August/September 2007 Volume 24, Number 4

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1 Network August/September 2007 Volume 24, Number 4 Making a Difference: An Interview with Laura Fuehrer, BSN RN Making a Difference is a new section that highlights an ARN member new to the specialty of rehabilitation nursing. Our first profile features ARN member Laura Fuehrer, who received her bachelor of science in nursing in 2000 from the University of Nebraska Medical Center, Omaha, NE, and began her nursing career on a medical/surgical floor. She moved on to ambulatory surgery where she provided pre-, intra-, and postoperative care, while serving as the quality improvement coordinator for 3 years. Since 2006, she has been employed by Madonna Rehabilitation Hospital, Lincoln, NE, first as the ventilator assist/special needs nurse manager and then as the director of nursing for the long-term care area. In her free time, she enjoys being with her family her husband Gene, stepson Forrest, and cat Callie watching movies, playing outdoor sports, going out for dinner. In This Issue President s Message Recognizing Depression in the Older Adult ARN Conference Paper and Case Study Sessions RNF Basket Auction Certification Update ARN-CAT Updates Now Available Why I Took the CRRN Examination Plan to Renew Your CRRN Credential ARN Strategic Plan: A New Vision for the Association ARN Supports Increased Funding of Nurse Education Programs Q. What made you decide to pursue rehabilitation nursing? A. I always felt that Madonna had the reputation of being a place where miracles happened. I knew I wanted to be a part of Madonna and have the opportunity as a nurse to help make those miracles happen. To me, all nursing is rehabilitative because the goal is to improve the health of our patients and residents. Q. Who has had the most influence on your career? A. My mom. She is the best nurse I know and has been a role model for me both personally and professionally. Q. What do you consider to be the most important innovation in rehabilitation nursing? A. The use of evidence-based practice to guide our current practice. Q. What do you enjoy most about rehabilitation nursing? A. The opportunity to provide hope to residents and see improvements. Working with the interdisciplinary team to focus on the goals for each resident is also rewarding. Q. Knowing what you know today, what would you have done differently in your career? A. I would not change anything. All of my experiences have shaped the nurse I am today. They have all contributed to my knowledge base, my decision making, and my critical thinking. Each individual s nursing experience and history bring new and fresh ideas to the table. Q. What are your interests outside of rehabilitation nursing? A. I enjoy spending time with my family and friends. I love the lake and everything that comes with it: fishing, swimming, and boating. I also enjoy reading, sports, movies, coffee with friends, going out for dinner, and indulging in the Sunday newspaper. Q. Tell us about your most memorable patient. A. We had a resident who came to our unit on a ventilator; his goal was to go home without it. He was so motivated and worked so hard to progress. He left our facility without the ventilator and the tracheostomy tube, and was ambulatory without assistance. He had the most positive attitude and desire to improve his situation. He truly was an inspiration to all who met him. Q. Why did you join ARN and what do you enjoy most about your involvement with the organization? A. I joined ARN to be a member of an organization that is on the cutting edge of rehabilitation nursing. I felt this would be an opportunity to collaborate on different ideas, successes, and opportunities for the benefit of our residents and patients. Q. Complete the sentence, I can t live without my... A. Family. They are the most important priority in my life. Their love, support, and understanding have helped me become the nurse and person I am today. Q. Where do you see yourself in 5 years, both personally and professionally? A. I see myself continuing to be part of Madonna Rehabilitation Hospital s nursing leadership. I see this as an opportunity to facilitate changes in the long-term care area to benefit the residents. Q. Do you have a favorite quote, saying, or words to live by? A. One small change today can create many big changes tomorrow. Chinese fortune cookie

2 PRESIDENT s MESSAGE A Look Back at Recent ARN Achievements Terri Sue Patterson, MSN RN CRRN FIALCP Summer is finally here! I hope you all are taking a few days off to enjoy it while it lasts. The President s Messages in the past three issues of ARN Network have focused on the Strategic Plan, inception to completion. Please take a few minutes and read through the Plan on page 8 or read a more detailed Plan on our Web site (www. rehabnurse.org). The Strategic Plan can be found in About ARN. If you have any questions, comments, or suggestions, the board would love to hear from you. There s a link at the bottom of the Strategic Plan on the ARN Web site to send us a message, or you can contact me or any other board member directly. I want to extend a very sincere thank you to all the ARN members who participated in this monumental project. I would also like to express my appreciation to the ARN staff, especially Karen Nason, Mary Beth Benner, Laura Davis, and Gayle Elliott, who have all contributed above and beyond to this process from scheduling and attending on-site meetings, to consulting with facilitators and providing moral support to the board. In this issue of ARN Network, I would like to share all of the other contributions the board, committees, task forces, and individual ARN members have provided to our association over the past 6 months. I know how valuable your time is we all have extremely busy lives ARN thanks you for all of your contributions and for volunteering. Standards and Scope of Rehabilitation Nursing Practice A committee of ARN board members and members at large comprised this special task force, chaired by Cyndi Murphy and Debra Dzenko, to revise our Standards and Scope publication. It was then sent to American Nurses Association (ANA) for review because it follows the ANA model. With any luck, we should have the new edition of Standards and Scope available by the first of the year. The Specialty Practice of