Quit Rx and it is a program that would allow any employee, both university and medical center, to come see one of our occupational health providers and the consultation with us is free and we talk about motivation to quit. We discuss whether or not some of these medications that you talked about may be appropriate, and we can prescribe them and follow you throughout your care and that could be up to three months and in some cases, there is indications for longer or help kind of get you in with your PCP to continue to follow you. We do, as you said, if you are in this program with us, we do also get you connected to a health coach through Health Plus who is also following you for counseling around smoking cessation so that you have got both of those pieces going. We like to remind folks that this is a service that can be done in person. It can be a telemedicine appointment. We like to make it convenient and accessible for all employees. So, I will link some resources to that when we post the podcast. If you are interested, you can call our main Occupational Health line too at 615-936-0955 and setup an appointment.

Lesa Abney, R.N.: It is a great program. From different staff members that I have worked with, I have heard a lot of really good things about your program.

Shaina Farfel: Yes. Just trying to get the word out because we are all here and ready to help you guys. Well, Lesa, thank you so, so much for your time today. I think folks will find this information incredibly helpful and we really appreciate your expertise and sharing with us. Thank you again.

Lesa Abney, R.N.: I appreciate the opportunity. Thank you.

Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/health-wellness.  

Tags

Addiction, Counseling, Medical Care, Prevention, Tobacco Cessation, VU, VUMC

Lockdown Auth

Is Lung Cancer Screening Right for You?

harnessg — Fri, 04 Feb 2022 14:00:00 +0000

Is Lung Cancer Screening Right for You?

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 02/04/2022 - 08:00 RSS:

Occupational Health Clinic

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Ms. Alexis Paulson, Radiology Nurse Practitioner and the Clinical Coordinator of the Vanderbilt Lung Screening Program, discusses lung cancer screening recommendations and eligibility.

Vanderbilt Lung Screening Program

Vanderbilt Health Lung Cancer Screening

Begin Transcript

Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Ms. Alexis Paulson, Radiology Nurse Practitioner, Clinical Coordinator of the Vanderbilt Lung Screening Program and a tobacco treatment specialist. Alexis, thanks so much for joining us today.

Alexis Paulson, N.P.: Thank you.

Shaina Farfel: When most of us think about cancer prevention, screenings for breast, colon, and cervical cancer are probably some of the first things to come to mind. However, for a big segment of our population, there is another cancer prevention strategy that we want to bring awareness to today and that is lung cancer screening. Can you tell us why lung cancer screening is so important and also how it is performed?

Alexis Paulson, N.P.: I think it is important for everyone to realize the prevalence of lung cancer and the burden of lung cancer deaths on Americans. Lung cancer kills more Americans than breast, colorectal, cervical and ovarian cancers combined. While breast has the highest incidence of cancer detection in our country, lung cancer has the highest number of people who pass away from cancer. Unfortunately, that has a lot to do with how late lung cancer is typically detected. Like all cancers, it is much easier to treat when the disease has not metastasized or spread into the tissues around the lungs. We have found over decades of research that chest x-ray and other sputum cytology tests have not been shown to reduce the risk of dying from cancer because they do not catch lung cancer in that early, early stage. Annual lung cancer screening CT scans have been shown to reduce lung cancer deaths by 20% in a population of high-risk individuals and that is done by performing a low-dose CT scan of the lungs which gives us a highly detailed image that can be compared over time from year to year to see what is new or changing, that way we can catch lung cancers at its earliest stage, stage I or II. If we catch a lung cancer at the earliest stage before any symptoms arise, patients have a 60 to 90 percent five-year survival rate rather than a 10 to 36 percent survival rate when caught in later stages.

Shaina Farfel: That is really significant there. Are there any risks associated with the lung cancer screening, this low-dose CT scan that patients may need to be aware of?

Alexis Paulson, N.P.: Yeah, so, there are risks with all cancer screenings and lung cancer screening is similar to other cancer screenings in that the biggest real risk of lung cancer screening is that we may see abnormalities on the scan that are not actually cancer, but do require additional testing. So, most of the time we can rule out cancer with additional imaging, but sometimes we have to do invasive lung biopsies or surgeries to rule out cancer. Most people are relieved when a lung cancer is not detected with these additional tests, but we have to consider all of that additional time, energy and sometimes expense that comes along with additional testing and we have to call that a potential harm of screening. Like with all tests there is always a chance of missing something on the scan too which would be really hard to do, but coming every year is the best defense against that because, again, we are comparing those images over time to see what is new or changing. There is also a low dose of radiation given with lung cancer screening CTs. This is more radiation than with a chest x-ray, but it is about a quarter of the typical chest CT scan. We keep those doses as low as possible so we can safely give them very year.

Shaina Farfel: Thanks for clarifying that. Who would be eligible for screening? I know that there may have been a recent change in some of the guidance and if so, how has that changed recently in terms of eligibly?

Alexis Paulson, N.P.: Again, lung cancer screening is just recommended at this point for people who are considered higher risk for lung cancer. The current recommendations define that as anyone who is 50 to 80 years old with a 20-pack-year smoking history and who has smoked in the past 15 years. Now, pack years are calculated by the packs per day a person smokes and the number of years that they have smoked. So, a pack a day for 20 years or more would qualify you as a 20-pack-year history or two packs a day for 10 years would also quality as a 20-pack-year history. The age recommendation recently went down from 55 to 50 and the pack-year recommendations went from 30 to 20 and these changes were intended to capture more patients at high risk for developing lung cancer based on newer research showing the benefit from lower risk individuals.

Shaina Farfel: How can patients access lung cancer screening here at Vanderbilt and is it something that is typically covered by insurance?

Alexis Paulson, N.P.: Medicare and Vanderbilt insurance, and private insurances currently cover lung cancer screening in full for all individuals who qualify as high risk and this is always determined and documented by one of our nurse practitioners prior to the lung screening CT. So, you would have a conversation with one of the N.P.s prior to the scan to confirm that you meet the criteria and make sure you understand all the risks and benefits. Like I said, most private insurances cover the screenings in full, but some plans have not adopted the new criteria that we were discussing about the new ages and pack-year history. So, some people still have to be 55 and have a 30-pack-year history rather than 50 with a 20-pack-year history. Now to get screened at Vanderbilt, you can call our program navigator at 615-322-0580 for assistance or speak with your provider and ask if they think that lung screening would be beneficial to you. If you do not quality as high risk by the current criteria but would still like to be screened, we do offer a 145.00-dollar self-pay option as well.

Shaina Farfel: Okay. That is wonderful. Thank you so much Alexis for sharing your expertise and for continuing to bring awareness to this important issue. We hope to have you back again soon.

Alexis Paulson, N.P.: Thank you so much.

Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/health-wellness.

Tags

Cancer Prevention, Medical Care, Primary Care, Risk Reduction, Tobacco Cessation, Prevention, VU, VUMC

Lockdown Auth

Psychological Flexibility: Go with the Ebb and Flow

harnessg — Fri, 14 Jan 2022 18:33:49 +0000

Psychological Flexibility: Go with the Ebb and Flow

Health Plus, Wellcasts, Wellcasts - Health Plus

harnessg Fri, 01/14/2022 - 12:33 RSS:

Health Plus

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Stepping into a new year can feel exciting and overwhelming. Join Dr. Jim Jackson as he introduces us to psychological flexibility, which he calls the super power of super powers for mental wellbeing. He teaches us how to develop this type of flexibility and why it can help us go with the ebb and flow of life more easily.

Begin Transcript

Bridgette Butler: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Bridgette Butler with Health Plus. Today, our guest is Dr. Jim Jackson, Psychologist with the VUMC Critical Illness, Brain Injury, and Survivorship Center. Welcome Dr. Jackson and thank you for joining us again today.

Jim Jackson, M.D.: Thank you, Bridgette. It is really lovely, as usual, to be with you today, so thanks for the opportunity.

Bridgette Butler: Absolutely. Now, Dr. Jackson, we have heard quite a bit in the last year about topics like resilience, coping with stress and navigating change and today we are going to take a new approach towards mental wellbeing by talking about psychological flexibility. Can you tell us what psychological flexibility is and how it is different from the topics that we have been hearing about?

Jim Jackson, M.D.: I have been thinking about psychological flexibility a lot of late Bridgette. We grapple a lot with what techniques and what characteristics are useful during this hard season we are in, and many psychologists believe that psychological flexibility is the super power. It is the superpower or superpowers. People with that trait, with psychological flexibility, what they are really good at doing is they are really good at being confronted with hard situations and finding novel and creative ways to cope with them. So, they do not let those situations define them. They are not overwhelmed by them. They maybe daunted by them, but they find innovative ways to deal. They find effective ways to cope. They are flexible.

Bridgette Butler: How can psychological flexibility benefit us as we start this new year?

Jim Jackson, M.D.: If this new year is like the last two New Years, it is going to be a bit of a doozy. You know, we are in the throws perhaps of a third wave of COVID. People are worn down and discouraged and depleted. I am hopeful about 2022, but I am worried that it will be hard. So, psychological flexibility can benefit us tremendously because if we rely on it, if we nurture it and cultivate it, it is going to help us cope more effectively with the hard challenges we are facing. Here is an example. You have two trees in your yard. We have many more than that. You have got a big oak and you have a slender willow. That big oak is rigid, right? The wind comes, it breaks the tree in half. The tree falls on your house. It is a disaster, unpleasant, all of that. That tree is rigid. The willow is the sapling. The wind comes. That sapling bends in one direction, bends in another and it survives that. So, that is not that different necessarily than how we are as people. There are people that you know, and I know, people we have observed, people in our neighborhoods, our churches, whatever who have really hard things happen to them and they find a way to cope, right? They find a creative way to make sense of things. They find a way to reframe things. They find novel ways to take the challenge on. Those are flexible people. They do better. Their quality of life is better. Their functional outcomes are better and that is what we want to foster, that flexibility. We want people, simple stated, to be more flexible. We equally want people to be less rigid. Rigidity is not your friend, right? We need to let go of rigidity.

Bridgette Butler: You mentioned that psychological flexibility is something that we can cultivate. What are some simple practices that might help us develop psychological flexibility in our work lives and in our personal lives?

Jim Jackson, M.D.: One of the underappreciated traits that psychologist is increasingly talking about, but only really recently is curiosity, right? We have a lot of negative connotations associated with curiosity. Curiosity, it killed the cat, right? Well, curiosity does a lot of really good things, right? Curiosity, being puzzled, wondering, that often helps us arrive at new strategies, different ways of engaging problem. So, one thing I would say is when people are faced with big challenges, maybe even immovable ones, let's start by getting curious, right? Let's not start by making assumptions. Let's not start by panicking which really reduces your cognitive feel. Let's step back and be curious. That would be one thing. Let's engage things with humility. Second idea, right. Let's not assume that we know everything there is to know about this. Let's imagine that there could be ways out of it, right, that could workable. Let's recognize too that we can tolerate more distress perhaps than we think we can. Distress tolerance, another concept that no one really wants to talk much about, but it is really important, right? We are strong, right? We have been steeled by the pandemic over the last couple of years. We have been made gritty. We can do hard things, right? So that is all under the rubric of psychological flexibility. The other thing I would say is let's surround ourselves with people with similar values, right? Let's surround ourselves by flexible people. Let's follow their example as they can follow ours.

Bridgette Butler: Those are great examples of ways that we might be able to grow our own psychological flexibility which is so necessary during this time. Thank you so much Dr. Jackson for joining us today and giving all of us all of these very helpful insights on psychological flexibility.

Jim Jackson, M.D.: Yes, so great to be here with you. Let's stay flexible.

Bridgette Butler: Thanks for listening. If you have a story suggestion, use the Contact Us page on our website at www.vumc.org/health-wellness.

Tags

VU, VUMC

Lockdown Auth

Understanding Workplace Violence

harnessg — Fri, 07 Jan 2022 14:39:29 +0000

Understanding Workplace Violence

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 01/07/2022 - 08:39 RSS:

Occupational Health Clinic

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Jay Morrison, Senior Associate in Nursing at Vanderbilt Adult Hospital, discusses workplace violence and prevention.

Additional Resources:

What is workplace violence? | Workplace Violence (WPV) (vumc.org)

Work/Life Connections - Employee Assistance Program | Vanderbilt Faculty & Staff Health and Wellness (vumc.org)

Adult Ambulatory Clinics – WPV SOP

Begin Transcript

Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Mr. Jay Morrison, Senior Associate of Nursing at the Vanderbilt University Adult Hospital. Thanks for being with us today, Jay.

Jay Morrison: Thanks for having me.

