interviewed Susan Van Cleve, DNP, RN, CPNP-PC, PMHS, FAANP, FAAN, Clinical Professor and Primary Care Pediatric Nurse Practitioner program director, University of Iowa College of Nursing, on identifying and treating anxiety in children and teens who present comorbidities. The discussion includes whether medication is always a viable option for treatment and whether there are situations in which it is obvious that medication is the best option for children and teens.

Van Cleve noted that periodically, there are situations in which the best option is to pursue medication. She said, “There will be a patient who has received lots of therapy, and the therapist has been working with that child or the teen, and they feel that they're at a standstill, and that the only next step would be medication. That's when we would just start with medication and encourage that child to continue with a therapist.”

Van Cleve also discussed whether identifying anxiety as a disability in academic settings is important for the success of treatment, whether anxiety being seen as more commonplace today is advantageous or disadvantageous when approaching treatment, and how the treatment of anxiety in children and teens may be progressing in the future.

Videos

Contemporary Clinic® interviewed Susan Van Cleve, Clinical Professor and Primary Care Pediatric Nurse Practitioner program director, University of Iowa College of Nursing, on identifying and treating anxiety in children and teens who present comorbidities.

Approaching Medication as a Treatment for Children and Teens with Anxiety 

 Hi, I'm Alana Hippensteele from Pharmacy Times. Before we get started, one of our top articles today discusses how a recent study that is the first of its kind demonstrated that there has been a decline in cancer-related deaths following the adoption of the Affordable Care Act in states that adopted it. There’s more of that on PharmacyTimes.com.

Today, I’m speaking with Dr. Dawn Garcon Maaks, the Immediate Past President of NAPNAP and the Associate Professor at the University of Portland in the School of Nursing, on caring for children with ADHD in advance of her presentation on the subject at the 2020 Virtual Conference on Pediatric Health Care.

How has caring for children with ADHD changed over the years?

 I think it was just like I said when I was in my NP school. I remember, you know, 

Oh my gosh, we're gonna talk about ADHD now. That's mental health!

 So I think we've kind of gone from this stigma of not knowing what it is to the flip side, and now people come in and say, 

Well my teacher said she can’t tell me my kid has ADHD, but she thinks he does and he needs medicine.

have they done any school testing, have they figured out if this is a learning disorder?

Is this in fact happening in 2 domains because if it's just happening at school and it's not happening outside of school, that to me sounds like an intellectual or learning disorder and not an attention deficit disorder. Is it just happening at home and the kid does fine at school? In which case, there might be some interplay between the adults and the child in the home that might be contributing to some of those behaviors.

So, I think we've gone from not wanting to talk about it, talking about it like it’s a dirty word. I vividly remember the first couple of times I talked to parents about putting them on stimulants, they were like, 

I don't want my kid to be addicted, and he's gonna be a junkie.

 I don't think we feel that way now. I do feel like people are, and rightly so, a little concerned about what are the long-term effects, and 

I don't know that I want to subject my child to taking medication every day for the rest of their lives

, and that's where I think having conversations around if we can set them up with behavioral modification, as this child developmentally gets better, he may be able to get off medication for this isn't necessarily something they have to do their whole life. But if a child is not doing well socially, if their grades are poor, they're not learning what they need to learn, and we know they have increased injury risk and all the other comorbidities that we know of untreated ADHD, to me it sounds like if we can use a little bit of medication—and I am of the start low and go slow crew, I openly admit to that—if we can start with a low dose and a teeny amount, like you know 18 milligrams of extended-release methylphenidate, and it changes this kid's world, well that's the kind of kid that probably will grow up to the point that they may not need medication in the future, and we should celebrate that. We should celebrate that they develop the skills that they needed to be successful, and that they didn't have to be managed by medications.

 Yeah, absolutely. How do you see caring for children with ADHD progressing in the future?

 That's a question! There's a part of me that goes, you know, artificial intelligence is going to dramatically change health care in the next 5 to 10 years. Some of us are going to be replaced, honestly, and given the fact that in some instances, computers do better jobs at diagnosing in some circumstances, that may or may not be a bad thing. That's a coffee talk, 

. You can have that conversation on your own, and whatever your belief is on that.