Rehabilitation Nursing: A Core Curriculum, 5th Edition Kristen Mauk, editor, chaired the immense effort to publish the new Core, which should debut at our national conference in October in Washington, DC. Please stop by the ARN booth this fall to see the latest edition of our core curriculum. Oh, and you may certainly purchase it as well! Rehabilitation Nursing Journal Our journal has been very successful with excellent articles and wonderful advertising support. Elaine Miller was unanimously reappointed editor at the spring board meeting. We are very fortunate to have her, as well as our strong editorial board. And, as Elaine would say, have you thought about submitting an article? CANS: Council for Advancement of Nursing Science RNF Chair Linda Pierce represented ARN at this research symposium. Linda has recommended that we explore partnerships with various specialty practices for research opportunities, and we will address this with RNF committees. State-of-the-Science Symposium on Post-Acute Rehabilitation Barbara Lutz represented ARN at this symposium on February 12 13, 2007, in Arlington, VA. The goal of this conference was to develop a research agenda for post-acute rehabilitation. At this meeting Barbara learned about a project to develop a system-wide Uniform Patient Assessment tool to assess patients needs across the continuum of care. The tool is slated to be piloted in American Society of Association Executives (ASAE) Karen Nason (Executive Director) and Karen Manning (ARN President Elect) attended the Spring Leadership Conference in Washington, DC, sponsored by ASAE. The content parallels our new strategic thinking philosophy and promotes the essential co-partnership between an association s chief executive officer and chief staff officer. We have recognized through this strategic planning process how critical it is for this partnership to be stable, supportive, and synergistic. American Congress of Rehabilitation Medicine (ACRM) ARN has been invited to participate in ACRM s annual conference to share our mission, interests, and activities and to promote mutual awareness of our associations. President Elect Karen Manning will be presenting an educational session focusing on the Safe Patient Handling initiative and Nurse Staffing and Patient Outcomes in Inpatient Rehabilitation Settings Research Study. Nurse Staffing and Patient Outcomes in Inpatient Rehabilitation Settings Research Study The results of this study have been finalized and will be published in the September/October issue of Rehabilitation Nursing. In addition, Audrey Nelson will present the final results of the study in a concurrent session at the conference in October. This study was an enormous undertaking and we thank Audrey and all of the coauthors who worked tirelessly to complete this important study. Of course, we are also grateful to the facilities that participated in the study. Without them, this study would not have been possible. Christopher and Dana Reeve Foundation Paralysis Task Force ARN was invited to participate in a workshop to develop specific initiatives focused on improving quality of life for individuals with paralysis. The workshop was held in April in Washington, DC, and member Mary Jean Kotch represented ARN. She also provided an excellent report to the ARN board for ongoing involvement in these efforts. Congressional Briefing on Safe Patient Handling ANA held this congressional briefing in Washington, DC, in May, and Cathy Tracey (Region 1 Director) attended the meeting as ARN s representative. During the briefing, ANA provided an update on the legislative agenda and efforts by Congress to promote safe patient handling. Cathy also chairs the ARN Safe Patient Handling and Movement Task Force, which is currently working with the American Physical Therapy Association and the American Occupational Therapy Association to develop a toolkit for clinicians in rehabilitation settings. ARN s Mission ARN s mission is to promote and advance professional rehabilitation nursing practice through education, advocacy, collaboration, and research to enhance the quality of life for those affected by disability and chronic illness. Continued on page ARNNetwork August/September 2007

3 Gerontology UPDATE Recognizing Depression in the Older Adult Beth Culross, RN APN-CNS CRRN Earn a FREE Contact Hour Mrs. Jones, an 82-year-old with Parkinson s disease, is being treated for multiple falls that occurred during the night while she was trying to get out of bed. The primary medical concerns are dementia or a urinary tract infection. Her urinalysis is clear and her mini mental score is 25. Her geriatric depression scale score is 12 (i.e., severe depression). So, do you really know when your elderly patient is depressed? Depression can complicate the recovery process and keep the patient from making gains in rehabilitation. It can be a preexisting and possibly exacerbated condition or a new onset. To some, depression may be considered commonplace and even expected in the elderly, but that does not make it acceptable. The research has shown that depression is a serious issue for older adults, which makes recognizing it crucial for practitioners. By overcoming barriers and using a simple 15-question Geriatric Depression Scale, recognition and treatment can be made easier. Why Is Geriatric Depression an Issue? According to the National Institutes of Health (1991), depressive symptoms occur in approximately 15% of community residents over the age of 65, and the rates of major and minor depression vary from 5% in primary care to 25% in long-term care settings. It is estimated that only 10% of elderly who require treatment ever receive it. Mortality rates for depressed elderly are higher compared to nondepressed elderly. Much of this may be due, in part, to the presentation of depression in the elderly. Symptoms may vary from the typical depression observed in younger adults and may not meet all the criteria listed in the American Psychiatric Association DSM-IV-TR. These criteria and the atypical symptoms of the older adult are shown in Table 1. Often barriers, either on the part of the patient or the healthcare provider, cause difficulties in diagnosing depression. These potential barriers are listed in Table 2. The barriers discussed by Corrigan et al. (2003) must be overcome in order to recognize and treat the