Shaina Farfel: Today, I want to discuss the importance topic of workplace violence which is often an under recognized problem that can have major implications for individuals as well as the organizations that they work for. Jay, can you define workplace violence for us and tell us how prevalent it is?

Jay Morrison: It is a broad topic and we, as an organization, have been very intentional in trying to define it so that it is as inclusive as possible, so that staff and anyone else here at Vanderbilt understand what we mean. Specifically, we would consider workplace violence to be abusive or disrespectful behavior that would be anything that is inappropriate, demeaning or otherwise offensive and would create an uncomfortable, hostile, or intimidating environment. If it sounds like I am reading it, it is because I am because it is extremely important, and we have very well-defined policies and procedures so that we get it right. This is really important. Unfortunately, you talked about the prevalence. We are seeing more and more aggression that leads to workplace violence, whether that is physical, verbal, it is pervasive unfortunately in our environment. Specifically, working with patients, those at the front lines are our most vulnerable, but that does not mean that those that are supportive do not experience it as well. Who is at risk? All of us. We need to have a good baseline understanding of what we mean by the topic and then when I identify it what do I do with that information.

Shaina Farfel: Have you noticed at all during the COVID pandemic, have we seen an increase in maybe some of these workplace violence encounters at all? I know that there has been increased stressors with employees and patients, have you noticed an uptick?

Jay Morrison: So, we have. It has been trending up pre-COVID. It is not like there is this major spike all of a sudden. We see the slope increasing, unfortunately. We are seeing the trend increase. We are seeing more verbal than we have before and I think that maybe more of a reflection of what you talked about, the stressors in our society and some of the rules that we have put in place that patients and visitors may not understand and certainly may not like, but for their safety we have done what we feel is appropriate for the organization and for our staff so we all stay safe.

Shaina Farfel: You touched on this a little bit, but what should an employee do if they experience violence in the workplace? What is their first step, where can they go, what are the resources?

Jay Morrison: Great question. Important question for staff. First and foremost is get safe. Remove yourself from an unsafe situation first and foremost. Second is report it to your immediate supervisor so that in the moment we can bring resources to help support staff and deal with the situation as it is happening. We really do not want to put staff out on an island to try and understand how to deescalate a situation. Now, we do have training available and I think we will talk a little bit about that in a bit, but we do have training so that in the moment I as a staff member may have some techniques that can help deescalate a situation, but when an event occurs, whether it is physical or verbal, we need to remove ourselves if we can and call for help, right? So, ask for assistance from your supervisor. We are fortunate to have Vanderbilt University Police Department here on campus and their resources and if we need to alert them, by all means, they are experts in this and they have been great partners in this work. If we need to reach out to our police department, we need to do that to keep us safe.

Shaina Farfel: So, stay safe is number one. Is this something that an employee would complete a Veritas for, or a supervisor would Veritas?

Jay Morrison: Yes. I will just say, once we can exhale, right, we are now in a safe place, the environment is safe and we have deescalated the situation, we need institutional learning, right, and Veritas is our system for reporting that. It helps provide the specifics that only someone who was involved in the event will know, so that we do not rely on someone downstream saying yeah, I think that happened in the lobby and I do not remember if that was the wife or a bystander. So, if someone who is involved can put that information in Veritas, they are the best one to understand the situation and the environment. A, so we know what happened. We can understand who was involved and we can understand what resources we need to bring to bear in the future based off of the reported events.

Shaina Farfel: Again, we have sort of started to touch on this, but what is Vanderbilt doing to prevent some of these events of workplace violence?

Jay Morrison: This is the exciting point for me from an operational perspective. We have always had our VUPD colleagues, which they are great partners. Over the last few years, a big thanks goes to our local leaders in our entities and our executive leaders and VUMC as a whole at saying, we need to have a concerted effort instead of having a good program in this one area. We, as an organization, need to have a standardized way to address this and specific resources to support our patients and our staff. Our staff are unfortunately getting the brunt of this, and it is in some physical instances. So, we need to make sure that we have the systems and structures in place to support them. Much like I was reading the definition of workplace violence, our overarching policy is very specific in defining the types of violence and then those steps that we would ask our staff to follow up with, with the Veritas, with our supervisor support. Each entity has created their own SOPs because each area is unique and may need to provide different resources based off of staffing, patient population, et cetera. Speaking for the adult hospital and our SOP, we have created different algorithms to try and make it easy after the fact, say what support needs to happen? So, we have specifics on how to support our staff because even if it is not a physical event, there is emotional trauma that happens after some of these events and we need to make sure that we are evaluating our staff and that they know the resources available for them so that they are not out on an island alone trying to deal with these issues. Then there is the patient situation or family, right? We do see the predominant groups involved are our patients towards our staff, but we do see events where it is visitors as well. How do we manage those situations? What are the resources to make sure clinically we are managing the patient appropriately and then we have the right behavioral techniques in interacting with the patient downstream as well as the environment in which care is being provided? We have experts here, thankful to our psychiatric colleagues, and on the adult side, we have access to a behavioral intervention team, and they are experts in helping us understand the right plan of care for patients that do have dysregulation. It is important for staff to know what their resources are and to get the primary teams involved so that this becomes a multidisciplinary review. We do not want staff to feel like I have got to now solve this problem myself, whether that is the staff nurse or the local leader, it needs to be a team effort. We are all in this together and we need to support one another together. We really wanted to put processes in place to support our staff so that they can stay safe and then the patients to make sure that we can manage those situations appropriately and not have a repeat event.

Shaina Farfel: So, it sounds like interdisciplinary multifaceted approach. That’s wonderful. You mentioned emotional trauma and I just wanted to point out that there is the Employee Assistance Program that we have here that is a free service, a confidential service for employees and just wonderful staff that are there, and I will, along with this podcast, I will post some links to that service and others as well as the VUMC Workplace Violence Policy that was mentioned so folks have some resources. Again, we do just want to remind folks that if they experience any of these acts of violence in the workplace or they have concerns please, please reach out for support and report it. Jay, thank you so much for your time and your expertise on this. We really appreciate it.

Jay Morrison: Certainly. It is an important topic. I am glad you are covering it. Thanks.

Shaina Farfel: Yeah. Thank you.

Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/health-wellness.

Tags

Crisis, Mental Health, Personal Safety, Prevention, Stress, Violence, VU, VUMC

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Asking For Help: Myths & Facts

harnessg — Fri, 10 Dec 2021 21:01:53 +0000

Asking For Help: Myths & Facts

Wellcasts, Wellcasts - Work/Life Connections, Work/Life Connections

harnessg Fri, 12/10/2021 - 15:01 RSS:

Work/LIfe Connections

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Ted Rice, Clinical Counselor at the Vanderbilt work/Life Connections-EAP, highlights the fears and the positive reasons about engaging in a psychotherapy relationship.

Begin Transcript

Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Rosemary Cope with Work/Life Connections.

My guest today is my colleague, Ted Rice, who is a clinical counselor at the Vanderbilt Work/Life Connections Employee Assistance Program. Ted completed his master’s in education and human development counseling right here at Vanderbilt.

You know, the decision to seek out therapy can be wrought with fear, ambivalence, and shame. You may be struggling with some issue, or you might want to improve your own mental state and while popular culture affirms the merits of wellness too often mental health is still stigmatized making the decision to enter therapy even more difficult. If you are considering therapy or if you are about to have your own first therapy session, you might be nervous, skeptical, or downright frightened about starting. Many of these fears may have led you to have some unrealistic ideas about the therapy relationship. So, Ted, would you talk about some of the myths surrounding therapy?

Ted Rice: Rosemary, thanks for having me on today. You know, as you stated, seeking help, clinical assistance, can be exceedingly difficult. I think one of the key myths when we consider counseling is this idea of, I must have failed taking care of my own issues myself, and I always explained to clients that asking for help, it really is not a sign of failure, but it truly is a tangible expression of one's courage. The truth and the fact is that we all have what I call blind spots about ourselves and the world in which we live. The therapy that we enter provides us the opportunity to examine not only our interior lives, our relationship with ourselves, but the world in which we live, so again, therapy provides, really, the opportunity to gain insight into these blind spots, education and skills to make the adjustments we need to get unstuck and move forward in life with improved confidence, empowerment and the opportunity to meet our clinical goals that will be formulated as we continue in the counseling process.

Rosemary Cope: The therapy relationships, what we have been talking about to some degree, it is unlike any other that we are going to have. You, as the client, will spend time with someone who is initially a stranger talking about some of your more hurtful or distressing situations. You will know little or nothing about your therapist's private life, and they will know everything about yours. Ted, can you also share with our listeners some of the facts about the effectiveness of therapy?

Ted Rice: Definitely. Therapy real simply said, I think it is one of the kindest, most gentleness gifts we can give ourselves. I say that with every client that comes in. People are so concerned, will this work, will it help, and it always does. Having the opportunity, a safe place, to look at our pattern of our issues and to sit with another professional to begin to share what is hurting, to begin to share what we have considered, to begin to examine and share that which we do not have a knowledge of when we enter into care. Frankly, therapy, it is effective. It gives our clients opportunity to, what I call, uncover the source of our problems, then to discover the connection between the past and our current lives, and gives us really opportunity to self-correct and, frankly, feel better Rosemary.

Rosemary Cope: Ted, one of the things you said I loved, and that was about therapy being gift, a kind gift to ourselves. That is wonderful. Because I know, it is not always an easy process for somebody to go through and someone might feel worse before they feel better. How would someone know if it is working and if their therapist is a good fit for them?

Ted Rice: Great questions. Is it working, right? The first question that you asked, is it working? It is hard initially. What I have noticed over the years in a counseling process and our clients notice that often times other people see the changes happening to ourselves before we see them. So, I encourage folks to ask for feedback. I know here at Work/Life Connections EAP we use some pretty sophisticated rating scales when folks come in, we use a Burn's Depression and anxiety inventories so we can actually see objectively the severity of the hurt and pain a person has, and then in the counseling process, we can go back in a month, two months and we can retest, and then there becomes a tangible difference. It is evident that the therapy is working. Besides scales, really Rosemary feedback from others is critical to know if our counseling is working. We can seek feedback from our medical providers, from our families, our friends, our colleagues, and we can get that feedback from our counselors as well. I think some simple questions to ask is counseling working, ask yourself these questions: Am I experiencing hope? Do I feel optimism? Do I feel unstuck? I kind of just feel like myself again. Are the skills that I am working on and learning from my counselor, are they helping to address my specific issues or problems? The other part of your question, goodness of fit, is real tricky because I think often times clients will stay stuck in therapy, sometimes because of their own stuff that is going on and their inability to connect with the therapist. Yet, other times, it really is an ineffective relationship between the counselor and the client and if that is the fact then it is really important to bring it up into therapy and talk with your provider about this so that things can be resolved so that if it is my stuff that is blocking the relationship let's talk about it. If it actually is exterior and has to do with a lack of connection, then simply ask your counselor or therapist for a referral. We really will not take it personal, so I encourage you to use your voice and ask for what you need.

Rosemary Cope: Ted, thank you for sharing your insights about this. I think, based on your own personal experiences of being a counselor for all these years, these are great insights and good advice for somebody who is considering or is about to start therapy and for our listeners, if you would like to get a taste of that or you have something that you would like to initially start with, please contact us at the Work/Life Connections Employee Assistance Program and we would be happy to talk to you about any and all of your concerns.

Thank you all for listening. If you have a story suggestion, use the Contact Us page on our website at www.vumc.org/health-wellness. 

Tags

Counseling, Mental Health, VU, VUMC

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Health and Safety Tips for International Travelers

harnessg — Fri, 03 Dec 2021 14:21:08 +0000

Health and Safety Tips for International Travelers

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 12/03/2021 - 08:21 RSS:

Occupational Health Clinic

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Today we are discussing international travel health and safety tips with Paula Monte, Physician Assistant at Vanderbilt International Travel Clinic.

Additional Resources

Vanderbilt Occupational Health International Travel Visit

Vanderbilt Travel Clinic

Smart Traveler Enrollment Program (STEP)

Begin Transcript

Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Ms. Paula Monte, physician's assistant, at the Vanderbilt International Travel Clinic. Paula, thanks so much for being with us today.

Paula Monte, P.A.: Thank you, Shaina.

Shaina Farfel: As our world begins to open up again for the first time in almost two years, I wanted to discuss the importance of promoting health and safety during international travel. Paula, can you tell us what is travel medicine and under what circumstances is it appropriate for someone to think about scheduling an appointment with a travel clinic.

Paula Monte, P.A.: Travel medicine specializes in diseases and conditions that can be acquired traveling abroad, mostly to developing countries. Travel to different countries, it involves foodborne, inset borne diseases, amongst other potential risks. Diseases, injury, even security issues.