So, I do see that happening, I could see better diagnostic precision, maybe over time as we do more of the psychiatric epidemiologic studies of really looking at the population level because anytime you just deal with people that are seen in clinic, you're getting the worst cut of any condition, you know, when you go out and you look at symptoms in the general population, then you see the full spectrum.

So, a lot of our recommendations and evidence are based on the worst of the worst that show up at an academic medical center because the majority of kids never step foot in an academic medical center their entire childhood. And so all of our recommendations are based on that population, so I could certainly see, you know, with like big data and data analytics starting to get a better idea of what that spectrum looks like and maybe identifying kids better. You know, I would love to see something that is as efficacious as the stimulants without the side effect profiles that come with them.

I think there is a financial incentive to the development of drugs that people will be on for a long time, and so I wouldn't be surprised that there aren't some exceptionally smart people that are working on that as we speak. So, I'm sure there will be different approaches. I just don't see human development evolving to the point that kids in 50 years are that much different than kids are today. So, I mean I think this always going to be an issue. In 50 years from now, are they gonna look back and go, 

You filled out a piece of paper and looked at what the teacher said and the parent said, and then you did this 20 minute interview, and that's how you figure it out

? I think some of that probably will be different, but I will tell your readers, I have made many a prediction in the 30 years I've been a nurse, and I'm rarely right. So, I certainly wouldn't go hedging any bets on what my opinion is today.

 It can be very hard to make accurate predictions about the future, specifically in relation to understanding mental health or AI or technology because we really have no idea.

 No we don’t. And I think, you know, there's a big push on psychogenomic analysis, and, as many of us are aware, there was testing for ADHD and then that proved not to be evidence-based, and so we got rid of that, and so we're not doing that anymore, but I'm pretty sure there's a company that's working on that right now. But I do have full faith and confidence that we're still gonna have kids with ADHD, we're still gonna have adults with ADHD, we're still gonna have companies that are trying to figure out a way to help us identify them, and help us figure out which medication works because, as we all know, this is not, you know, amoxicillin is a first-line for upper respiratory tract infections that 90% of the time is going to knock it out. There's a lot more personal variability as far as tolerance, as far as response to our psychoactive drugs. And so, I think 10 years ago we never would have talked about the prefrontal cortex, the amygdala, the nerves in the patients, this pathway and that pathway, and how this medication affects the GABA receptor versus the serotonin receptor. We never would have had that conversation 10 years ago because we've grown leaps and bounds in our understanding of the central nervous system and how it functions, and therefore understanding why these medications work.

But what I what I can guarantee is it's still going to be an issue. I think we're going to have a better understanding of how the brain works and why the brain works, and I think as we develop, we're going to do better and not have as much failure with our first lines as we do now because I think we'll be able to have more targeted approaches to that individual’s biology, if that makes sense. It would be a cool, like a Jetsons moment.

 I'm looking forward to getting some, I don't know, little tech thing to be able to tell me what's wrong and what needs to be fixed.

 That and I need Rosie to clean my house.

 I'm all for that. Alright well, thank you, Dr. Maaks, so much for taking the time out to speak with me today. Now, let's hear from some of our other MJH Life Sciences brands on their latest headlines.

Dawn Garcon Maaks, PhD, CPNP-PC, PMHS, FAANP, FAAN, the Immediate Past President of NAPNAP and the Associate Professor at the University of Portland in the School of Nursing, discusses how caring for children with ADHD has changed and may progress in the future.

How Caring for Children with ADHD Has Changed, May Progress in the Future

Dawn Garcon Maaks, PhD, CPNP-PC, PMHS, FAANP, FAAN, the Immediate Past President of NAPNAP and the Associate Professor at the University of Portland in the School of Nursing, discusses the realities of clinical primary care management for children with ADHD symptoms.

So, what are some of the realities of clinical primary care management for children with ADHD symptoms?