depression. According to Schwenk (2002), there is also a priority issue for both the patient and the provider. Depression does not compete well for time and attention with other medical problems that require more urgent care. However, the profound negative effect of depression on overall health, function, medical comorbidity, healthcare outcomes, and cost may be more significant than that of other medical illnesses. Also, depression has been shown to increase the risk for the development of coronary artery disease and leads to poorer outcomes for patients with existing coronary artery disease. The Geriatric Depression Scale Depression screening tools were reviewed by Watson and Pignone (2003). This systematic review of instruments used to screen for late-life depression looked at 18 articles pertaining to screening tools that are specifically used for older adults in primary care. This study found that there are accurate screening tools available for late life and recommends the 15-item Geriatric Depression Scale because it is easy to use, has a yes/no format, and an easy-to-understand scoring method. The mini mental status exam can easily be used in conjunction with this and performing both tests can be done in approximately minutes. Table 1. Presentation American Psychiatric Association DSM-IV-TR criteria Five or more of the following symptoms present for a minimum of 2 weeks: Depressed mood Loss of interest or pleasure in activities Changes in weight or appetite Insomnia or hypersomnia Psychomotor agitation or retardation Low energy Feelings of worthlessness Poor concentration Recurrent suicidal ideation or suicide attempt From Lapid, M. I., & Rummans, T. A. (2003). Evaluation and management of geriatric depression in primary care. Mayo Clinic Proceedings, 78, Atypical presentation of depressed older adult Deny sadness or depressed mood May exhibit other symptoms of depression Unexplained somatic complaints Hopelessness Helplessness Anxiety and worries Memory complaints (may or may not have objective signs of cognitive impairment) Anhedonia Slowed movement Irritability General lack of interest in personal care From Gallo, J. J., & Rabins, P. V. (1999). Depression without sadness: alternative presentations of depression in late life. American Family Physician, 60(8), Table 2. Barriers The Patient Concerns about perceptions or stigma related to mental illness Perception of support system Concern about disapproval by family or other members of support system Financial concerns regarding cost of treatment, Medicare coverage, etc. Knowledge and ability to recognize signs of depression Concern regarding other medical conditions, such as chronic illness, take priority The Practitioner Ageist attitudes: unwillingness to listen Belief that depression is a normal part of aging Lack of knowledge or recognition of symptoms Search for other physical reason for depressive symptoms versus assessment for a depressive syndrome Other chronic and medical conditions take priority The Importance of Recognition Depression is a serious issue at any age; however, it is especially deleterious to the elderly. Symptoms are often left unreported by the patient or unrecognized by the practitioner. Suicide rates and overall mortality are higher in elderly who suffer from depression. For more information about depression in older adults, the John A. Hartford Foundation Continued on page 11 August/September ARNNetwork

4 2007 ARN Conference Paper and Case Study Sessions ARN 33rd Annual Educational Conference October 3 6, 2007 Hilton Washington Thursday, October 4, :30 am Session 601 ARN Chapter Members: Don t Give Up! Jill L. Rye We Got Game: A Unique Approach to Teaching Patricia A. Mucia Rehabilitation Nursing: The Foundation for a BSN Course Claudia Diebold Celebration of Caring: Application of Jean Watson s Caring Theory into Rehabilitation Practice Gail L. Sims Session 602 The Challenge of Developing a Comprehensive Fall Prevention Program in Homecare Sharon Driscoll Reshaping the Safety of Our Patients with a Restraint-Free Environment and a Fall Prevention and Reduction Program Aloma (Cookie) Gender Alternative to Go : Safely Managing Behavior is as Easy as PIE! Joan Munchiando Getting the Train Back on the Track: Reducing Sitter Costs Julia M. Libcke Session 603 Acute TBI Unit s Use of Positive Deviance Model to Prevent Transmission of Methicillin- Resistant Staphylococcus Aureus Lisa Pinder Reshaping Rehabilitation Nursing: Evidence- Based Care for the Medically Acute TBI Patient Margaret Thomas Where s the Salt? A Rehabilitation Nurse s Guide to Endocrine Complications Post-TBI Tiffany R. LeCroy Seize the Day! Proper Care for the Rehabilitation Patient with Seizures Craig E. Andrews Session 604 The Growth and Development of a Pediatric Rehab Nurse: My Journey with Sarah Kim A. Lynn Are We There Yet? The Tough Road to Implement a Safe Patient Handling Program in an Acute Care Facility Stephanie Davis Burnett 3:45 5:15 pm Session 701 Consensus Decision Making and Interest- Based Problem Solving for Improved Rehabilitation Programs Michelle E. Camicia Creating Meaningful and Effective Customer Service Programs Ann Marie LaRocca Communication Breakdown : Get the Picture? Laura J. Merkner SBAR: Showing the Way to Improve Communication in the Rehabilitation Setting Tegwedd Makem Session 702 Complications Related to Gastric Bypass Surgery Requiring Rehabilitation Enid Mercado Creating a Minimal Lift Unit Margaret A. Waszkiewicz Safe Patient Handling Program: It s the Right Thing to Do! Christine M. Rutledge Leading Change Ruth Ann Kiefer Session 703 Evaluation and Treatment of Successfully Managed Spasticity Ellen Barker Effects of Co-Morbid TBI in the SCI Population: Therapeutic Challenges in Rehabilitation Care Linda Dufour Meeting the Needs of the SCI Patients Post- Discharge with Rehabilitation Nursing Deborah Muenchow A Collaborative Approach to Optimizing Upper Extremity Function for the Tetraplegic Patient Deanna Watson Session 704 The Global Perspective: Teaching Rehabilitation Nursing in Cambodia Karen S. Reed Como Se Dice? Hispanic Cross-Cultural Questions and Answers for Rehabilitation Nurses Olivia Joy Taveras-Koranda Using Cultural Competence Assessment Tools to Establish a Culture of Understanding Paul Nathenson Health-Related Beliefs of Hispanic Patients Sally Ann Gutierrez Friday, October 5, :15 