Shaina Farfel: For any type of travel or any destination, would someone maybe think about making an appointment for a travel clinic or are there only maybe certain areas that, that might be necessary to consider?

Paula Monte, P.A.: Good question. Mostly to developing countries. The industrialized world is fairly safe to travel to. It is just like living her in the United States, but when you travel abroad to countries where there are risks of diseases, some countries have requirements for vaccines in order to enter such as the Yellow Fever vaccine. If a traveler is at all concerned, making an appointment, coming in, sitting down for a consultation is always a good idea.

Shaina Farfel: So, sounds like it cannot hurt, maybe even if you are not quite sure.

Paula Monte, P.A.: Absolutely right. Cannot hurt.

Shaina Farfel: What vaccines or medications might be recommended for international travel? This also kind of gets into, for getting vaccines, when would be an appropriate to get those? How far in advance would I need to start thinking about that?

Paula Monte, P.A.: So, the most commonly recommended vaccines for travel is hepatitis A and typhoid and, of course, a current tetanus. Everyone should have a current tetanus vaccine. There are some vaccines that are in series. For instance, two to three given over the course of three to four weeks. So, a month prior to departure is always a good idea. At least 10 days. Most vaccines take about 10 days for them to become effective, but if you want to come in months before you travel that is always a good idea as well. Prescriptions, malaria is always an issue in of course malaria-risk area and then I always recommend and prescribe an antibiotic to treat traveler's diarrhea which can always be an issue when traveling abroad.

Shaina Farfel: So, it is good to have those things just on hand in case. Sure. Other than vaccinations, what do you think are some of the most important tips to protect an individual's health and safety when going on international trips?

Paula Monte, P.A.: I mostly talk about foodborne and bug borne diseases. Foodborne diseases, I usually talk to the traveler about their specific itinerary and a lot of my advice does depend on their specific itinerary. Where they are going exactly. What activities they plan to do while they are there. If they are traveling with a guided tour. If they are sleeping in a hotel or if they are sleeping under the stars. All of these factors are taken into consideration when I do sit down with the traveler. Foodborne and bug borne diseases are the biggest topics of conversation. I also talk about travel safety. Of course, in this world of the pandemic, COVID-19 entry requirements are a big part of the consultation. I always recommend that people who are leaving the United States, especially in this world, that they register with the Smart Traveler Enrollment Program and that is something that anyone can go online and Google and register. It is a communication tool. You can give them your itinerary, your contact information, and they basically track you while you are abroad. If there is anything going on in the areas, they have the opportunity and the ability to contact you and the U.S. Embassy if needed. I always recommend that they register about a month before they leave so that the COVID-19 entry requirements will start to pop up on their smart phones.

Shaina Farfel: That sounds like a great tool, and I am glad that you mentioned COVID because I know lots of folks are obviously having questions about that as they travel. We get this a lot from folks at Occupational Health, but what should a person do if they were to get sick or injured during an international trip? Any recommendations there or ways to prepare?

Paula Monte, P.A.: Good question. For patients who are at high risk to travel, for instance those that have underlying medical conditions, pregnant travelers, I always recommend that they research evacuation health insurance. This is an insurance that will evacuate them to an industrialized country in the event of an illness or an injury. For other travelers, the STEP program is a good resource, if there is something going on in the area, they will be made aware and then they can alter their plans if necessary. The embassies where they are traveling to, I always recommend you find out where the U.S. Embassy is in case you need it, especially for those adventurous travelers that plan to go without guides and go off of usual tourist itinerary. There are several organizations that do provide evacuation health insurance, fairly inexpensive. You can purchase them for short term. For instance, the length of your trip. They are very good at arranging evacuation and providing fairly good healthcare as well. Of course, the most important part of staying healthy is just to be careful. Know what the risks are where you are going. Know what the risks are with the activities. Plan ahead.

Shaina Farfel: Great advice. What resources are available locally here at Vanderbilt and how might somebody schedule an appointment with the Travel Clinic if they were interested. Does that require a referral? Do they just call to get in?

Paula Monte, P.A.: We are self-referral. So, the International Travel Clinic does require an appointment. So, any Vanderbilt University employee who is traveling for Vanderbilt business can go to the Occupational Health Clinic and receive the consult, vaccines, and prescriptions at no cost to them. If they do need the Yellow Fever vaccine, they are then referred to me. I will administer the vaccine again at no cost to them. The Occupational Health Clinic does require an appointment for that. All university students traveling, the Student Health does have a travel component. And again, it is an appointment. If they do need the Yellow Fever vaccine, they are referred to me. The students though are required to pay, but only for the vaccine.

Shaina Farfel: Wonderful. Well Paula, thank you so much for your expertise on this subject and I am sure many of our employees with future travel plans will find all of this very useful and we will also post a link with some information about the Travel Clinic and Occupational Health's international travel resources with this podcast for folks who are interested. Thank you again.

Paula Monte, P.A.: Great. Thank you, Shaina.

Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.

Tags

Consultations, Medical Care, Personal Safety, Prevention, Travel Health, VU, VUMC

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5 Tools for Meaningful Connection

harnessg — Fri, 12 Nov 2021 14:49:53 +0000

5 Tools for Meaningful Connection

Wellcasts, Wellcasts - Health Plus, Health Plus

harnessg Fri, 11/12/2021 - 08:49 RSS:

Health Plus

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Have you noticed changes in your social experiences and how you connect with others during these tough times? Listen in as Dr. Shari Barkin discusses what social reintegration is, why it’s so important, and how we can do it successfully with 5 Tools to Create Meaningful Connections!

Begin Transcript

Bridgette Butler: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Bridgette Butler with Health Plus. Today, our guest is Dr. Shari Barkin with the William K. Warren Endowed Professor and Chief of General Pediatrics at Vanderbilt Medical Center. Welcome Dr. Barkin and thank you for joining us today.

Shari Barkin, M.D.: Thank you. So happy to be here.

Bridgette Butler: Dr. Barkin, you have said before that we are designed to be a social species and that we survive because we are connected to each other. I think we have all realized at this point how to true that is and it is also easy to notice that our social experiences and how we connect with each other has changed. We are finding ourselves exploring what it looks like and what it feels like to interact with one another again. Can you explain what social reintegration means and now this personally affects us?

Shari Barkin, M.D.: Well, you said it really well that we are designed to be a social species. That means it is actually in our DNA, it is in our anatomy, how our brains function, it is in our physiology and what it means to be healthy in terms of our mental health and physical health and we were then thrust into the pandemic and social unrest and these things together created a disruption to our social connection. It is so important what it is to be human is what we mean to each other and that is about connecting to people and really connecting to them in real life. So, when we talk about this notion of social reintegration, we are in a much better place now, not perfect, but better. This allows us, because of so many medical advancements such as the vaccine and other things, to actually now begin to reintegrate in real life with real people and that process sounds like it is simple. It sounds like it is just a simple flip of a switch, but it is not, and it is not because all of these elements have created a disruption in our sociology and physiology. So, reintegration is the notion that it is time for us to learn or relearn how to connect in deep ways in real life with each other.

Bridgette Butler: It sounds like we are going to be experiencing it just a little bit differently now. As adults, what challenges do we experience with social situations at this point?

Shari Barkin, M.D.: Well, I think the first one is again sort of wired in our brain is, is this a safe situation? The first thing that happens and it might not even be slow and intentional, it might be automatic at this point is, do I feel safe? Is this the right environment to be in? If I were to put myself in that environment, am I affecting my health, my family's health, people that I work with, the people in my community? I think because that is our knee-jerk reaction it creates cortisol cascade, creates a lot of stress and anxiety. So, that is a big challenge, is slowing it down that automaticity in saying, all right, wait a minute, am I safe? The answer might be different now than it was a year ago. In fact, it should be depending on context. I think the other piece about that is, how do I do this? Now, some people, if you are an extrovert, and I am a big extravert, I am so excited that I might enter into a conversation and just completely overwhelm you with all of my deep interests and questions for you. So, my reintegration approach is being mindful to turn that down so that it is slow and steady. Whereas if you are wired more than introvert, your first reaction might be, I do not know if I want to do this. It is going to take a lot of energy, or I would like to reintegrate, but I am not exactly sure even how in a social situation where I am going to get started with conversation. We are kind of out of practice with that on all amps of that spectrum and in between.

Bridgette Butler: How about children and families collectively? What are children and families experiencing?

Shari Barkin, M.D.: I see this a lot in our clinic. It depends on the age. It depends on whether you are a COVID baby or not. So, I am actually going to start with our littlest people that are COVID babies. In fact, when I meet people in the clinic they will say, this is my COVID baby, and they are not a baby anymore they are a toddler. This toddler's experience is really uniquely different than the toddlers that were pre-COVID. They have not interacted with a lot of other children. They are not really sure how to interact. That is something really critical that your are learning how to do in infancy, toddlerhood, preschool period is that social/emotional learning. It does not end after that. We are all still involved in our own social/emotional learning throughout our lives, but it is really exceptionally important because it builds a foundation of how you interact with people and expectations of what social norms are and communication and behaviors are. So, for our youngest children, this is an incredibly challenging place and families are asking us, how can I socialize my kids who really have not ever experienced "normal" social contacts? As children are older, if they have experienced being in a school setting or being on a sports team which maybe they did not go out for because of the COVID context, they are really craving that connection and craving that structure. So, for them, there is an infinity to be back in that space. They too need to sort of reintegrate and understand what are social norms and behaviors that are acceptable in a variety of situations. Then, you move to adults and families and families have had to be everything to their children. So, not only a parent, but in many cases a teacher and maybe even a mental counselor and the parents are the classic multihyphenate in coming out of COVID. That means that they are, depending on how you feel and sort of your natural inclination about how you are interacting, you might as a parent feel like I am not sure how to get back into this world and what is available to me. It is experienced, I think, differently at all different ages depending on your prior experience and what your expectations of today are.

Bridgette Butler: Excellent points. What is important to consider that may help us feel motivated and comfortable to reintegrate?

Shari Barkin, M.D.: Well, I want to reemphasize something you started with Bridgette and that is the valve of social connection. So, social connection improves depending on the people that you are connecting with. So, a big caveat here. Imagine your favorite people you are connecting with it improves your mood, it reduces depression and anxiety turning the volume down. It improves your memory. It improves your ability to learn. If you look at the level of your functioning, it improves your immune functioning as well as many other metabolic health pathways. So, in so many ways, strong positive social connection is the best treatment around for a lot of the things that are ailing us right now.

Bridgette Butler: That is very motivating. What actionable steps can we take while deciding when and how to reintegrate with our different social circles?

Shari Barkin, M.D.: Great. So, I am just going to throw these things into the tool kit recognizing that it is different for everybody. So, here are just some tools and you all decide how to use them and what is meaningful to you. The first tool is deciding what you are comfortable with and that means paying attention to context and the latest information and evidence. We live in a world that is uncertain. It is not that it was certain before, it just felt more certain than it does now, and so paying attention and deciding what you and your family are comfortable with recognizing that the context is shifting and changing. The second thing is to be intentional. By being intentional, you can identify something that is motivating to you and your family or the people that you love. So, for some people that might be setting up a play date or it might be going on a picnic with one neighborhood family. It might be gathering up, if you have musicians in your life or brining along your guitar or harmonica or kazoo and sitting outside but being intentional and playful and creative were you feel like you are controlling the environment a bit, but inviting at least one other person, family, into that circle. The third thing is to be proactive. So, I encourage you, I challenge all of us to just reach out to one person that we have not seen for a while that we really enjoy in making that connection. I know we feel like people should reach out to us and that is true. On the other end of that, we need to do the reaching out. So, even if we can reach out to one person that we have not spoken with for a while and find an opportunity maybe to go hiking or biking or have a conversation on a rocking chair outside or in the grass that intentionality plus proactivity, you will see that you will get an immediate boost from that. The fourth thing is to stay flexible. We know that everyone's lives are chaotic right now and unpredictable, so you might plan something, it might fall through, don't worry about it. Let it go. Try again. The fifth thing that I recommend is practicing random acts of kindness. So, a random act of kindness that connects you to somebody. It might be somebody that you know or somebody that you do not know, but it really highlights and underscores what it is to be truly human, what we mean to each other and bringing out the best of humanity. So, that can look like a lot of things. If you are on campus, it might be going to a Susie's and getting a gift card and giving it to somebody randomly to make their day. It might be bringing food to a sick colleague. It could be volunteering. Some of my favorite places to volunteer are the Nashville Food Project, Second Harvest, Faith Farms where you are outside and your actually, I am not a farmer, but I do like that kind of connection to the earth and maybe even reading to young children. I recently became a Book 'em volunteer. So, things that allow you to connect with other people, people that you do not even know where you are able to see really the best of humanity and bring that out in yourself recognizing who we are to each other is what makes us truly human.