 So, I think, you know, first, I have a one-word answer to that: It's reimbursement. If you talk to those of us who work in this space, it's like, you know, our system is set up right now to be a volume-based system. I don't think any of us that work in the clinical arena feel that that's the best thing, but it's the reality of it. In pediatrics, our margins are particularly poor compared to other subspecialties, and so, you know, if I'm a primary care provider, I'm hoping to do this assessment of this kid, if I'm lucky, in a 30-minute visit, but I might be trying to do it in a 15 to 20 minute visit. If you see me in behavioral health, my intakes are an hour and a half. I get to go back to this kids’ development, I get to really assess, you know, symptoms that are suggestive of maybe an autism spectrum disorder, where maybe they're just regulating because they're overwhelmed because of sensory input, and not necessarily that they're impulsive or inattentive in the traditional sense.

So, I think some of it is just the timing of it. I think the other thing that is really hard for people in primary care, like I said, is I know within my FQHC, I had two pediatricians that will not diagnose or manage these kids. They don't feel like they had the training that they needed for it, they don't feel like they have the time for it, and so, you know, I think those of us who work in pediatric primary care, whether it's as family practitioners or as pediatric specialists, that we really understand the gift and the responsibility of taking care of children with developing brains. And so if we don't feel that we don’t have sufficient education to be comfortable with it, if we don't have systems that are in place to allow us the time once we do have the education and know the right way of doing it, then I think that's what leads to people saying, 

If you fail the first line, you need to go out and get in the 6 to 12-month line.

 And that's why I feel like these conversations like the one we're having at our virtual conference are so important because these are direct conversations for people in primary care about increasing their competence and their confidence in this space. So maybe when they fail that first line, they're willing to look at a second line and try that before they send them out, or if there's something more serious that's happening, they recognize that, 

Hold on, I probably shouldn't monkey with this for two or three other drugs, this is a kid that might have something more severe I need to get him out and get him the care that they deserve

 Right, right. So, you were talking about how the mild to moderate symptoms may not require medication. In terms of moderate to severe, what are some potential symptoms, except I don't want to be too broad with it, but what are some potential symptoms where it becomes very obvious that medication is the only route?

 I personally never feel like medication is the only route for ADHD, and I'm pretty clear with my families about that because I feel like, in public disclosure, I live with someone who openly admits he has ADHD, and he's a 50-something year-old man who struggled with this for years, and I've watched him develop really good coping skills that use the theory of behavioral economics. And basically what that says is: You and I probably didn't spend a lot of time thinking about what we were going to put on today, like I knew I was doing this interview, and so I needed to look professional, and so I knew a t-shirt probably wasn't appropriate, but beyond that I don't know that I said to him that, 

, or let's really like, I was standing in my closet and I went, 

Okay this is the professional section of my clothing

I'm gonna grab something, put it on, does it feel good? I'm wearing this today.

 It wasn't like some great thought out thing. I got up this morning, I had breakfast, I made my egg whites like I always do, I made my coffee the way I always do. Did I really stand there and think about how much cream I was putting in my coffee? No, I automated it.

What we know is that human only have so much processing bandwidth in their brain. And so, for people with ADHD, the worst thing you can do is take them to a Chinese restaurant with a 10-page menu because there's so many choices there they just get completely overwhelmed. And so like, a great coping mechanism is, if you go to a restaurant and there's like 5 pages of things, knowing that food style, what's something that you like that's pretty sure to be on the menu, and then you don't have to get overwhelmed by the menu. Like, you know, I'm a General Tsao's chicken person. I openly admit that that's my jam, and so, if I have ADHD and I'm sitting there getting overwhelmed by 5 different styles of egg foo yung, my brain just goes, 

Alright, I'm going to make this decision,

 because it needs that bandwidth for the fact that, if I have ADHD, while you and I are having this conversation, the back of my brain is having a whole separate conversation, and I'm thinking about something that has nothing to do with what we're talking about right now. You don't ask kids with ADHD to make repeated kind of boring everyday decisions, you simplify things for them. The child has a uniform, okay in the winter, you need to wear long pants, and a long shirt, you need socks on your feet, you need a closed-toe shoe. In the summer, you need a short sleeve shirt, you're gonna wear, you know, this color shorts, and pretty much when you go out and you buy stuff for your child, you put it all in the same color range so that everything is kind of mix-and-match. Almost, if you think of like your garanimals, if you remember your garanimals, they were kids clothing where like the lion tag always went with the lion pants, and the tiger shirts always want with the tiger pants.