11:45 am Session 801 Measuring Effectiveness: The Role of the Rehabilitation Nurse in the Transdisciplinary Team Rhonda Johnston Team Conferences: A New and Efficient Look Irene Tranowski Reshaping the Team Process: Meeting the Standards Rose M. Anderson Integration of Theory into Practice: Strategies to Build Nursing as a Profession Erin Hodson Session 802 Preventing Disaster: Empowering Nurses Through Critical Thinking in Rehabilitation Donna Mack The Use of Bar-Code-Enabled Point-of-Care Scanning: Success in Reducing Medication Errors in an Acute Rehabilitation Unit Sharon A. Bryant Neuropathic Pain Diagnosis and Treatment Ellen Barker Rehabilitation Nurses Take the H.I.T. Head On Linda Dufour Session 803 Teaching Staff to Manage Neurogenic Bowel Tamera Corsaro Removing Urinary Catheters Post-Stoke Jan C. Gross Catheter-Associated Urinary Tract Infections: A Nurse-Sensitive Indicator in an Inpatient Rehabilitation Program Lisa A. Salamon Bladder Management: Where Is the Evidence? Michele Cournan Session 804 A New lease on Life: My Lung Transplant Adventure Halina Craig Maximizing Resources Through the Effective Utilization of Charge Nurses in a Nurse Administrator Role Patricia Dimond, RN CRRN ARNNetwork August/September 2007

5 Saturday, October 6, :30 10 am Session 901 RN with Physical Disabilities Leslie J. Neal-Boylan Culture and Disability: Implications for Providing Culturally Competent Care Ramesh C. Upadhyaya Sexual Counseling and Evidence-Based Practice: Implications for Rehabilitation Nurses Donald D. Kautz Adult Day Health Care: A New Population, A New Focus Elizabeth A. Faulkner Session 902 What a Difference a Team Makes: Best Practice for Wound Care Mary T. Aleksiewicz Pressure Ulcer Update: Ramifications for Rehabilitation Maria Ebert Hardinger Wound Management: A 21st Century Online Course for Nurses Deborah A. Rastinehad Evidence-Based Practice Digital Imaging of Pressure Ulcers Documentation Savithri Ramanujam Session 903 What Happens to the Forgotten 25% Kathleen DeLaFuente 24-Hour Rehabilitation Nursing: The Proof Is in the Documentation Pam E. Hentschke Electronic Bladder Documentation Marie McGrath Libbey Update on Medicare s Post-Acute Care Reform Demonstration Anne Deutsch Session 904 Music Group as a Therapeutic Modality Kathleen Scavetta Family Caregivers as Surrogate Reporters of Depression in Stroke Survivors Rosemarie B. King Caregiver Safe Haven: Thanks for Letting Me Ramble Teresa Cervantz Thompson Effect of Hatha Yoga on Fatigue and Balance in Persons with MS Susan Folden r e g i s t e r n o w! ARN 33rd Annual Educational Conference October 3 6, 2007 Hilton Washington, Washington, DC Reshape your future in rehabilitation nursing by attending the rehabilitation nursing educational event of the year! Discover groundbreaking strategies for treating patients who have suffered from a variety of disabling conditions. You will learn approaches to improving patient care and outcomes, as well as best practices in rehabilitation nursing. How You Will Benefit Gain clinical knowledge you can apply in your practice right away. Network with other rehabilitation nurses from across the country. Learn from experts in the field covering such valuable topics as diabetes, amputation, stroke, cancer, traumatic brain injury, neuropathic pain, wound care, falls, bariatrics, geriatric nursing, and much more. Earn up to 30.5 contact hours R e s h a p i n g O u r F u t u r e This is the one conference that will give you the updated knowledge to help you grow professionally, become a better rehabilitation nurse, and make a difference in the lives of your patients. To register, go to or call 800/ Silent Auction to Benefit the Rehabilitation Nursing Foundation Imagine the anticipation of bidding on creative gift bags filled with collectibles and gourmet foods from sunny California or the Pacific Northwest or baskets brimming with unique gifts and regional food items from New England or the Southwest. ARN members, chapters, and exhibitors are encouraged to donate eye-catching tote bags or packages for a silent auction that will benefit the Rehabilitation Nursing Foundation (RNF). Then experience the excitement of bidding on these appealing packages during the ARN annual conference in Washington, DC. Winning bidders will be announced in the exhibit hall on Friday, October 5, For complete information, visit the ARN Web site at All proceeds from the silent auction will benefit the RNF. August/September ARNNetwork

6 CERTIFICATION UPDATE 2007 CRRN Examination Your next opportunity to take the Certified Rehabilitation Registered Nurse (CRRN ) examination is December. The application receipt deadline is October 15, Don t miss this opportunity to demonstrate your skill and commitment to caring for individuals with physical disability or chronic illness. The application is available at or by calling 800/ Is it Time to Renew Your Certification? Did you pass the exam or renew certification in Your certification expiration date is The renewal application postmark deadline is Your time frame for earning points is December 2002 December 31, 2007 September 30, 2007 September 30, 2002 September 30, 2007 January 2003* June 30, 2008 March 31, 2008 October 31, 2002 October 31, 2007 OR March 31, 2003 March 31, 2008 February 2003* June 30, 2008 March 31, 2008 November 30, 2002 November 30, 2007 OR March 31, 2003 March 31, 2008 March 2003* June 30, 2008 March 31, 2008 December 31, 2002 December 31, 2007 OR March 31, 2003 March 31, 2008 April 2003* June 30, 2008 March 31, 2008 January 31, 2003 January 31, 2008 OR March 31, 2003 March 31, 2008 May 2003* June 30, 2008 March 31, 2008 February 28, 2003 February 28, 2008 OR March 31, 2003 March 31, 2008 June 2003 June 30, 2008 March 31, 2008 March 31, 2003 March 31, 2008 July 2003* December 31, 2008 September 30, 2008 April 30, 2003 April 30, 2008 OR September 30, 2003 September 30, 2008 August 2003* December 31, 2008 September 30, 2008 May 31, 2003 May 31, 2008 OR September 30, 2003 September 30, 2008 September 2003* December 31, 2008 September 30, 2008 June 30, 2003 June 30, 2008 OR September 30, 2003 September 30, 2008 The points of credit renewal application is mailed approximately one year prior to the certification expiration date. Please be sure to contact the office at 800/ if you do not receive the renewal materials within 6 months of the certification