Bridgette Butler: That is wonderful. Thank you so much for outlining some very actionable steps that we can take to motivate and to begin to socially reintegrate. We really appreciate you joining us today, Dr. Barkin.

Shari Barkin, M.D.: Thank you so much for this opportunity.

Bridgette Butler: Thanks for listening. If you have a story suggestion, use the Contact Us page on our website at www.vumc.org/health-wellness. 

Tags

VU, VUMC

Lockdown Auth

Two Eyes Are Better Than One - The Importance of Eye Injury Prevention

harnessg — Fri, 15 Oct 2021 13:11:51 +0000

Two Eyes Are Better Than One - The Importance of Eye Injury Prevention

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Exposures

harnessg Fri, 10/15/2021 - 08:11 RSS:

Occupational Health Clinic

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Dr. Avni Finn, retinal specialist the Vanderbilt Eye Institute, discusses common types of eye injuries and how best to prevent them.

Begin Transcript

SHAINA FARFEL: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health.
Today, we are speaking with Dr. Avni Finn, Assistant Professor in the Department of Ophthalmology and Visual Sciences and Retinal Specialist at Vanderbilt Eye Institute. Thanks for joining us today, Dr. Finn.

Avni Finn, M.D.: Thank you for having me on here, Shaina.

SHAINA FARFEL: So, Dr. Finn, can you start by telling us what the most common causes of eye injuries are and where they most frequently occur?

AVNI FINN, M.D.: I would like to start by just saying this is a really important topic because eye injuries can be really serious, even causing vision loss or blindness when we least expect it. So, to answer your question, some of the most common eye injuries can be blows from balls during sports, from hands during contact sports, flying objects like bungee cords during exercise and then other types of things during industrial work such as metal or nail pieces, BBs from guns we see a lot, bullets, darts, fireworks and then also chemical splashes or injuries which are really important, kind of in the population that we are all working with. These can affect all different parts of the eyes. Chemical splashes often effect the surface of the eye, the conjunctiva, and the cornea. Metallic pieces can be lodged into the cornea but can also get deeper into the eye as well and the flying objects like bungee cords and BBs can affect any part of the eye from causing damage and bleeding inside the eye to causing retinal detachments or even effecting the orbit surrounding the eye.

SHAINA FARFEL: How can we best prevent eye injuries? Can I, let's say, wear my regular glasses, my sunglasses, would that do the trick or what is the recommendation there?

AVNI FINN, M.D.: So, regular glasses and sunglasses do not offer much protection when you are at higher risk for eye injuries because they are not shatterproof and often times even the glass from the glasses breaking can also injury your eye. So, when you are performing or participating in activities that are higher risk, like contact sports, working with chemicals or other types of work where there may be flying particles such as objects or dust, you should really wear safety glasses that have side shields. And for chemical work, we recommend goggles. The other thing I would say is if you have children, it is also really important to supervise the use of any tools with your children, like scissors, forks, pencils and knives which can all cause eye injuries and also keeping chemicals away from children at all times.

SHAINA FARFEL: Absolutely. That is a really good reminder. Let's say I do get an eye injury. Are there any first-aid measures that I, myself, may be able to take at home to improve symptoms or prevent any further complications?

AVNI FINN, M.D.: Yes, definitely. So, I think the most important thing to remember is if you get something in the eye, I would try not to rub the eye and try not to apply any pressure in the eye. Particularly if it appears that an object is stuck or has penetrated into the eye, you do not want to attempt to remove it. So if you think there has been a penetrating injury, you should place a shield over the eye and seek immediate medical attention. For chemical burns and splashes, the most important thing to do is to immediately flush the eye with clear water as much as you can and then to seek emergency care. It is also really helpful if you can bring in any information you know about the chemical that got into the eye so that we know if it is an acid or a base and that can further inform the type of injury we are looking for and treatment. Also, if you are hit by something in the eye, again do not apply pressure to the eye, and if you have any visual disturbance, again, seek care of an ophthalmologist to ensure there is no retinal detachment. And I think in any circumstance if you are having visual symptoms and your concerned at all seeking immediate emergency care or the care of an ophthalmologist is really important.

SHAINA FARFEL: And as a reminder to folks too, we at Occupational Health are also happy to be first line for folks who may have an injury that happened here at work to the eye and typically we are referring over to the Eye Institute as well, but folks can always come to us. You touched on this too kind of already, but certainly there are things that are appropriate to do at home. Any specific signs or symptoms that people should look out for that would really necessitate going and seeing an ophthalmologist that you can tell people about?

AVNI FINN, M.D.: Some of the symptoms, I think, that should lead you either to Occupational Health or to an ophthalmologist would be severe pain in the eye, like a foreign body sensation, like a grittiness that feels more severe than that, like something is stuck in the eye or under the lid. Obviously, any sort of blurry vision or loss of vision in either part or all of your field of vision. That can be accompanied by flashing lights or floaters, as well if you have a cut or tear in the eyelid, any difficulty moving your eye or protrusion of the eye, and then usual pupil size and shape. We may not notice visual symptoms, but you might see that your pupil is a different size or a different shape than normal and then lastly any blood or haziness in the clear part of your eye.

SHAINA FARFEL: Thank you so much for sharing your expertise with us today. We are really lucky to have such a wonderful resource as the Vanderbilt Eye Institute right here on campus and for everybody listening, please, please remember to always, always wear eye protection when appropriate whether it is at home or on the job. Thank you so much again.

AVNI FINN, M.D.: Thank you.

Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.

Tags

Acute Care, Medical Care, Personal Safety, Risk Reduction, VU, VUMC

Lockdown Auth

New Kid In Town

harnessg — Fri, 18 Jun 2021 19:49:59 +0000

New Kid In Town

Wellcasts, Work/Life Connections, Wellcasts - Work/Life Connections

harnessg Fri, 06/18/2021 - 14:49 RSS:

Work/LIfe Connections

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Rosemary Cope, an WLC/EAP counselor, talks about adjusting to a new job and a new city for the many employees who move to Nashville.

VU Employee Affinity Groups

VUMC Employee Resource Groups

Begin Transcript

Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I'm Rosemary Cope with Work/Life Connections.

Nashville remains a very popular city to visit and to relocate to. Many Vanderbilt employees are new to the university or medical center as well as to the city. My colleagues and I hear all the time about difficulties making the transition, especially if you are single, and it is in the middle of a pandemic. In the best of times, moving is stressful and exhausting. Under pandemic conditions, the transition to a new home can be deeply disorienting and isolating.

Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions; high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression just to name a few. On the other end, people who engage in meaningful productive interactions and activities with others, they tend to live longer than their counterparts. They show elevated mood levels and feel a sense of purpose. As hard as it may be to meet new people during this pandemic, Miriam Kirmayer, a clinical psychologist, and friendship expert, points out there is an upside to looking for friends right now. Lots of people are feeling lonely. People are more open about the experience of loneliness and more aware and open about their desire to make new connections, she said. This could be a time to put ourselves out there and be transparent about our desire to make new connections. It is even harder to explore a new city.

In Nashville with music themes, music venues, shops, restaurants closed or offering limited hours, you may have not found any of those favorite spots that make a place feel like home. Nashville is a beautiful city. You can go by the river. You can walk the greenways, enjoy the lakes or the parks, but aside from the grocery store, one employee related that she has yet to create any rituals. Where are the cool places? If I ever have a friend visit, where would I take them? I don't know she mused. Here are some suggestions to find connections as you make the transition to Nashville and Vanderbilt life.

Say yes to everything. You will probably want a few of the following life essentials in your new city; some friends, a BFF, maybe a romantic partner and a job of course. You will not find these by sitting at home, ordering take out and watching Netflix. Get out there. Go to everything people invite you to. Joint local Facebook groups in your new community and engage in the forums. Be a tourist in your new hometown. Remind yourself, you are on a mission to find these life essentials.

Ask to be setup on friend dates or date dates. Welcome to the way grownups make friends. Ask your friends in your old city if they know anybody in the new city. Ask your family if they know anybody who might be a nice pal for you. Scour Facebook, LinkedIn, Twitter, Instagram, and whatever other social media you are on to find out who from your network lives in town. You might be surprised at what you find. Look for friends on apps like Bumble BFF but watch screen time as it can also be isolating.

Join organized groups from nonprofit volunteering to kickball leagues. Even if you do not consider yourself a joiner, joining something is a way to meet new people. Look for hiking, cycling, or jogging meetups or start with a hobby or a faith-based community and find a group to sign up for. There are also employee resource and affinity groups on campus to join the like-minded people. Even better find something find something you have never done before, but have been interested in. Being a beginner is a great way to connect with other people who are also beginning. You feel awkward. They feel awkward. Bingo. Maybe a new friend.

For your first six months, think about staying somewhere comfortable. You are in a new city. So, it is all strange and unfamiliar. You do not know where CVS or the grocery store is or who your best pal will be. You do not know the good neighborhoods from the okay neighborhoods. You do not know the secret side streets to cut around traffic, which we all need these days. You do not know the cool bars, the cool restaurants, or where the best farmer's market is. So, instead of adding to the stress, I encourage you to consider staying somewhere comfortable for your first chunk of time while you get used to your surroundings. Wherever you land, make sure you make it feel like home. Unpack those boxes. Put the things up on the wall. Surround yourself with things that are comforting to you.

Give yourself a year to acclimate. Any time you start thinking, OMG this was a huge mistake. I was so stupid for thinking this was a good idea or I am never going to like living here and I am going to die alone and trust me, it will happen. Remind yourself that things are still in transition, moving is hard and you’re giving yourself until you have a year under your belt before making any overarching judgements on the move. Don't forget about your friends and your network from your former city. You have it easier. You left. I have always believed that the mover has it easier than the person left behind. You are out exploring a new city. You are having new adventures. You are learning new things. Your old pals are in their same routine and probably missing you. Don't forget about them. Try to keep in touch. Go back if you can and visit from time to time. Yes, it will be hard. You are not sharing all their day-to-day adventures and even a small-time difference can be awkward, but soon enough things may be able to fall into place.

Finally, do not be hard on yourself. But if you continue to feel overwhelmed, consider calling the Work/Life Connections EAP to talk confidentially with a counselor about your concerns.

Thank you all for listening. If you have a story suggestion, please use the "Contact Us" page on our website at www.vumc.org/health-wellness.  

Tags

Change, Counseling, Mental Health, Resilience, Social Connections, VU, VUMC

Lockdown Auth

Facing the Facts of Fad Diets

harnessg — Fri, 11 Jun 2021 19:44:56 +0000

Facing the Facts of Fad Diets

Wellcasts, Wellcasts - Health Plus, Health Plus

harnessg Fri, 06/11/2021 - 14:44 RSS:

Health Plus

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Join Marilyn Holmes, Registered Dietitian, as she shares the truth about fad diets and how to make healthy, lasting changes to your nutrition.

Listen to this WellCast above, or you can watch a video version of it.

Begin Transcript

Bridgette Butler: Hello, and welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I'm Bridgette Butler with Health Plus. Today our guest is Marilyn Holmes, Registered Dietitian and Associate Director of the Vanderbilt Recreation and Wellness Center. We will be discussing the truth about fad diets and what to consider when deciding how to make lasting changes to your health and nutrition. Welcome, Marilyn and thank you for joining us today.

Marilyn Holmes: Thank you, Bridgette.

Bridgette Butler: So glad that you are here. Well, Marilyn there are several diets that have gained popularity recently and let's start with the facts. What is considered a fad diet and what makes them so appealing?

Marilyn Holmes: Well, the first thing I would say that makes them so appearing or makes them fad diets is the fact that they are making claims that seem too good to be true and there is not a lot of research behind them to really prove that what they are making the claim on is actually the truth. So, there is not enough evidence about them. They are a lot of times trying to sell you a book or a supplement at the same time that they are trying to tell you that you are going to have this fast weight off and that's what we want if we are trying to lose weight is to get that weight off and get it off fact even though it may have taken us a long time to get it on. And then, a lot of times, folks who are making the claims about this diet have no nutrition background. They have research in the background of it or education in the background of it as well.

Bridgette Butler: Can you describe a few of the most popular fad diets that are out there today?

