Sickle Cell Disease Care Planning for School Nurses

Schoolchildren with sickle cell disease (SCD) experience physiologic and psychologic stress that can affect school functioning, mental well-being, and physical health. Student needs are unique and individualized; however, school nurses can support students and families with SCD through comprehensive and thorough care planning efforts. In addition to components specific to individual prescriptions and other nonpharmacological therapies, school nurses should consider school access and inclusion, pain management, racism, and disease self-management when care planning. As a healthcare provider who may have several continuous years of near-daily contact with students, the school nurse is an imperative provider, educator, and advocate for students learning to manage their SCD and avoid the related complications and challenges.

Lateral Violence of Nurses in the Hospital Environment: The Need for Caring

Workplace violence has a major impact on productivity, morale, increase absenteeism, turnover, patient outcome, and cost. The hierarchy of the hospital structure is based on a patriarchal system dominated by male physicians and administrators with nurses in the lower position. However, because of nurses being in a lower position of hierarchy, their frustrations are acted out laterally (horizontally) toward other nurses. This paper is an analysis of the literature in addressing the psychological process of lateral (horizontal) violence among health healthcare employees in health services organizations. A model was developed describing this psychological process with the proposed impact of preventive strategies. Horizontal hostility or lateral violence (LV) has been defined as unkind, discourteous, antagonistic interactions between employees in the workplace. Also, nurses experienced numerous physical and psychologic stress and even death. In many health services organizations, this horizontal/ lateral violence behavior is accepted and considered the norm and often overlooked and not reported. Health services organizations need to promote better working relationships among healthcare professionals to have better patient outcomes. In the hospital environment, physicians and nurses need to work more collaboratively. Therefore, nurses need to be empowered to report and advocate against violence.

The Psychological Development of Horizontal ( Lateral) Violence in Health Services

Workplace violence has a major impact on productivity, morale, increase absenteeism, turnover, patient outcome, and cost. The hierarchy of the hospital structure is based on a patriarchal system dominated by male physicians and administrators with nurses in the lower position. However, because of nurses being in a lower position of hierarchy, their frustrations are acted out laterally (horizontally) toward other nurses. This paper is an analysis of the literature in addressing the psychological process of lateral (horizontal) violence among health healthcare employees in health services organizations. A model was developed describing this psychological process with the proposed impact of preventive strategies. Horizontal hostility or lateral violence (LV) has been defined as unkind, discourteous, antagonistic interactions between employees in the workplace. Also, nurses experienced numerous physical and psychologic stress and even death. In many health services organizations, this horizontal/ lateral violence behavior is accepted and considered the norm and often overlooked and not reported. Health services organizations need to promote better working relationships among healthcare professionals to have better patient outcomes. In the hospital environment, physicians and nurses need to work more collaboratively. Therefore, nurses need to be empowered to report and advocate against violence.

Concerns about disease management and psychological stress in SAPHO patients during the COVID-19 epidemic

Objectives The coronavirus disease 2019 (COVID-19) epidemic brings potentially impact on the care of patients with rheumatic diseases, including SAPHO syndrome. We aimed to investigate the disease status, concerns about management, and psychological stress in SAPHO patients during the COVID-19 epidemic. Method A structured questionnaire was distributed online to patients with SAPHO syndrome enrolled in a Chinese cohort study on March 3rd, 2020. Patients were ask about the current treatments, disease status, and concerns about disease management during the epidemic. Psychologic stress (scored from 0 to 10 points) and psychological problems were reported by the patients. Results A total of 157 patients (mean age 38.4 ± 12.3 years, 66.9% females) were included in the study. None of the patients were diagnosed with COVID-19. Sixty-five (41.4%) patients worried about their disease conditions during the epidemic with concerns including medication shortage (73.8%), delay of consultation (46.2%), and disease aggravation (61.5%). Sixty-seven (42.7%) patients had medication withdrawal or dose reduction due to lack of drugs, irregular daily schedule or subjective reasons. The most common psychological problems reported was little interest or pleasure in doing things (66.2%). Patients with progressive disease condition were more distressed and disturbed by the epidemic. Patients with nail involvement felt more worried about their disease conditions than patients without (59.6% vs 31.0%, p =0. 001). Conclusions The COVID-19 epidemic imposes a negative impact on the disease management and psychological stress in SAPHO patients. Patients' access to specialty care and medication well as mental stress is of great concern.

SAT-641 Self-Reported Psychological Stress and Glucose Variability in Type 1 Diabetes on Sensor Augmented Pump over 5 Weeks

Introduction: Patients and their families and medical providers have assumed that psychologic stress impacts glucose control in T1D (Type 1 Diabetes) though studies providing confirmatory evidence in real world settings are, to our knowledge, lacking. We hypothesized that self-reported psychologic stress worsens glucose control in T1D. Method: We studied 20 adults with T1D on continuous glucose monitor (CGM), sensor augmented insulin pump (SAP) prospectively at 2 clinical research centers. Patients reported psychological stress through stress diaries for 5 weeks on a severity scale of 1-7 using hard copy logs including time of onset and offset of stress and severity. For analytic purpose, grades 1-4 are classified as mild and grades 5-7 as severe. Results: Baseline characteristics were age 44.9±15.0 years, F/M 12/8, HbA1c 6.8 ± 0.7%, and diabetes duration of 22.9±15.9 years. We analyzed glucose variability during days of stress versus days without stress. During a 24 hour period, patients experienced less hypoglycemia during days with stress versus days without stress (p value 0.03). During the 5 week period, patients reported 23 ± 19.5 events. We analyzed the impact of self-reported stress on CGM data streams after excluding stress events associated with missing CGM data, nocturnal events (from 12 MN to 6 AM, too few events) and events for which subjects did not provide duration of stress. Thus, we analyzed 19.5 ± 17 events per patient from 6AM to 12MN. From 6 AM to 12 MN, the episodes lasted 179 ± 255 minutes with 83 % episodes being mild/moderate and 17% moderate/ severe. Number of CGM readings during daytime stress episodes were 717± 1120 compared to 8768± 1238 during non-stress periods. Impact of stress from 6 AM to 12 MN (Mid-Night) on CGM glucose was analyzed using matched paired t test. Mean glucose (160.6±41.9 vs 148.3± 28.6) and SD (53.2 ±17.7 vs 56.1±14.6) did not show a difference; however % of time spent below 70 mg/dl was less (4 ± 5) in patients during stressful periods compared to times without stress (6.3± 5.5, P value 0.02). Conclusions: To our knowledge, this is the first study attempting to analyze the impact of self-reported stress using daily stress diaries on CGM data streams in T1D patients on SAP. The study revealed significant challenges experienced by patients in reporting adequate data. Self-reported stress was not associated with hyperglycemia. However, days of self-reported stress and periods during patients reported stress were characterized by less hypoglycemia on CGM data streams.