expiration date. *As you were notified earlier, the Rehabilitation Nursing Certification Board (RNCB) is in the process of consolidating all CRRN expiration dates to June or December, depending on the original expiration date. During this renewal cycle, you will have a choice of two time frames for earning points of credit. Please note this is a one-time choice. All future time frames will be based on the new expiration date. ARN-CAT Updates Now Available ARN volunteer experts have been hard at work updating the ARN Competencies Assessment Tool (ARN-CAT) with NEW questions for the following competency areas: bowel and bladder function dysphagia musculoskeletal/body mechanics/functional transfer techniques pain rehabilitation sexuality and disability. Nurse managers, administrators, or rehabilitation nursing educators need a simple way to evaluate staff competency in the basic areas of rehabilitation nursing. The next time you need to provide evidence of competency to JCAHO, test your staff s knowledge to meet internal education goals, or evaluate the proficiency of visiting or floating nurses, think of ARN. ARN-CAT is a free and easy-to-use online assessment tool that encompasses 14 basic rehabilitation nursing competency areas. Upon completion, your staff will receive instant documentation of the accuracy of their answers. The tool also identifies areas where further education may be needed and provides suggested references. To see for yourself how easy it is to use and to test the updated assessments, log on to the ARN Web site at 6 ARNNetwork August/September 2007

7 Why I Took the CRRN Examination Christine M. Ralyea, MSN RN CRRN As the Assistant Vice President for Nursing/Chief Nurse Executive at Carolinas Rehabilitation (CR), Charlotte, NC, I believe it is essential to promote professionalism and excellence among the nursing staff. Specialty certifications send a strong message to patients, families, medical staff, administration, and peers that rehabilitation nursing is a specialty and that expertise is a part of our everyday practice. When I started in September 2005, I made it a personal goal to have at least twelve nurses certified each year, until 50% of staff had their CRRN. This takes a commitment on the part of CR. A review class/study group was developed, which consisted of six classes, each a 4-hour session. CR supported the employees by paying for 2 hours of the class time. Staff members who attended the class were expected to take the certification exam. After the employee passed the certification exam, CR paid for the examination fee, and the new CRRN member was advanced on the clinical/career ladder by receiving a 10% pay increase. In October 2005 CR had twelve nurses who were CRRNs; in 2006 fourteen more RNs obtained their certification. A reception and luncheon was held to honor all CRRNs and a goal was presented to the honorees; each CRRN would recruit and mentor a new potential CRRN candidate for certification in We are well on our way toward having 12 more RNs become certified in 2007, and in years to come we are confident we will have 50% or more of our staff certified. By taking and passing the CRRN exam in December 2006, I served as a role model for staff members. I am proud to add the credential CRRN after my name. I am mentoring a clinical case manager who will take her CRRN exam in Christine Ralyea, MSN CRRN, is Assistant Vice President for Nursing/ Chief Nurse Executive at Carolinas Rehabilitation in Charlotte, NC. Plan Now to Renew your CRRN Credential Mary Ann Reilly, MS RN CRRN You worked hard to achieve your Certified Rehabilitation Registered Nurse (CRRN ) certification and renewing your CRRN is an important activity. To renew your CRRN certification, you must have a current, unrestricted RN license at least 2 years of rehabilitation nursing experience as an RN within the previous 5 years 60 points of credit that meet the published criteria. You may earn points by participating in the following professional development activities: continuing education, presentations, academic course work, item writing, publication, or community service. Each category has specific requirements and these are available at Oftentimes the certification staff receives calls asking about what types of classes are acceptable for certification renewal. The answer is very broad. Rehabilitation nurses are unique in that their practice can range from pediatrics to geriatrics. Their patients may be beginning their lives or nearing the end of their lives. I recommend that you evaluate your practice setting and the type of patients you work with. President s Message Continued from page 2 Role of the Nurse in the Rehabilitation Team Co-chaired by President Elect Karen Manning and Treasurer Donna Williams, this committee further delineated the role of the rehabilitation nurse in a rehabilitation team. The description is located on our Web site. Government Relations Consultant/Government Relations Task Force A major outcome of our strategic plan is to develop a government relations program that will help ARN have an impact on rehabilitation legislation and regulation. A task force comprising myself, Karen Manning, Susan Wirt, and Sharon Murphy-Potts interviewed three government relations firms in Washington, DC, in May. At this time we are in the process of outlining our health policy agenda with You may be in pediatric rehabilitation and have a newly diagnosed 15-year-old with multiple sclerosis (MS), which is a rather rare diagnosis for an adolescent. MS would be a perfect topic for a class or program. Or you may be a clinic nurse who has a patient with a spinal cord injury (SCI) who is asking questions about becoming pregnant and giving birth. In that case, a class on high-risk pregnancy may be perfect for you. Or you may have a geriatric patient who is dealing with long-term chronic diseases or a cancer patient who is entering remission and is debilitated. Programs on ethics and cultural competence are always appropriate. Programs can be found online at specialty nursing organization sites or in specialty journals. There are several companies that offer home-study classes and courses. A list of Web sites that offer contact hours is available at www. rehabnurse.org. ARN chapters often offer classes as well. Certification as a CRRN is an affirmation of your knowledge, skill, and commitment to caring for individuals with physical disability or chronic illness. Be sure you take the appropriate steps to maintain this valuable recognition. Drinker Biddle & Reath LLP. We will have a Capitol Hill Kick Off at the annual conference to move forward into this exciting area of government relations. There are so many committees and task forces that meet on a regular basis to support the regular programs and activities that ARN offers. Currently, there are 16 other committees, task forces, and review panels in place that contribute their time, knowledge, and talent to advance rehabilitation nursing practice. ARN will acknowledge all of these members in the conference program book, but I wanted to extend my sincere thanks now to all of these volunteers as well. Without the contributions of our volunteers, ARN would not be the extraordinary association it is today. August/September ARNNetwork 7