Marilyn Holmes: I can. Some of those that you may have heard a whole lot about are Paleo, Intermittent, and we will come back and talk about these, the keto, the ketogenic diet. Also, ketogenic lite which is a little more palatable for some, it's a newer one out, and then the gluten free are some of the ones that we hear most commonly. If you are talking about Paleo, there is some good evidence that it can help you with weight off and the reason it is doing is because you are using lots of fruits and vegetables. You are trying to use a lot of unprocessed food. Sugary kinds of foods are restricted on this kind of diet. You are using foods that are traditionally thought of as the caveman or the hunter gather, prior to the time that we had a lot of the cultivated crops. So, the good thing about this is that it is a lot of unprocessed foods, but the bad thing about it is it is restricting. It is also restricting some of the good plant-based things that we are knowing at this time that are really healthy for us. Legumes are some of the things. Whole grain bread is some. Dairy is another. So, you may get into some nutrient problems as well. So, there are some bad things about it, but more research is really needed for us to know the long-term effects of it as well. The Intermittent Diet can be a variety of things. You may eat one day all that you want, the next day you may have maybe 500 or 600 calories which is very, very low, and then the next day eat. Some folks do lose some weight on it, but what we do see with it is the fact that long term people are not keeping that weight off. We know that fasting is something that goes back eons as well. We also known that there does not seem to be any physical or mental problems from using this kind of diet, but, again, there does not seem to be any advantage of it over just generally eating a healthy food plan that does not have a lot of extra calories in it as well. Some people like it just because of the fact that they can eat whatever they want to one day and then starve the next day and then the next day... so, it is not as hard to follow as some of the others. The gluten free is definitely needed for people who have gluten-induced enteropathy or gluten sensitivity, but there is no advantage to restricting, which is the rye, the barely, the grains, the wheat that we know are good sources of food for us as well. It is good sources of nutrients. There is also the claim of it of using the gluten-free diet for reducing inflammation, but we have not seen that long term for folks. So, again, if you are trying to use it in the weight off arena, we are not seeing that it has been very helpful, but it is definitely needed for people who have gluten sensitivity or gluten-induced enteropathy.

Bridgette Butler: As you said, there is so much conflicting information about fad diets like the ones that you described. So, in your expertise, what should we understand about nutrition and fad diets?

Marilyn Holmes: Some of the things that we need to really think about is the harm that they can cause long term. What we have seen in the research is that people who gets the weight off and gets it off really fast, first of all maybe losing a lot of muscle mass and you don't want to lose muscle mass. You want to conserve muscle mass because that is the most efficient burning of calories that we can have and it may not over time help us to keep that weight off and when we go back to eating the old way, because it is so restrictive and can be so harmful to us in many ways, when we go back to eating the way that we were eating, we have not made change, then we can gain that weight and more. Over time, we can have ended up having more weight on us than we started out in the very beginning. So, a lot of times we see from them that they are just hard to follow. They may be very expensive. They can be harmful to us, especially if you are taking some of the supplements that can cause some problems later one as well.

Bridgette Butler: What are better alternatives to fad diets for someone who wants to make changes to their nutrition and their health and is perhaps understanding that fad diets are not the best choice?

Marilyn Holmes: You kind of want to first of all get the facts and you want to get evidence-based facts for another thing. One of the things that our faculty and staff have available for them here at Vanderbilt is you all. You are health coaches, and you are a registered dietitian and can help people with their questions and help them get started. So, finding a reliable source or person of information is one thing that can be very helpful. There are other things out there. We know that there is evidence that some of the diets such as the Mediterranean Diet that we have seen a lot of publicity about recently and the dietary approach is to stop hypertension are both very well documented as far as being evidence-based plans with lots of fruits and vegetables. That is a cornerstone for helping us be able to make healthy food choices that can support our weight maintenance or loss as well and helping us be sustainable in what we are trying to do. So, looking for reliable sources. Now, other things that are out. There is MyPlate.gov is a great source for people to look at and see, get some recommendations that can help them get started on eating a healthy food plan. Eating a variety of foods is another good way and then, again, seeking out reliable sources to help us set our short-term and long-term goals that are achievable and that can help us make change that will sustain our change over time.

Bridgette Butler: Wonderful. Thank you so much. It is a lot of great information about fad diets and healthy alternatives to fad diets and also some wonderful information about resources where you can begin if you do want to stick with a healthy eating approach as opposed to continuing to diet. Marilyn, thank you so much for joining us today.

Marilyn Holmes: You are welcome and thank you for inviting me.

Bridgette Butler: Thanks for listening. If you have a story suggestion, use the Contact Us page on our website at www.vumc.org/health-wellness. 

Tags

VU, VUMC

Lockdown Auth

Build a Balanced Fitness Plan

harnessg — Fri, 14 May 2021 19:39:39 +0000

Build a Balanced Fitness Plan

Wellcasts, Wellcasts - Health Plus, Health Plus

harnessg Fri, 05/14/2021 - 14:39 RSS:

Health Plus

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Join Derek Buss, Physical Therapist, as he shares how to balance your workout to create an ideal fitness plan. Along with his expert tips, you will find extra resources that will help you get active today!

Listen to this WellCast above, or you can watch a video version of it.

Begin Transcript

Bridgette Butler: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Bridgett Butler with Health Plus. Today our guest is Derek Buss, physical therapist, in the Vanderbilt University Hospital In-Patient Physical Therapy Department. We will be talking about how to balance your workout to create and ideal fitness plan. Welcome, Derek, and thank you for joining us today.

Derek Buss: Thank you for having me today.

Bridgette Butler: We are so glad that you are here. So, the COVID-19 pandemic pretty much brought this fast-paced world to a standstill over the past year or so and that had a big impact on work, home life, mental health and physical health. Most people had to change what they do to stay healthy, especially when it comes to being active. Now that the vaccinations are available and restrictions are lifting, we are experiencing yet another transition. So, people are considering a return to the gym while others are planning to get more active outdoors or perhaps continue with home workouts. In your expertise, what are some important considerations when creating an ideal exercise plan in 2021?

Derek Buss: I think that depends on your comfort level. You want to think about engaging in physical activity in different forms, so you can work on the outside, you can go to a gym, you can work on walking, running, so just trying to think of ways to increase activity throughout the day.

Bridgette Butler: I like that and based on comfort level absolutely. We know that a balanced fitness plan will include both muscle strengthening exercises and cardiovascular exercises like walking or biking. Why are these both important and how do they work together?

Derek Buss: Well, when engaging in cardiovascular exercise you move large muscle groups in your body and your body responds. You start breathing faster and taking deep breaths which maximize your oxygen in your blood. The heart will beat faster and increase blood flow to your lungs and muscles. Cardio is an excellent way to lose weight and maintain a healthy body weight. If your heart is beating faster, you will be a stronger heart. It helps decrease your heart rate with more cardiac output.

Bridgette Butler: What is an example of a simple routine that includes the cardio and strength exercises?

Derek Buss: There are many different types of routines you can set up. The most common, interval training, circuit training, just trying to incorporate multiple exercises into your workout program. Such an example would be setting up maybe jogging in place for one minute and then move to the next exercise with the compound movements of maybe a squat movement and then setting up another exercise that you are going to be doing resistance training or adding a little bit more weight during that exercise movement. So, just trying to set up a variation of different types of exercises to work on strength and cardio together.

Bridgette Butler: Strengthening exercises, they can be intimidating for anyone who has not had previous experience with it. What are some of the dos and don'ts of strength training when you apply it at home or at the gym?

Derek Buss: Well, you want to lift your appropriate weight. A lot of people go to the gym, and they try to lift too heavy or they don't add enough resistance. You need to lift so you can do 12 to 15 repetitions. You want to make sure you are not putting too much stress on your body if you are just starting out. You don't want to become too sore, achy, painful, cause too much of an inflammatory repose to your body, you want to make sure to practice safety, you want to make sure you use a spotter if you are using heavy resistance or heavy weights. You just want to make sure you are protecting your body. You want to make sure you are using all your larger muscle groups, if possible, during your workouts. You want to make sure you are also breathing and just controlling your breath as you breathe in and breathe out during the exercises. I did a lot of the dos there. Some of the don'ts, you don't want to rush your form. A lot of people move really quickly during their exercises, so you want to make sure you are doing the proper technique and proper form. So, a personal trainer or someone like an exercise specialists can help develop a program for you. You don't want to ignore any kind of pain. So, if you have pain, you want to kind of detour away from that and give your body time to rest if you are causing your body too much stress.

Bridgette Butler: Now, tell us a little bit about flexibility. How can flexibility be an important piece to a balanced exercise plan?

Derek Buss: We use flexibility in our daily routines. We are always reaching and bending and trying to pick up objects throughout the day, so we want to incorporate flexibility throughout our workout program and also our daily routine of stretching and prior to doing any kind of heavy lifting. So, you usually want to stretch your muscle group after it is warmed up. A lot of people try to static stretch, holding a stretch prior to working out. A good example is getting on an elliptical machine or jogging in place and doing some range of motion movements prior to doing a static stretch.

Bridgette Butler: Thank you for outlining a safe and effective exercise plan. Do you have any final advise to share when it comes to our mindset about COVID-19 and how we can adapt our physical activity routines going forward?

Derek Buss: Well, I feel like it is a big mind shift. I feel like we need to try to develop using our older routines and tie them into our new routines and find different ways to get out and be physically active. A lot of people had to work from home, so they are not able to walk into work. They are not able to establish a daily routine setup around fitness. They are not engaging. A lot of people go to the gym to have communication and networking of friends, so a lot of people lost that during COVID. So, I think developing a program that works best for you in your comfort levels during this challenging time, but also moving forward with people's fitness to better suite their nutrition and have a healthier lifestyle.

Bridgette Butler: Thank you, Derek, for joining us today and for sharing this important information on how to stay physically active at the moment and how to stay active going forward and the ideal balanced exercise plan. We appreciate it.

Derek Buss: You are welcome. Thank you for having me.

Bridgette Butler: Thanks for listening. If you have a story suggestion, use the Contact Us page on our website at www.vumc.org/health-wellness. 

Tags

VU, VUMC

Lockdown Auth

Promoting Back Health While Working from Home

harnessg — Fri, 07 May 2021 20:19:38 +0000

Promoting Back Health While Working from Home

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 05/07/2021 - 15:19 RSS:

Occupational Health Clinic

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Today we speak to Mr. Jeff Cobble, physical therapist at the Dayani Center, about prevention of neck and back injuries while working from home.

Begin Transcript

SHAINA FARFEL: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, we are speaking with Jeff Cobble, physical therapist, at the Vanderbilt Dayani Center. Jeff, thanks so much for being with us today.

JEFF COBBLE: Thank you for having me.

SHAINA FARFEL: A few months ago, we spoke with Occupational Health's in-house ergonomist, Wilma Traughber, about setting up a home office. Since the trend from working from home continues today and likely will continue into the future given the pandemic, I wanted to get a physical therapist's perspective on best methods to avoid back and neck injuries related to these types of work environments. First off, are you seeing an increase in neck or back injuries in people who have transitioned from an office to working from home during this time?

JEFF COBBLE: I do not have any hard figures, but just anecdotally speaking I have noticed more people are coming in and they have been working from home for the past year, so they have not really been as active because of the pandemic and so from an anecdotally standpoint, yes, I think we are seeing a few more neck and back problems from people who have been at home for the past year.

SHAINA FARFEL: I am sure we will be gathering probably more data as the months and years go on with all of this too. What are you seeing as the most common causes of these types of injuries, kind of in the home office setting?

JEFF COBBLE: Generally speaking, posture tends to be the big one that we look at. A lot of times your home may not be setup like your office workstation, so you might have your back twisted in a different position or you might be looking one way and trying to work the other way. Another one for people who spend a lot of time on the phone, if they are holding their phone between their ear and their shoulder, and trying to type, and they are on the phone all day, that can cause problems in the neck definitely. The posture tends to be the biggest thing that we look at.

SHAINA FARFEL: Given that, what are some of the most important tips and/or strategies that you may suggest to prevent some of these common neck or back injuries that occur at home?

JEFF COBBLE: For the phone, if you are on the phone all day, if you have access to a headset or get something where you can be not having to hold the headpiece of the phone between your ear and your shoulder that way you can sit up straighter, and you would be able to type or do whatever you need to do on your computer without having to handle the headset for the phone. From a posture standpoint, looking at your workstation, if you are working on your couch or you are at a makeshift dining room table or something like that, try to setup a designated workspace that you can make specifically for work. If you have access to an ergonomics expert, you can look at that too, but you generally want to be able to sit up straight, have your elbows at about a 90-degree angle, so that monitor is not too high or too low, but at eye level. So, a lot of just basic workstation tips like that can be very helpful as far as that goes.

SHAINA FARFEL: It sounds like you do not necessarily need anything fancy, but just thinking through some of these basic things.