We know that we as humans don't always think about the things that we do repetitively. We've all been in our car going home or walking home after commute, and we're like, 

 Because we were thinking about something else. Well, that's their life all day, every day. So if we know that's what it's like for these kids, then teaching them behaviors and skills that they can put into place to make them be successful, teaching them organizational skills, teaching them documenting skills of where they can save things that they can retrieve at a later date, so something like the Evernote app is an amazing thing for somebody with ADHD because I can create subfolders where I keep important things that I need to remember. So, somebody says to me, 

 I have a piece of paper that I can pull up on the computer that I can immediately go to that and not have to trust that my brain that has 5 different things going to have the bandwidth to process that additional thing. Teaching parents that sleep matters, if your child has bad sleep habits, and if they're not sleeping well, their behavior is going to be more disregulated. Teaching them that physical activity, running around, getting hot, stinky, and sweaty makes the difference. Michael Phelps became a swimmer because he had god-awful ADHD, and his mom needed to be able to burn some of that energy off. Sticking them in the backyard or going out on a bike ride with them or letting him run around a park and burn that energy off, those are as effective in some cases as medication.

So, if I have a parent who comes in with a kid whose grades are really good, it bothers them cause, frankly, if it doesn't bother the kid it doesn't bother me. I don't treat parents’ concerns with medication, I treat if it disturbs the child. So if I have a kid who comes in and they're kind of worried about it, but they're not sure if they want to take medicine, I'm always like, 

Great, let's go connect you with one of our therapists, let's work on some behavioral strategies, some behavioral modification, let's see how that works

. And then the other conversation when it comes to medication is: These are medications that I'm going to be able to tell you if they're going to help you in 3 days because of their short half-lives. You're going to go home, you're going to take this medication, you're going to notice a difference within a week, and you know what, if you have bad side effects, if you say yeah I can't sleep, stop it, the next night you're going to be able to sleep because it will have worked out of your system. This isn't like, you know, SSRIs and other drugs that have a long ramp up until we see treatment response, and then a long time to get them out of their systems. And so what I think is important is that pharmacists and nurse practitioners and physicians and PAs and nurses and anybody who are mental health people that are working in this space have these conversations with parents about what their concerns are and helping them understand that the very pharmacokinetics of these agents means that we can stop and pivot relatively quickly, at least when it comes to the stimulus. You know, the alpha-adrenergics, not the same thing the, you know, atomoxetine is not the same thing, but at least kind of the first line drug. We've got some wiggle room to deal with the issues that come up and be able to do some education around that, and then pivot and respond if issues develop.

 Yeah, absolutely. Alright well, thank you, Dr. Maaks, so much for taking the time out to speak with me today now let's hear from some of our other MJH Life Sciences brands on their latest headlines.

Dawn Garcon Maaks, PhD, CPNP-PC, PMHS, FAANP, FAAN, the Immediate Past President of NAPNAP, discusses the realities of clinical primary care management for children with ADHD symptoms.

The Realities of Clinical Primary Care Management for Children With ADHD

Contemporary Clinic® spoke with Brigit VanGraafieland, DNP, CRNP, FAAN, assistant professor and director of the Fuld Program at the Johns Hopkins School of Nursing, about telehealth visits for pediatric patients.

VanGraafieland said that telehealth has taken off immensely and has become more mainstream in response to the coronavirus disease 2019 (COVID-19). Although the beginning required a lot of onboarding and training for some health care providers, she has seen telehealth being utilized on multiple different levels in her outpatient setting.