8 ARN Strategic Plan: A New Vision for the Association From January through April of this year, the Association of Rehabilitation Nurses (ARN) engaged in an aggressive Strategic Planning Initiative to create the association s future strategic direction. The goal of this initiative was to develop clarity and focus on how ARN should invest its valuable resources to best meet the identified wants, preferences, and needs of its members and others within the rehabilitation nursing profession. As envisioned, the resulting Strategic Plan will facilitate identification of the future needs of ARN members and other identified stakeholders, and options for satisfying those needs. Using the Four Planning Horizon s model (Figure 1) as a framework and group dialogue and deliberation as the information source, ARN leaders created the following: a set of assumptions about the future of the profession(s) they represent and the professionals who work in them a list of relevant factors in the long-range horizon (10 15 years into the future), core purpose, core values, big hairy audacious goal Figure 1. Four Planning Horizon Model ARNNetwork August/September 2007 (BHAG), and a vivid description of future success four goal areas that focus on outcomes beneficial to ARN and its members and identify where ARN will direct its energy in the next 5 years a set of strategic objectives in each goal area that provide a measurable direction for the organization and a path for achieving its goals a set of strategies that identify the actions the organization will undertake during the next 1 3 years in order to achieve each goal area. The leadership of ARN views the process of strategic planning as ongoing within the association. This is not a strategic planning project that is completed and filed away. Adoption of a plan is an affirmation of the general intent and direction articulated by the vision, goals, and objectives. Progress toward achieving the plan s objectives will be assessed annually, and the plan will be updated based on achievement and changes in the needs of the stakeholders served Year Planning Horizon: Core Ideology and Envisioned Future A core ideology describes an association s consistent identity that transcends all changes related to its relevant environment. It consists of two elements: core purpose (the association s reason for being) and core values (essential and enduring principles that guide an association). The envisioned future conveys a concrete, yet unrealized, vision for the association. It consists of a BHAG a clear and compelling catalyst that serves as a focal point for effort and a vivid description that is vibrant and illustrative of what it will be like to achieve the BHAG. (Refer to Figure 2.) ARN s core purpose is to advance rehabilitation nursing practice. ARN s four Core Values are leadership, professionalism, community, and client care. Leadership: Our organization provides visionary leadership that reflects the diverse interests and needs of its members. Professionalism: We uphold high ethical standards, lead with integrity, and are good stewards of the association s resources. We practice innovation in support of member needs and expectations. Community: Our diverse community of members will value different perspectives, celebrate its collective accomplishments, and will enjoy the opportunities to pursue success together through member-centered services, effective communication, life-long learning, and the support of research to build and disseminate the science of rehabilitation nursing. Client care: The association will uphold our members commitment to a holistic, collaborative, and evidence -based approach to improving client care and the quality of life for all people. ARN s BHAG is to reshape healthcare by integrating rehabilitation nursing concepts into care for all people. In our vivid description of the future, ARN is recognized as the premier provider of resources for the practice of rehabilitation nursing. ARN professional development opportunities provide the latest advances in the field, are available to a wide spectrum of healthcare professionals, and support the sharing of best practices and techniques. ARN public policy and advocacy efforts have been so successful that legislators and regulators routinely turn to ARN for rehabilitation knowledge and expertise. Membership continues to grow and ARN members are energetically engaged in the

9 political process and actively participate in the association s professional development and networking opportunities. The public has a greater understanding of the benefits of rehabilitation and are regularly requesting assistance from a rehabilitation nurse as a result of ARN s public education efforts. Other professional associations turn to ARN for advice and support on issues affecting the future of healthcare. The requests for research funding will exceed the available resources. As a result of ARN s efforts, nursing school curricula include rehabilitation concepts, and state licensing exams include an assessment of rehabilitation knowledge. Research-based rehabilitation concepts are included in every care plan in every setting. Insurance companies and third-party payers recognize the importance of rehabilitation and reimburse appropriately for it. The diverse members of ARN are recognized as experts in a holistic approach to patient wellbeing, prevention, and management of chronic illness and disability and are routinely consulted on rehabilitation concepts for client care across the continuum. Consumers of healthcare will experience enhanced quality of life as a result of rehabilitation services, evidenced by a decrease in complications of disability and illness. 