JEFF COBBLE: Right and for your height, weight, and things like that, if you chair is too low or too high or things like that.

SHAINA FARFEL: As I mentioned Wilma Traughber is one of our ergonomists that we have here at Occupational Health, and she is available to employees as a resource as well. What would you consider to be good standing and sitting posture, and I guess one of the things that I always want to know and questions we get from people is, is standing really better for you than sitting? If you have an opportunity to use a standing desk, is that preferable for preventing injuries?

JEFF COBBLE: It depends on the purpose. From a general health standpoint, Americans tend to spend too much time sitting during the day anyway, so even if you are not working at your desk, if you can get up and move around a little bit and takes some breaks throughout the day so you are not sitting for several hours in a row, that can be helpful. From a posture standpoint, the biggest thing with computers is, we kind of talk about computer head where your head just kind of creeps forward, your shoulders round forward, you are just kind of slumped over your keyboard, so really engaging the muscles in your upper back and kind of pulling the shoulder blades back, sit up nice and tall almost like if you have a string pulling up out of the top of your head, so sitting up nice and tall. The same applies for standing posture. You try not to be slouched or slumped or skewed to one side or the other but try to keep the back straight and aligned and those can all help have better posture and you will probably feel a little bit better and breathe easier too.

SHAINA FARFEL: If someone does notice or is concerned that they may be developing an injury or starting to notice some pain, especially while working, what are some resources available to them? What would you recommend at that point, and I will say, if it is someone who is an employee and is concerned about a work-related injury, they can always start by coming to Occupational Health, but how might they access Dayani, if that is a good resource, just any recommendations?

JEFF COBBLE: We have physical therapy here. We also have some group fitness classes that are meeting via Zoom and those are all virtual. Exercise physiologists leads those classes, but we have 23 classes, I believe, throughout the course of the week. You just need to contact the Dayani Center to ask about them. If you are interested in just doing some of the movement classes, we have everything from cardio to yoga to a seated stretch, some destress, some balance, gentle movement, so a variety of intensities and skill levels depending on what a person is looking for. For physical therapy, you need referrals from a doctor. The Orthopedic Physical Therapy Clinic would handle probably more of the new injuries, like you have never had a back injury before and this was something you just did last week or something versus if you have had some nagging back issues for several years, but it has just kind of gotten to the point working at home then you might end up at the Dayani Center, but your physicians can set you up with referrals to physical therapy.

SHAINA FARFEL: It sounds like you have got a great number of offerings. That is wonderful. Well, Jeff, thank you so much for sharing your expertise with us today and I know Vanderbilt employees will find this incredibly helpful, especially as we are all continuing on this ongoing pandemic journey and how it has shifted how we are working, so we really appreciate you taking the time out today.

JEFF COBBLE: Thank you for having me. It is my pleasure.

Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.  

Tags

Acute Care, Exercise, Medical Care, Prevention, Primary Care, Risk Reduction, VU, VUMC, Work Injury/Illness Care

Lockdown Auth

#MeToo in the Workplace

harnessg — Fri, 16 Apr 2021 19:18:19 +0000

#MeToo in the Workplace

Wellcasts, Wellcasts - Work/Life Connections, Work/Life Connections

harnessg Fri, 04/16/2021 - 14:18 RSS:

Work/LIfe Connections

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Heather Kamper from the VUMC SHARE Center talks about workplace misconduct and the reactions people have about it.

Begin Transcript

Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Rosemary Cope with WorkLife Connections. Our guest today is Heather Kamper. A graduate of the University of Pittsburg, Heather is the new coordinator for the SHARE Center and is also a clinical counselor with our Employee Assistance Program. April is sexual assault awareness month. So, we thought we would look at concerns about sexual harassment in the workplace. According to the U.S. Equal Employment Opportunity Commission an estimated 75% of individuals who get harassed at work do not file a complaint. The reasons are varied and complicated. According to research firm Gartner about 60% of all misconduct observed in the workplace is never reported. In the age of Me Too, it is helpful to look at the bigger picture. Heather, would you give a brief definition of workplace misconduct so that we all know what the issue is?

Heather Kamper: Sure, Rosemary. First, I want to say thanks so much for having me here and more importantly for bringing light to the shadow by dedicating your Wellcast to sexual harassment today. According to the Human Resources Department here at VUMC, sexual harassment is defined very specifically as unwelcomed conduct of a sexual nature, unwelcomed sexual advances, requests for sexual favors and any other verbal or nonverbal conduct that is of a sexual nature. You can think of it in broader categories such as physical sexual harassment, verbal sexual harassment, and nonverbal sexual harassment. VUMC also has a clearly stated zero tolerance policy for sexual harassment. I feel particularly empowered as a VUMC staff by this policy summary statement from human resources that says, our sexual harassment policy is to have a culture at VUMC where employees clearly define, prevent, and stop sexual harassment. We will not tolerate sexual harassment in our workplace. Our culture is based on mutual respect. That is a powerful statement from our leaders and employer, Rosemary. We are living and working in exciting times.

Rosemary Cope: I agree, Heather. I can think of all kinds of reasons people might not want to talk about this topic. Would you enlighten us on why people stay silent?

Heather Kamper: Many people fear retaliation by the abuser or other witnesses in the workplace. Of course, the fear of not being believed is an experience shared by many. Many survivors talk about the role that shame and even self-blame play in staying silent. Lack of access to supports such as friends or family that could encourage the survivor to speak out often worsens the isolation present in sexual harassment. Another factor that can sometimes create additional barriers to disclosure is the power hierarchy that exists in society and within our own VUMC which is closely linked to fear of retaliation and not being believed.

Rosemary Cope: I also know there are people who do tell about their experiences. How is that beneficial to the person who does that?

Heather Kamper: Powerful things can happen when we start to tell the story, Rosemary. Many survivors have reported that they began the healing process when they first spoke up whether to a friend or supervisor or a confidential support like a therapist. People who live through sexual harassment also indicate that it was at the moment they spoke out that they began to take their power back, if you will, from the person intimidating or causing them harm. They began to own their rightful place in the workplace and the world again. Survivors may report that they speak out so that they can benefit from resources and access support systems, which we know exists here at VUMC and at VU. Some survivors report that they disclose to get feedback and ideas and the opportunity to know more about options for next steps. I have always been particularly moved when a client tells me they reported, and they are speaking out to help protect others from experiencing the same form of harassment and abuse that they have experienced. Finally, one significant reason why people speak out is to reduce the emotional, psychological, and often physical toll that holding the experience has had.

Rosemary Cope: So, if someone wants to take back that power that you talked about, Heather, and they would like to speak confidentially about this, how do they reach out to you?

Heather Kamper: For any staff person at VUMC, our newest program in Health and Wellness is available for those who have experienced or witnessed sexual harassment and needs support. It is called the SHARE Center and we have only recently celebrated our first birthday. SHARE stands for sexual harassment, awareness, response, and education. SHARE has been regularly participating in ongoing efforts at VUMC to ensure equity, safety, and respect across the enterprise through individual counseling and departmental consultations and even educational presentations. We serve a unique role in the VUMC system and as a result we are able to ensure that information about sexual harassment shared with me or any other staff person in a counseling session within SHARE will be held as confidential. We are here to be patient, knowledgeable, empowering and understanding listeners. If you would like to contact the SHARE Center, VUMC staff, faculty or Allied Health professionals can give us a call at the Work/Life Connections-EAP phone line at 615-936-1327 and let our staff know that you would like to make an appointment with a SHARE provider. The SHARE Center is located in the basement of the Medical Arts Building in Suite 010. We are open from Monday through Friday from 8:00 a.m. to 5:00 p.m. If you need more information, you can look at the SHARE Center's website at VUMC.org/health-wellness/SHARE-Center. Thanks, Rosemary.

Rosemary Cope: Thank you, Heather, for enlightening us about this important center and giving out great information to all of our employees here at Vanderbilt.

Thank you all for listening. If you have a story suggestion, please use the Contact Us page on our website at www.vumc.org/health-wellness.

Tags

Counseling, Mental Health, Personal Safety, VU, VUMC

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Exercise Your Way

harnessg — Fri, 09 Apr 2021 19:15:51 +0000

Exercise Your Way

Wellcasts, Wellcasts - Health Plus, Health Plus

harnessg Fri, 04/09/2021 - 14:15 RSS:

Health Plus

Join Sarah Hendricks, Athletic Trainer at the Vanderbilt Orthopedic Institute, as she shares a timely reminder to exercise your way and how goal setting can help you stay motivated. You’ll find 3 simple ways to help you start exercising today!

View Wellcast

Tags

VU, VUMC

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The 411 on Blood and Body Fluid Exposures

harnessg — Fri, 02 Apr 2021 20:12:40 +0000

The 411 on Blood and Body Fluid Exposures

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 04/02/2021 - 15:12 RSS:

Occupational Health Clinic

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Today we speak with Tanicia Haynes, nurse practitioner at Vanderbilt Occupational Health, about what to do if an employee has a blood and body fluid exposure.

Begin Transcript

Shaina Farfel: Welcome to this addition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today we are speaking with Tanicia Haynes, Nurse Practitioner, at Vanderbilt Occupational Health Clinic.

Hi, Tanicia. Thank you so much for being with us today.

Tanicia Haynes, N.P.: Hi. Thanks for having me.

Shaina Farfel: Today, we wanted to talk about blood and body fluid exposures, also known as BBFs, you may hear them referred to as that. Here at Occupational Health, I know we see a lot of employees, sometimes daily, for blood and body fluid exposures; and we just want people to know and the employees to know that they are common things that happen, but we also want you to know what to do about them when they do happen because we do get a lot of questions from folks. So, Tanicia, can you tell us the definition of a blood and body fluid exposure?

Tanicia Haynes, N.P.: The definition of a blood and body fluid exposure would be contact that someone has with blood or body fluids from an individual that could be potentially infectious for HIV, for hepatitis B or C, and those body fluids or blood has to come in contact with another person's mucosal membranes, through mouth, nose, eyes or potentially through contact with the skin whether it be through open skin or with a needle stick or a sharps injury.

Shaina Farfel: What should a Vanderbilt employee do if they think that they may have had a blood and body fluid exposure?

Tanicia Haynes, N.P.: The first thing an employee should do is first aid to the injury site. Whether that be a needle stick, you need to try and make sure that puncture wound is allowed to bleed and then wash your hands with soap and water or wash the area with soap and water. If there is contact with mucosal membranes to the eyes, nose or mouth, then you want to flush the area for 15 minutes. The next thing that you need to do is identify the source patient. So, whoever the exposure comes from you want to make sure you have the medical record number for that patient, name of that patient and before anything is done as far as coming over to see us, we always want to make sure that you guys are trying to order the labs for that person. Those labs are run on a STAT basis with the HIV testing that we want to do. There is an order set in eStar for the source patient, so it is a very quick and simple way to order the labs. Anyone can order the labs whether it be the nurse that sees the patient, whether it is one of your colleagues as you want to come over and see us, a provider can order those patient's labs and there is no need to wait on those labs. If you are a nurse on the floor, you do not have to wait for a provider to order the labs. You can go ahead and send the labs to be ordered and you can send them for cosign to that provider just so that things are done on a timely basis because we do want to know those labs pretty quickly to know what we need to do for the employee that has been injured. Lastly, the employee needs to come over and see us over at Occupational Health and then you sit down with a provider and you guys discuss risks of exposure and what we do from here on out. If Occupational Health is not open at the time of the injury, so if it is outside of our business hours, then you would go over to the emergency department and you would see one of the providers there and get the same care.

Shaina Farfel: What too would happen if it were someone who was like off campus? Could they call Occupational Health?

Tanicia Haynes, N.P.: For offsite exposures, you could certainly call over to the clinic, if it is during business hours. There are other locations that you could be seen at for work injuries, and you could call the clinic at any point. We always have a provider that is on call through the weekends and late at night. If you have any questions about exposures, even if you are not sure if it is an exposure, you can always call and speak with one of our providers at any point during the day. If it is a question of, did it happen? Should I go get seen? If it is a question of, I am out in Murfreesboro and it is a Saturday, where do I go? You could just call our clinic and you will get connected through our call service to one of the providers here.

Shaina Farfel: Okay. That is really helpful. I think some people may be wondering, you mentioned an order set in eStar. How exactly would they find that? Another question we get commonly is, would the source patient get billed for these labs that we are ordering?