VanGraafieland also discussed the health care in the rural and urban setting, screening for adverse childhood experiences in childcare, and the future of telehealth.

Contemporary Clinic® spoke with Brigit VanGraafieland, DNP, CRNP, FAAN, assistant professor and director of the Fuld Program at the Johns Hopkins School of Nursing, about telehealth visits for pediatric patients.



Telehealth in the Pediatric Patient Setting

spoke with Carla Burns, research and database analyst at Environmental Working Group (EWG) about the EWG Sunscreen Guide and sun care.

Burns said that EWG has been releasing their sunscreen guide for 14 years, starting back in 2007 when many products on the market weren’t as safe and were misleading. The origin behind this guide was to help consumers know what exactly is in their products and how SPF products work for them and their family.

Burns said that each product is analyzed by 2 different factors: the ingredient hazards associated with any ingredient on the product label and sunscreen efficacy.

“We found that only about a quarter of the products met our standards and are on what we call our ‘best list’,” Burns said. “Those products have adequate UVA and UVB protection and do not contain ingredients of concern.”

Burns also discussed the most common misconception that EWG has found in sunscreen use research and recommendations for those who have skin conditions/skin cancer history in their family.

Articles

Contemporary Clinic® spoke with Carla Burns, research and database analyst at Environmental Working Group (EWG) about the EWG Sunscreen Guide and sun care.

Updates to the EWG Sunscreens Guide and Sun Care

Susan Van Cleve, DNP, RN, CPNP-PC, PMHS, FAANP, FAAN, Clinical Professor and Primary Care Pediatric Nurse Practitioner Program Director, University of Iowa College of Nursing, discusses how to identify and treat anxiety in children and teens who present comorbidities in advance of her presentation on the subject at the 2020 Virtual Conference on Pediatric Health Care.

Before we get started, one of our top articles today discusses a new survey that shows that pharmacists believe COVID-19 will result in lasting changes in how local pharmacies do business across the country. There's more of that on pharmacytimes.com. Today, I’m speaking with Susan Van Cleve, Clinical Professor and Primary Care Pediatric Nurse Practitioner Program Director at the University of Iowa College of Nursing, on how to identify and treat anxiety in children and teens in advance of her presentation on the subject at the 2020 Virtual Conference on Pediatric Health Care.

So, what is your background in treating anxiety in children and teens?

I've been a pediatric nurse practitioner for more than 30 years, and about 15 years ago I started working in a Child Development Center, and 10 years ago I started what's called an integrated practice. So that is a practice where there are 2 nurse practitioners and a nurse, and well I'm one of the nurse practitioners. We provide assessment diagnosis and treatment of children and teens with health disorders in our primary care practice. This is quite a large practice in Pittsburgh, Pennsylvania, and we have separated off and segmented off the behavioral health care, and we tried to do a really comprehensive evaluation as well as do a good job of providing high quality health care to this population.

Why is assessing, diagnosing, and treating anxiety in children and teens a complicated issue?

Well, I think that there's so much comorbidity in terms of children and teens who have either depression with anxiety or ADHD, mostly inattentive ADHD, and anxiety, that it really requires that the clinician spend a large amount of time, I shouldn't make it a large amount of time, but is really comprehensive in terms of assessing and evaluating for all these different disorders, so that we don't miss a disorder. I think that the tendency for people who are in a hurry is that they will just look at maybe ADHD, or maybe just look at depression, or they'll look at, you know, other kinds of characteristics, but we really have to do a big picture before we can sort of settle in on anxiety as the diagnosis. So it requires a fair amount of time, it requires a lot of questions. We need to get information from teachers, parents, and kids themselves, as well as look at their symptoms and how much that's interfering with their functioning, and then come up with a proper diagnosis and treatment plan. So it takes a fair amount of time.

Why is the use of screening tools for assessments important?

Screening tools provide us with so much objectivity, and it takes away the subjectivity from the clinician. It also provides us with an opportunity to hear from people that are not present during the visit, so that can be a teacher, that can be a daycare worker for younger children, that can be a counselor or a therapist who's working with a child or the teen, and including the parents as well as the teen or the child.