3 5 Year Planning Horizon: Outcome- Oriented Goals and Objectives The following represents ARN s goal areas for the next 3 5 years. They are areas in which ARN will explicitly state the conditions or attributes it wants to achieve. These outcome statements define what will constitute future success. The achievement of each goal will move the organization toward the realization of its vision. The goal areas are not listed in order of importance. Objectives and strategies provide direction and action for how the association will accomplish its articulated goals. Initially, the strategies are developed by the ARN board with the input of the strategic planning participants. Future strategies will be developed by volunteer work groups and staff members and will be reviewed annually by the board. Leadership. ARN will be recognized as a leader and preferred partner regarding rehabilitation. Objectives 1. Increase collaboration with other organizations that affect rehabilitation in support of ARN strategic goals. Figure 2. ARN Strategic Plan 2. Increase awareness and value of rehabilitation nursing to military veterans. 3. Increase awareness and value of rehabilitation nursing to baby boomers. 4. Enhance the influence of ARN with national nursing organizations that affect nursing education. 5. Enhance the perceived value of rehabilitation nursing to healthcare executives. 6. Increase ARN s influence on state licensing and accreditation standards. Research. ARN will be the global leader in building, disseminating, and translating the science of rehabilitation nursing into practice. Objectives 1. Increase the number of research activities funded by RNF. 2. Enhance the accessibility of existing and new rehabilitation nursing science. 3. Expand the translation of rehabilitation research knowledge into practice. Government Relations. ARN will influence healthcare as a leader in creating rehabilitation public policy. Objectives 1. Increase members knowledge and participation in public policy relevant to rehabilitation nursing. 2. Enhance ARN s image as a leader in the public policy arena. Professional Development. ARN members will be experts and leaders in integrating rehabilitation nursing concepts into all areas of healthcare. Objectives 1. Increase the diversity of ARN delivery methods for knowledge dissemination. 2. Increase the number of nurse members prepared to assume leadership within ARN. 3. Increase the number of participants in all educational offerings. 4. Increase the number of ARN members from across diverse nursing settings. 5. Increase the number of CRRNs. More detailed information on the Plan can be found on the ARN Web site, We welcome your input and suggestions for the Plan. Please forward your comments to Rehabilitation Nurse Staffing Study The final results of the research study, Nurse Staffing and Patient Outcomes in Inpatient Rehabilitation Settings, cofunded by RNF, will be presented by Audrey Nelson, PhD RN FAAN, on October 5, 2007, at the ARN annual conference in Washington, DC. The results of the study will also be published in the September/October 2007 issue of Rehabilitation Nursing. August/September ARNNetwork

10 ARN Supports Increased Funding of Nurse Education Programs ARN joined with other national nursing organizations to support increased funding of nurse education programs. Their combined lobbying efforts encouraged two representatives, Congresswoman Lois Capps and Congressman Steven LaTourette, to persuade 96 members of Congress to sign a letter to the House Appropriations Committee calling for additional funding for Nursing Workforce Development Programs. The bipartisan letter noted that the nursing shortage poses a grave threat to both patient safety and domestic preparedness efforts. This additional funding is critical to addressing our country s nursing shortage, said Capps, a nurse and member of the Energy and Commerce Committee s Subcommittee on Health. Year after year, we have shortchanged nurse education funding, despite the fact that our national nursing shortage is growing. At a time when we should be increasing nurse education funding to properly address our nation s health crisis, the Bush Administration has proposed further cutting funds for successful programs that increase our capacity to train the next generation of nurses. These misguided cuts will further contribute to our nation s shortage of health professionals, thereby compromising our ability to deliver quality health care and to ensure that we are prepared for domestic challenges like a bioterrorism incident or a pandemic. My colleagues and I are strongly committed to providing the resources necessary to meet the rising demand for registered nurses and will continue fighting for increased funds. ARN President Terri Patterson (left) presents a plaque to a staff member of Rep. Capps. Photo by Sonny Odom THE SHEPHERD CENTER Specializing in the medical and rehabilitative treatment of people with acquired brain injuries, spinal cord injuries, multiple sclerosis and other neurological conditions, Shepherd Center has an immediate opportunity for: CLINICAL NURSE SPECIALIST FOR A NATIONALLY RECOGNIZED, ACQUIRED BRAIN INJURY REHABILITATION UNIT Take an online video tour and apply at: or call: The House Members requested $200 million for the Nursing Workforce Development Programs, the main source of funding for programs that support a sufficient nursing workforce. Following several years of flat funding at $150 million, the President s budget proposes a substantial cut in funding for Title VIII programs to only $105.3 million in FY2008. In their letter, the House Members noted that funding for nursing education and recruitment has fallen in the last 3 years, even as the nation s nursing shortage has grown. The current funding shortage has had a devastating impact on the financial support provided to nursing students and the ability to recruit and retain much needed nurse faculty. ARN will continue to address governmental issues as we move forward with our new Strategic Plan; one of our goals is to be leaders in influencing rehabilitation public policy. Atlanta, GA Photo by Sonny Odom Equal Opportunity Employer Karen Manning, Terri Patterson, and Sharon Murphy-Potts (from left to right) at the reception honoring those who supported the bill. 10 ARNNetwork August/September NAS (Media: delete copyright notice) ARN Newsletter