Tanicia Haynes, N.P.: So, in order to find them, depending on if you are in an ambulatory clinic or if you are in an inpatient setting, you can look in Smart Sets or search within the ordering system for “source” and there should be a panel that comes up and that includes the labs that we check for HIV and for hepatitis B and C. It is best to go with that panel because then you know that we have ordered the correct labs on the patient because there are different hepatitis B tests and there are different hepatitis C tests and there is specific ones, we are looking for with these exposures so using that panel or that order set is the best idea. The patient does not get billed for these services. You go ahead and you order them through the chart like you normally would any other lab or order that goes in, but on the back end we do find out who those patients were, and we are in coordination with billing so that those patients do not get billed for these exposure labs.

Shaina Farfel: Those are great answers and I think will be really helpful to folks. So, big take away. Definitely want the employee to, as best they can, get that source information and start ordering those labs as soon as possible. What happens next? What is the risk of transmission to the employee for each of these types of infectious exposures? I know it depends a little bit on the type of exposure.

Tanicia Haynes, N.P.: So, it kind of depends on the injury for one. With hollow-bore needle stick injuries, the risk of transmission from an HIV-positive patient to someone who is HIV negative is about 0.3%. So, not very high. With hepatitis C, the risk is about 1%. With hepatitis B though, that is kind of our heavy hitter with blood and body fluid exposures, and it can be transmitted up to 30% of the time, but that is part of the reason why we want employees to be vaccinated, why we want to know what your immunity status is so that we know are you protected if you were to be exposed to hepatitis B or are you not protected and we need to do some additional care steps with you. With splashes to the eyes, mouth, nose, mucosal membranes, those tend to run a little lower of a risk. HIV is typically only transmitted about 0.1% of the time with those. There is not great stats with hepatitis C and hepatitis B for those exposures, but again we would assume that it would be lower just because of the way the injuries occur.

Shaina Farfel: Once an employee has had that consultation, what is the general recommendation for follow-up after these types of exposures and again I know it may depend?

Tanicia Haynes, N.P.: For these exposures, we will have the employee come in and talk with one of the providers. We get information about how the injury occurred. We order some baseline testing for HIV, for hepatitis B, for hepatitis C and then we look at our source patient's information from the labs that they have run, and we typically have a six-week follow up. We will repeat an HIV test and we also repeat a hepatitis C test where we are looking to see if the person is now making virus, that the employee is making virus after the exposure, and then we also have a four-month follow up testing where we repeat an HIV test and we can at times repeat a hepatitis C antibody at that point as an additional check after someone has been exposed to someone else's body fluids.

Shaina Farfel: Thank you so much for sharing this information today. I think it will be really helpful to our employees. As I said here at Occupational Health, we do see this happen daily for folks, so it is a common occurrence. You can always go to Occupational Health's website for more information, and I will be posting some links below this podcast as well. Thank you again, Tanicia.

Tanicia Haynes, N.P.: Thank you.

Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/health-wellness.

Tags

Acute Care, Exposure Management, Medical Care, Prevention, Risk Reduction, VUMC, Work Injury and Exposures, Work Injury/Illness Care

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The Dangers of Distracted Driving in Teens

harnessg — Fri, 02 Apr 2021 18:16:57 +0000

The Dangers of Distracted Driving in Teens

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 04/02/2021 - 13:16 RSS:

Occupational Health Clinic

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Ms. Purnima Unni, Manager of the Pediatric Trauma Injury Prevention Program at Monroe Carell Jr. Children's Hospital at Vanderbilt, discusses the hazards of distracted driving in teens and strategies for prevention.

VUMC Teen Driver Safety Program

Distracted Driving Facts and Stats

Begin Transcript

Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I'm Shaina Farfel with Occupational Health. Today, we are speaking with Purnima Unni, manager of the Pediatric Trauma Injury Prevention Program at the Monroe Carell Jr. Children's Hospital at Vanderbilt. Purnima, thanks so much for being with us today.

Purnima Unni: Thank you for having me.

Shaina Farfel: Getting your drivers license as a teenager is sort of a rite of passage, but with this newfound freedom comes a fair amount of risk, especially in the age of cell phones and other electronic devices. Since April is National Distracted Driving Awareness month, I wanted to discuss distracted driving as it relates to teenagers, sort of our youngest and most inexperienced drivers out on the roads. What are the most common types of distracted driving in teens and are teens more likely to engage in distracted driving than adults?

Purnima Unni: Yeah. It's a great question. So, I think, first, it is really important that we understand what distracted driving is. So, distracted driving is anythingthat takes your eyes away from the task of driving. So, that can include anything from texting and driving to passengers in the car to putting your makeup on to turning the phone. So, all that kind of stuff falls in the realm of distracted driving. When we talk about the most common distractions with teens, we are usually talking about, A, the phones. So, there is a constant need among teens to stay connected. So, they are always on the phone texting and getting in touch with their friends. So, phones is a big distraction. Friends. A big part of driving, again, is the ability to carry your friends around when you are a teen. There is a lot of research that shows that with every additional passenger a teen has in their car, the risk of a crash kind of goes up. Then, music. Music is a huge factor. You know, they have their playlists and they are always wanting to change the playlist. So, all of these are huge factors when it comes to common distractions among teens. So, you asked the other question about, you know, is it more dangerous, an adult or a teen, and the reality is that car wrecks are the leading cause of fatality and death for U.S. teens. It is especially true with newly licensed drivers. They are four times, believe it or not, more likely to get into a wreck than any other age group. So, teenagers are deeply connected with their phones and you add on the risk of a new driver. It kind of makes it more riskier than an adult driver.

Shaina Farfel: What are the laws around distracted driving here in the state of Tennessee?

Purnima Unni: Interestingly enough, believe it or not, in 2018, there were over 24,000 crashes involving a distracted driver right here in Tennessee. So, we are very excited that Tennessee actually has a hands-free Tennessee law. It had gone into effect on July 1, 2019. So, the law does state that if you are over 18, then you are not supposed to hold a phone in your hand or have it anywhere close to your body, that you are not supposed to write or send a text message out. You can't even reach for a cell phone. You are allowed to use a GPS device, but it has to be mounted at all times, and of course, you can use ... like, hands-free devices are allowed, so, you know, earphones/ear buds. Now, if you are a driver under 18 and you're newly licensed in that restricted phase or intermediate restricted phase, you are actually not even supposed to be on the phone at all. That's just part of their graduated driver licensing law - no phones allowed at all. So, that's something parents have to be kind of aware of and talk to their child about, and obviously, role modeling plays a huge role in all of this.

Shaina Farfel: Sure, and just circling back, so, you had mentioned some of these already, but what are the hazards associated with distracted driving and why is it important to prevent it?

Purnima Unni: Yeah. So, when you look, or think about it, it's really the statistics are really shocking, and I pulled some numbers just so that, you know, our listeners are kind of aware because I think sometimes data speaks volumes. So, according to the National Highway Traffic Safety Administration, 3,000 people are killed by the distracted driving alone in 2017, and according to the Centers for Disease Control, nine people are killed and more than 1,000 injured daily ... DAILY as a result of distracted driving. So, it goes without saying that distracted driving can have really devastating effects, from fatal injuries where, you know, you lose a loved one, or you actually can cause the death of a loved one, to you getting involved in a serious injury where it can affect your whole life.

Shaina Farfel: It can be really devastating, and so that's why it is so important to talk about this today. You know, a lot of parents out there might be wondering what they might be able to do to keep their children safe from distracted driving.

Purnima Unni: That's a great question. You know, I have one who is 18 and one who is 21, and I know this can be a really scary time for parents if you have a newly-licensed driver or even if you have one who has been riding on the road for a while. So, we will always recommend - be a good role model. You know, if you are out there with your child in the car, and that starts early on, put your seatbelts on and put your phones away. The message can wait. There is nothing more precious than you and your family that you are carrying around. Make sure if you have a teen who is a new driver, that you are kind of aware of the Tennessee Graduated Driver Licensing Law. There are several components to it as far as when they can drive, how many passengers they can drive, whether they can use their phone ... so, all good advice that you should be aware of as they are going through that phase. There are a lot of good parent-teen driving agreements out right now, where you can kind of sit with your teen and lay out what is expected of them in that learning phase, and don't be afraid, you know, to actually follow up and enforce it if they don't follow a rule that they were supposed to. Make sure you are able to enforce it, and if there is a punishment involved, there is a punishment involved, because that's how they are going to learn as they go on the roadways. Encourage them, really, if they have a phone, to use the "do not disturb" option on their phone, because what happens is they are going to be tempted if they see that light flashing, or, you know, hear some message coming on. If you put that "do not disturb" application on your phone, then they are not even going to hear it until they reach their destination. So, you can reassure them that none of their messages are going to be lost, but it's just making sure that they are not on the phone while in the car.

Shaina Farfel: Can you tell us a little bit about the Teen Driver Safety Program here at Vanderbilt or any other resources that you may be aware of that are available to parents and teens around middle Tennessee?

Purnima Unni: Yeah. So, we are very excited. In 2011, we started our "Be in the Zone - Turn off your Phone" teen driver safety initiative, and we are ever so grateful to the Allstate Foundation and Ford Fund for actually supporting our program since 2011, believe it or not, and the idea behind that program is to really encourage or increase awareness among teens about distracted driving and safe driving. So, it is kind of a unique hospital-school partnership. So, what we do is we partner with schools in high-risk counties that we have seen in Tennessee. We encourage them to send some of their youth into our hospital. We run like a six-hour program with the teens on kind of all the different aspects of being involved in the crash, from the ED to PT to just hearing from an individual who has been impacted as a result of a motor vehicle crash, and then, these teens become our champions of change. They go out into their schools and run a year-long anti-texting-while-driving campaign where they are kind of motivating positive change in their peers. So, this year, for example, we have 14 high schools across 12 counties participating, and we have reached more than 101 schools and more than 100,000 students since we started the program in 2011. So, definitely come to our website. You can just go to Vanderbilt Children's Hospital/Injury Prevention and it will take you to our Teen Driver Safety page, and the page has other information as well on it so that parents can kind of start this conversation with their teen.

Shaina Farfel: Yeah. It sounds like a wonderful, novel program.

Purnima Unni: Yeah, we've had a wonderful opportunity to do that and touch as many families as we can, and like we always say in our world, even if you can change one person's life, that's a huge deal for us.

Shaina Farfel: Absolutely. Well, thank you so much for sharing this valuable information. I think we can all relate to these concerns and it's important for teenagers and adults alike to have an increased awareness and, you know, their own strategy for how to limit distractions while driving. So, thank you.

Purnima Unni: Thank you so much for having me.

Shaina Farfel: Have a wonderful day.

Purnima Unni: Thank you.

Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.

Tags

Prevention, Risk Reduction, VU, VUMC

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Small Changes, Better Sleep

harnessg — Fri, 12 Mar 2021 20:13:56 +0000

Small Changes, Better Sleep

Wellcasts, Wellcasts - Health Plus, Health Plus

harnessg Fri, 03/12/2021 - 14:13 RSS:

Health Plus

Join Madeleine Hallum, Registered Dietitian and Clinical Nutrition Coordinator, as she shares a key to better health that might surprise you coming from a dietitian. Learn small, practical changes you can make to get a better night’s sleep.

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VU, VUMC

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Safe Patient Handling

harnessg — Fri, 05 Mar 2021 20:30:16 +0000

Safe Patient Handling

Occupational Health Clinic, Wellcasts, Wellcasts - Occupational Health Clinic

harnessg Fri, 03/05/2021 - 14:30 RSS:

Occupational Health Clinic

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On this Wellcast we speak to Mamie Williams, Director of Nurse Safety and Wellbeing, about safe patient handling at VUMC.

Occupational Health Smooth Moves Website

NIOSH Safe Patient Handling and Mobility

Begin Transcript

Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today we are speaking with Mamie Williams who is Director of Nurse Safety and Well-being here at Vanderbilt University Medical Center. Thank you so much for being with us today, Mamie.

Mamie Williams: Thank you, Shaina, for having me. I look forward to our discussion on patient handling.

Shaina Farfel: For so many of our employees here at the medical center a big part of their job is getting patients from one place or position to another, as it can be something as simple as just getting them out of bed to go to the bathroom or transporting them in a stretcher off the unit to get imaging. Can you tell me in your expert opinion why safe patient handling is so important and what the safe patient handling, also known as the Smooths Moves Program here at Vanderbilt, is?