So there's self-reports that we also use that can really give us a window of understanding into how their feeling and how that child is, what the struggles are that the child's having or the teens having. So, the use of screening tools is invaluable, and I really think that we should recommend that for every practice in terms of screening for depression and anxiety, we screen for all kinds of behavioral issues with our patients; it's very important.

Does the presence of comorbidities in children and teens make the process of diagnosing anxiety more difficult?

It does because we often have to really look at what diagnosis or what problem is interfering the most with the child's functioning. So if a child comes to us with a complaint of inattention in school and we go through our whole evaluation process and determine that the child may have a form of ADHD, it's called inattentive ADHD, but also have anxiety. We have to decide well what treatment is going to be appropriate because that diagnosis will affect the treatment, and so by doing a thorough evaluation and really looking at the symptoms that are interfering with that child's level of functioning, it enables us to choose the appropriate treatment plan.

So, it is really important to come up with the right diagnosis, and it sometimes it’s hard. It can be pretty challenging. Many times when I'm in practice, I'll really sit down with parents and children and say what seems to be causing the most harm in your life right now: is it the anxiety or is it the inattentive ADHD, and then that determines our plan.

What are some evidence-based treatment options available?

So, if we do determine that a child has anxiety, we always refer them for therapy. So, in some practices, I'm actually learning to do this now, we can provide some cognitive behavioral therapy within the practice, or we refer out to people who are skilled in cognitive behavioral therapy. Working in a big city, there are lots of therapists available who have that skill. I think that that's a bigger challenge for people who work in rural areas where there's really very few mental health therapists in the county or the community, but I am very fortunate in that we have a huge list of people that are skilled in that area, so we’re able to refer kids for therapy.

You know, this includes very young children. I see children who are 4 years old, 5 years old who can exhibit anxiety symptoms, and they benefit from treatment as well. Obviously, you need a skilled counselor in order to work with them, but the basis of the therapies called cognitive behavioral therapy, and it's basically cognitive restructuring and helping that child to sort of change the way he or she thinks about their life, and how they think about it, how they believe it, and then they sort of behave, what their behavior is, and how they feel about it. It's very interesting. It does work and children's brains are very pliable, so it's a wonderful thing to see when children can learn these skills and really reframe how they think about things.

Yeah, absolutely. Thank you so much for taking the time to speak with me today. Now, let's hear from some of our other MJH Life Sciences brands on their latest headlines.

Susan Van Cleve, Clinical Professor and Primary Care Pediatric Nurse Practitioner Program Director, University of Iowa College of Nursing, discusses how to identify and treat anxiety in children and teens who present comorbidities.

Treating Anxiety in Children and Teens Who Present Comorbidities

spoke with Bethany Rettberg, NPC, family nurse practitioner at CVS Minute Clinic, about vaping and the coronavirus disease (COVID-19) pandemic.

Rettberg said that even with the first emergence of e-cigarettes over a decade ago, the popularity has been growing ever since, with the biggest jump from 2011 to 2015 with a 900% of use for vaping products.

Rettberg discussed an in-depth analysis of how the e-cigarettes and vapes contain pro-inflammatory cytotoxic reactions in respiratory tissue, which correlates with COVID-19.

“Smokers are already kind of taking away their first line of defense by smoking or vaping,” Rettberg said. “Then, if you do get COVID-19 and you add that on to it, COVID-19 is pro-inflammation, cytotoxic…it will cause the same results. It kind of adds fuel to an already smoldering fire.”

Rettberg also discussed how individuals can stay aware of the implications of COVID-19 with severe respiratory issues, allergy season, and advice for how to stop vaping and smoking.

Bethany Rettberg, NPC, family nurse practitioner at CVS Minute Clinic, spoke with Contemporary Clinic about vaping and COVID-19. 

The Effects of Vaping and COVID-19

spoke with Tiffany Budzinski, FNP-BC, about asthma management in the urgent care setting, specifically with the emergence of coronavirus disease 2019 (COVID-19).