11 Special Offer Save $30 on the Specialty Practice of Rehabilitation Nursing: A Core Curriculum, 4th ed. Save $30 during the month of August on The Specialty Practice of Rehabilitation Nursing: A Core Curriculum, 4th ed. This comprehensive guide covers all facets of rehabilitation nursing. It is designed for new and experienced nurses who practice rehabilitation and restorative principles in any setting. Chapters focus on ethical, legal, and moral considerations; economics and health policy; the delivery and evaluation of rehabilitation services; cardiovascular and pulmonary rehabilitation; and the effect of information technology and computer applications. Every rehabilitation and restorative nurse should own a copy. Member sale price: $50 (originally $80) Nonmember sale price: $70 (Originally $100) Join ARN for $110 and receive the member price for the Core Curriculum and other products. Call 800/ or visit to order your copy today. Exclusive Offer for the Month of August Earn free nursing contact hours for newly posted articles ARN members can earn up to 3 free nursing contact hours in the month of August by visiting the Members-Only section of the ARN Web site at Simply log on, read the newsletter articles posted, complete the posttests, and earn 1 contact hour for each article. Certificates can be printed online immediately upon completion of the posttest. August s feature articles include Medications to Treat Hypertension Kristen L. Mauk, PhD RN CRRN-A APRN BC Medications to Treat Arthritis Kristen L. Mauk, PhD RN CRRN-A APRN BC Recognizing Depression in the Older Adult Beth Culross, RN APN-CNS CRRN Be sure to take advantage of these opportunities to earn free nursing contact hours related to rehabilitation nursing! National Awareness Rehabilitation Week September 16 22, 2007 Sponsored by the National Rehabilitation Awareness Foundation, this week focuses the nation s attention on capabilities, rather than disabilities, and increases awareness of the tremendous power and impact of rehabilitation. Recognizing Depression in the Older Adult Continued from page 3 Institute for Geriatric Nursing has published guidelines that are available at Other sites on the internet that are helpful include the National Institutes of Health (www.nih.gov) and the American Association of Retired Persons (www.aarp.org). The studies that have been briefly reviewed above include a variety of subtopics regarding depression. A common theme among these studies is that although a significant amount of research has been conducted, diagnosis, treatment, and outcomes still need to be improved. Possible reasons for this include the barriers discussed by Corrigan et al. (2003), a lack of public education, vague complaints and symptoms that are difficult for practitioners to pinpoint as depression, and recurrence in the elderly population after treatment. The research regarding depression is abundant; however, the education of both practitioners and patients is still deficient. As practitioners, we are responsible for educating ourselves about geriatric depression and the impact it has on treatment and recovery. By properly educating ourselves, we pass this knowledge on to patients and families. We must understand the subtle signs that are often confused with other problems and overcome the barriers that stand in the way of proper diagnosis and treatment. References Beekman, A. T., Geerlings, S. W., Deeg, D. J., Smit, J. H., Schoevers, R. S., de Beurs, E., et al. (2002). The natural history of late-life depression: a 6-year prospective study in the community. Archives of General Psychiatry, 59(7), Corrigan, P. W., Swantek, S., Watson, A. C., & Kleinlein, P. (2003). When do older adults seek primary care services for depression? The Journal of Nervous and Mental Disease, 191(9) 6, Gallo, J. J., & Rabins, P. V. (1999). Depression without sadness: alternative presentations of depression in late life. American Family Physician, 60(8), Lapid, M. I., & Rummans, T. A. (2003). Evaluation and management of geriatric depression in primary care. Mayo Clinic Proceedings, 78, Mueller, T. J., Kohn, R., Leventhal, N., Leon, A. C., Solomon, D., Coryell, W., et al. (2004). The course of depression in elderly patients. American Journal of Geriatric Psychiatry, 12(1), National Institutes of Health (1991). Diagnosis and treatment of depression in late life. Consensus Development Conference statement retrieved April 2, 2004, from Schwenk, T. L. (2002). Diagnosis of late-life depression: the view from primary care. Biological Psychiatry, 52(3), Yesavage, J. A., Brink, T. L., Rose, T. L., et al. (1983). Development and validation of a geriatric depression rating scale: a preliminary report. Journal of Psychiatric Research, 17(1), Watson, L. C., & Pignone, M. P. (2003). Screening accuracy for late-life depression in primary care: a systematic review. The Journal of Family Practice, 53(12), August/September ARNNetwork 11

12 EARN $150-$175 PER HOUR SET YOUR OWN SCHEDULE Become a Certified Nurse Life Care Planner today. Whether you are in business for yourself or working for a company, Nurse Life Care Planning offers you the opportunity to enter the ranks of the highest paid nurses in the country. Kelynco provides a complete range of educational offerings throughout your professional Nurse Life Care Planning Career. You can choose from several career options within the field. Nurse Life Care Planning in Litigation Senior Care Consulting Medicare Set-Aside Consulting All courses are taught by the founder of the American Association of Nurse Life Care Planning, Kelly Lance, BSN, RN, CNLCP. Kelynco courses are designed for nurses and build on your nursing education. The nursing process is the core of our curriculum. Visit our website for more information and course dates. Classes are limited and may sell out. Please register early. GET PAID WHAT YOU ARE WORTH Association of Rehabilitation Nurses 4700 W. Lake Avenue Glenview, IL Address Service Requested PRSRT STD U.S. Postage PAID Glenview, IL Permit No. 62

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