Mamie Williams: At Vanderbilt to start with the Safe Patient Handling Smooths Moves Program was implemented in 2005. The program was put in place to really protect our nurses, patients, physical therapists, occupational therapists and patient transporters, anyone, as you mentioned who moves, mobilizes, and helps to ambulate patients here at VUMC. The program is three parts. First, there is a policy which points out that Vanderbilt Medical Center is a minimal lift facility, meaning in instances where you are moving, ambulating, or mobilizing a patient you should use the available patient handling equipment or use enough staff so that you are at minimum lifting no more than 35 pounds of a patient's weight. It also includes patient handling equipment, as we pointed out, and the patient handling equipment, and we will talk about that a little bit more, was put in place so that nurse staff, again PT, OT, anyone moving, mobilizing, and ambulating patients had the appropriate equipment so that they would not have to physically manually do those tasks without assistance, and then it includes physical training on the various pieces of patient handling equipment. Staff get it in orientation. There are different learning exchange modules over it and so those are all the components of the program. It is an important program so that our caregivers who are caring for our patients are not injured while they are trying to do so. It is a national trend with the focus on preventing nurse injury and others as well. It really is important that caregivers take the time to care about themselves as they are caring for patients and the Patient Handling Program helps them to do that, and that is one of the reasons that it is so important. It allows nurses and the like to care for patients and to care for themselves at the same time by protecting their backs and not being injured while performing their job duties.

Shaina Farfel: Mamie, what types of patient handling causes the majority of injuries in our staff members that you see?

Mamie Williams: Very good question. Very good question. The Patient Handling Program does include injury trending for those folks who come over to the Occupational Health Clinic and see one of the healthcare providers. We do talk to them about what caused their injury, and what we have learned over the years of having the Safe Patient Handling Program in place, and it continues to this day, is that the vast majority of patient handling injuries are what we term repositioning injuries. When a PT, OT, patient transporter, or nurse moves a patient either up or down in bed, or helps a patient to reposition themselves in bed that by far causes the largest number of injuries at VUMC. It is unfortunate because that is the particular piece of patient handling equipment, slippery sheets and the Sage TAP system, which are most readily available and which can be supplied by our linen services to any unit or department that requests it. We have more than 8,000 pair of the slippery sheets which are used to offload the patient's weight and prevent someone from being injured while repositioning a patient. So, unfortunately, we termed it Small Moves Repositioning a Patient in Bed, and often times it is with our adult standard, not the bariatric patient, up or down in bed causes the vast majority of the injuries at VUMC unfortunately.

Shaina Farfel: Yeah, that is really interesting because I think people would think otherwise. So, you know, someone would think maybe some of these larger transfers or heavier patients would be the cause of the majority of injuries, so that is important to bring awareness to that.

Mamie Williams: Absolutely. We think perhaps people are not like fully aware that even a smaller patient, that is too much torque on the back to bend over in that awkward position and move someone up or down, so you really still, even it is an adult standard nonbariatric patient, you really still need to use the available, the slippery sheets, you could even use the HoverMatt or the Sage TAP system. So, you are absolutely right, Shaina.

Shaina Farfel: Absolutely. You touched on this already, but anything to add? What are some important strategies for safe patient handling to prevent these types of injuries in the workplace?

Mamie Williams: I think, one, Occupational Health Clinic wants all of our nurse staff, all of our folks who are caring for our patients to care for themselves as well. And, using the patient handling equipment, the available patient handling equipment, taking time to reintroduce yourself to that equipment by either going to the Occupational Health Safe Patient Handling website and reviewing the videos of the different pieces of patient handling equipment, or reviewing one of the learning modules on the Safe Patient Handling Programs, and then using that equipment, is the absolute best way to prevent yourself from being injured while moving, mobilizing or ambulating a patient. It is also the safest thing for the patient as well. If patients, unfortunately, are being helped to ambulate and you have a nurse on your side and the patient starts to go down, unfortunately sometimes the patient could fall and the nurse could be injured as well. The way to prevent that would be to use something like the STEADI, which is as much a fall prevention tool as it is a safe patient handling tool. It protects the patient, and it protects the nurse who is helping to ambulate the patient. Caring for themselves, it really gets into that whole thing of taking your breaks, thinking about yourself, taking care of yourself, it really all meshes together.

Shaina Farfel: And Mamie, the patient handling equipment for staff, should that all be available on the units for them? What if something was not available or was not working? Who would they reach out to or what would they do?

Mamie Williams: Very good question. There are a couple of components to it. The first is that each unit and department manager decides which pieces of patient handling equipment they have on their unit. However, a number of CSLs, nurse educators and even nurse staff have gotten together and decided, well for our unit based on the patients that we work with, we would like to see, say the Maxi Move which lifts up to 500 pounds of a patient's weight. It will take a patient from the floor, bed, chair or anywhere in between. There are certain number of pieces of equipment that are available, but again each manager purchases it for their floor with the help of their staff deciding what it is that they need. So, every floor does not have every piece of equipment, but they can if they so desire. They could reach out to me. You can call Mamie Williams, and I can send them information on what pieces of equipment are available and which difference patient handling movements it covers. For instance, the Maxi Move is the one that takes a patient from a lying position to a seated position and vice versa and the STEADI is for folks who, you are unfamiliar on whether they are good with ambulation or they are a fall risk, and we touched on that. The other is if your equipment is not functioning you would reach out to facilities for repair. You would fill out a facilities repair form and they would come and repair the equipment. If there is a need to determine what is needed, I can help with that.

Shaina Farfel: Any additional resources that you would want VUMC staff to know about in terms of safe patient transport that we have not already talked about today?

Mamie Williams: I think we touched on it, but just that there are a number of learning modules in the Learning Exchange related to safe patient handling. Each unit has at least one safe patient handling champion who is a nurse or a care partner who has gone through some additional training to be able to tell their colleagues which pieces of equipment are appropriate for which movements that they are anticipating having to do with a patient or for a patient and how to use the patient handling equipment. We also have the Occupational Health Safe Patient Handling website which has each piece of equipment and instructions on how to use it and when to use it.

Shaina Farfel: Below this podcast there should be links to the Occupational Health Safe Patient Handling website for those resources as well. Thank you so much, Mamie, for your time today. These are really important discussions to have and to remind folks about the resources available here at the medical center, and please come back and join us again sometime soon.

Mamie Williams: I certainly will. Thank you. Everyone stay safe.

Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the Contact Us page on our website at www.vumc.org/help-wellness. 

Tags

Ergonomics, Medical Care, Prevention, Risk Reduction, Return To Work Program, VUMC, VU, Work Injury and Exposures, Work Injury/Illness Care

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Follow Your Heart

harnessg — Fri, 12 Feb 2021 20:11:12 +0000

Follow Your Heart

Wellcasts, Wellcasts - Health Plus, Health Plus

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Hand Dermatitis in Healthcare Workers

harnessg — Fri, 05 Feb 2021 20:06:14 +0000

Hand Dermatitis in Healthcare Workers

Wellcasts, Wellcasts - Occupational Health Clinic, Occupational Health Clinic

harnessg Fri, 02/05/2021 - 14:06 RSS:

Occupational Health Clinic

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Dr. Aleta Simmons, Assistant Professor of Dermatology, and coordinator of the Skin of Color Clinic in the Department of Dermatology at Vanderbilt discusses hand dermatitis, a condition common to healthcare workers who frequently wash their hands.

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Shaina Farfel: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Shaina Farfel with Occupational Health. Today, I am speaking we are speaking with Dr. Aleta Simmons, Assistant Professor of Dermatology, who also helps to run and coordinate the Skin of Color Clinic here at Vanderbilt University Medical Center. Dr. Simmons, thanks so much for being with us today.

Dr. Aleta Simmons: Thank you for having me.

Shaina Farfel: As we are approaching winter when a lot of us struggle with dry, itchy and irritated skin and for our medical professionals who are washing their hands constantly throughout the day and probably even more so during the pandemic and for whom this can become an even greater challenge, I wanted to focus on a skin condition known as hand dermatitis that we see a lot in the occupational setting. Can you tell me, what is hand dermatitis and what causes it?

Dr. Aleta Simmons: When people typically come in with hand dermatitis, they usually have signs of dry, scaly, or chapped skin on the hands. They may see redness or even dark brown areas of irritated skin. It is often particularly itchy. Patients may have blisters or even fissures in the skin. It typically effects the palms or the fingers or the fingertips or a combination of those. Patients may also say, those cracks are bleeding, or they find that they have weeping, and usually in adults it is caused by an exposure to a chemical or something that they are handling with their hands at their job. Often times, people who have a history of atopic dermatitis or what we commonly call eczema, they can be more prone to develop hand dermatitis as well. To keep it plain, an itchy rash, it maybe red or scaly or both, that appears on the hands that causes patients a lot of itching.

Shaina Farfel: You touched on this a bit, but any other populations that maybe at increased risk for this condition specifically?

Dr. Aleta Simmons: Definitely. In terms of occupations, people who work with cleaning material. The staff at our hospital that do janitorial work, cement workers, and people who work with paper can also often get dermatitis to that or we also call dermatitis like eczema or rash. People who work in factories, they are often wearing gloves for long periods of time. People who wash their hands frequently, like you said before, the wet-to-dry cycle washing the hands and drying the hands often leads to irritation because our skin has a barrier, and once you break that barrier down with dryness and cracking in the skin, things that we handle can often get into the skin, we become sensitive to it and are more likely to develop a rash from it. We also cannot leave out kids. One example is children that like to play with slime and if they already have a history of eczema, the things in the slim can often cause them a rash.

Shaina Farfel: We talked about signs and symptoms a little bit. I did not know if you wanted to expand on that at all in terms of what folks may see that may guide them to know to come and be seen in the clinic and things to look out for.

Dr. Aleta Simmons: Typically, people will try things at home before they present to the clinic. By the time we see them, they have had hand dermatitis for a while and now it is affecting their day-to-day life. Patients say, I can no longer work comfortably. I am miserable. What can I do? At that point, we have to take a history in terms of what are they exposed to at work, what do they do at home, what are their hobbies. Bakers, those that work or people who do it often at home, can sometimes get a hand dermatitis too. We really need to know what patients are doing in their jobs and outside of their jobs because that is going to be key to treating them. Patients often come in and say, I am a babysitter, I watch kids frequently or I work in a daycare. We want to know, are you using wipes, how often are you washing your hands. Those types of questions are very important. When patients usually present to us, we are doing some investigative work to find out what they may be in contact with in order to stop one, the irritation and the itching in the skin, calm down the inflammation to try to get their hands to heal.

Shaina Farfel: Once you do that investigation and history, what are some of the recommended treatments for the condition?

Dr. Aleta Simmons: One great start for patients is doing patch testing. We need to see what the patient is allergic to and this entails using allergens or common things that people are allergic to in terms of what they are using based on their history and also getting information from their employer about what types of chemicals they are exposed to at work. We use that to place patches of those allergens on the patient's back and this is done over a course of a week where we see the patient three times to place the patches, look at the patches mid-week on a Wednesday and then look at them again on a Friday in order to see if they have had an allergic reaction to anything. Once we find out if a patient is allergic to a substance, we then can go into a database for contact allergens and give patients a list of things that they can use that do not have those chemicals or other items in them that should not cause them a rash. Also, patients that work at factories or even bakeries, they do paper or woodwork, we need to know what types of gloves can be accessible to them at their jobs. Because often times we will have people wear cotton gloves, the cotton gloves will absorb any moister from sweating or heat that they may work with and then put another type of glove over that in order to protect them from the chemicals they are using. Because the type of glove may matter because some chemicals can seep through particular types of gloves depending on what they are allergic to or what they use at work. Another thing that is really important is barrier repair. As I said in eczema, the skin barrier has been injured, so we need to try to support it and help it heal. Moisturization, white petrolatum, a moisturizer such as Vanicream that does not have too many allergens in it is going to be helpful for that barrier repair. Then, we need to treat the inflammation, so we use topical steroids or even nonsteroidal medications to get the inflammation down. If those things do not work, we may have to do other treatments like phototherapy or oral medications.

Shaina Farfel: For some of our workers who maybe most at risk for this condition, what are some recommendations in terms of prevention prior to symptom onset?

Dr. Aleta Simmons: Patients with atopic dermatitis may want to meet with their doctors even as early as teenage years to think about what they may want to do for a career because this may impact their life as they are more susceptible to developing hand dermatitis. That is the biggest part of prevention, but some patients may not think about that. They are already in a profession that they love, and they have developed hand dermatitis. It is important that they work with their dermatologist to come up with a plan to treat their dermatitis and to also prevent it from recurring.

Shaina Farfel: Well, Dr. Simmons, thank you so much for sharing your expertise with us today. I think we have a lot of employees, certainly cooks, hospital workers, and daycare providers, who I think could probably benefit a lot from this information and we truly appreciate your time today. Thanks again.

Dr. Aleta Simmons: Thank you for having me.

Shaina Farfel: Thanks for listening. If you have a story suggestion, you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.  

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Medical Care, Prevention, VU, VUMC, Work Injury and Exposures

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