Budzinski has seen access to primary care decline, with many patients not wanting to wait for a visit to their primary care physician, causing an increase in the management of patients with asthma in urgent and retail care clinics.

Budzinski mentioned the flexibility for practitioners to increase or decrease their patients’ treatment options based on their evaluation of the patient, using tools such as the step approach and asthma guidelines from the National Heart, Lung, and Blood Institute.

The COVID-19 pandemic is respiratory-focused and can cause severe complications for those with asthma, and Budzinski explained the possible implications for patients who smoke or have other respiratory diseases.

“There is no higher risk of becoming infected if you have asthma, but if you have asthma history, if you become infected, you have the possibility for more severe COVID-19 infections,” Budzinski said.

Budzinski also discussed World Asthma Day, the evolution of asthma treatments, and how patients can manage their asthma with the beginning of allergy season in full swing.

Tiffany Budzinski, FNP-BC, CVS Health Minute Clinic, talked with Contemporary Clinic about asthma management in the urgent care setting.

Asthma in the Urgent Care Setting

Contemporary Clinic spoke with Christy Blanco, DNP, APRN, WHNP-BC, Texas Nurse Practitioners President & Legacy Member, about the role of nurse practitioners during COVID-19.

Hi, this is Jill Murphy from Contemporary Clinic. Before we get started today, one of our top stories on Contemporary Clinic is about a new study conducted by the National Institutes of Health to help determine the incidence rate of COVID-19 in children and their family members in the United States. Today I'm speaking with Christy Blanco, DNP, APRN, WHNP-BC, President of the Texas Nurse Practitioners and Legacy Member, about the important role of nurse practitioners and nurses during COVID-19. How are you doing today, Christy?

I'm doing great, thank you for having me today.

Thank you for joining us. During the pandemic, how has the role of nurse practitioners and nurses changed?

So we've seen a big change going on right now. We've seen a shift from the primary care world into an acute type setting, and so that has probably been the biggest need that we have seen currently at the moment. But definitely, without a doubt, a lot of people are going without health care from the primary care aspects, which is concerning because their primary care needs are not going away. So we have this fear, and we need to brace for this, that we're going to see a huge shift to the primary care and nurse practitioners are able to take care of these type of situtations at this moment in time. And currently right now we're doing a lot of telehealth or a lot of telemedicine is what we're seeing, and that is definitely posed a lot of challenges that we can see. But definitely it's going to be in the future and it's something that we definitely want to focus on, so we're definitely seeing that. A big change within the nurse practitioner world.

And with that in telehealth, are there other things that you have been seeing in your facility as the pandemic continues?

So probably one of the biggest things is the drop in the primary care world. I see it in my facility and across the board, I think everybody has seen that. Everybody is afriad. They're afraid. They don't want to get their blood work done, you know, sometimes they don't have the ability to see patients, patients don't have the technology to be seen via telemedicine routes, so we're definitely seeing a lot of these challenges. I'm seeing it in my primary care aspects or in my world as is so many other people seeing it across the board, across the country, across the states, you know. So definitely a drop in the numbers, a drop.

And with that, so there's a lot of news coverage lately about certain states that are reopening, including your state of Texas. And what's the importance of continuing to screen and test patients while this is happening, enforcing social orders like social distancing?

Well I think the important things are to consider is, you know, by wearing a mask we know that we're not going to be protected necessarily, but what it's helping do is it's helping protect our loved ones, our community, it is helping protect other people. And maintaining a social distance, as well, I know can be challenging and especially because you know every state is so different, and then [you know] and a lot of the states have left it up to the mayors. And so there's, so [it's] I think it's a lot of confusion, but I think keeping up with your city and your state requirements is incredibly important as well because it's going to go based on [what] what's going on in your community at the moment because it's so different everywhere, you know, that we see and so we, so, I do believe though maintaining you know trying to wear your masks the CDC has come out with a lot of, you know, guidelines and but not only that how to make a mask you know? You can do it with a t-shirt, a scarf. and there's a lot of tutorials out there that you can do that you can actually make a make a face mask, you know, when you're out in public.

Yeah, that's really important right now especially when we can't go to many stores, it's really important that people can look at these tutorials online.

So I wanted to take a little detour with the [American Association of Nurse Practitioners] AANP. They recently called for policy makers and health systems to take action on the impact that the pandemic's taking on minority communities and that includes requiring healthcare barriers for nurse practitioners being lifted in all 50 states. Have you experienced this firsthand, and if so, how do you feel about their statement?

So healthcare disparities have existed for so long, and I'm so grateful that they are out, you know, promoting this and out making you know out actually showing what you know this is what we need to work on. And because, yeah, we haven't quite seen the statistics, and I would really love to start to see statistics to see how these healthcare disparities are affecting our certain communities. I mean from, you know, from what I read you know in [in] certain states. I mean, the majority of the people who are affected are, you know, gonna be the African-American community, even though [even though] it doesn't make up a large percentage of their state, it's a large percentage of the patients who are being affected by COVID-19. And so this is something that needs to be addressed, and Dr. Fauci as well, he brought this up at a national level. And I was really grateful to see this, because this is something that is a public policy issue that's always been around and it's

something that needs to be addressed and on all levels, yes.

I completely agree with that. And in addition to COVID-19, we're also in the midst of allergy season, and as people begin to sneeze and cough, I feel like there's gonna be more people worried about COVID-19 even more. Do you have any recommendations for differentiating between the two without going in to see a physician?

Yeah. Well obviously, I always recommend going in to see your provider to just kind of assess. But most people who have seasonal allergies kind of know when they're about to get seasonal allergies. And so a lot of times you just know. Do you have the itchy eyes? The itchy nose? The clear nasal drainage? Is it occurring during a time frame that it always occurs at, you know, now that we're heading into the spring months? You know, I mean, is this a time frame that usually that it occurs? And so I definitely understand that people are, you know, are more worried about this, and kind of having to evaluate themselves because they have a fear of, you know, being seen by their medical provider. but I do feel like your medical provider, also kind of has a good understanding of your own personal health care needs and can [can] help you decipher via telemedicine route. Is this truly, you know, just allergies? Because I know we're at a time of a high anxiety, a lot of stress, and so any little thing that happens, maybe one little sore throat, and you're thinking "oh my gosh, I might have this!" so, [so] we're definitely dealing with a lot of anxiety. So I encourage people, you know, if you don't want to go in to see your medical provider, because certain states you can't. Please, you know, it's okay to use telemedicine. It is a fabulous route to get healthcare, and [and] it can be, you know, just based on sometimes a lot of history, we can kind of determine "yeah, this is, this is allergies." You've got the itchy nose, that itchy throat, the itchy eyes, I mean, and so, and what we usually take for allergies what has worked in the past, and [might that] might that help again. So, so I think if somebody doesn't wanna go to see their medical provider, really look into telemedicine as a route.

And lastly, you have a focus on nutritional health. Are there any supplements people could take as preventive measures to stay healthy right now?

So yeah, I absolutely love preventive care, I think that's so great. And without a doubt at this point in time, I am not skipping my supplements, and it's just your basic nutritional vitamins that are absolutely gonna have vitamin C, you know, your B vitamins, just to kind of keep up with your immune system, but I think at this point you know we don't want to underestimate the importance of sleep, and nutrition, and exercise, everything that can help the immune system. So whenever I'm thinking about sleep, I'm always thinking "okay, is stress an issue? And what are some things that can kind of help with stress to kind of calm people's nerves? I always look into l-theanine, which is, you know, one of the components, and green tea. So maybe having a couple of cups of green tea if you're okay with the caffeine, just to kind of help calm your nerves in the morning and to just relax you. I always think as well to make sure you have appropriate magnesium, and I'm always trying to tell people the importance of magnesium to help with a more restful sleep, but you can get this via means of even food, you know, um, avocados are high in magnesium, nuts, almonds, cashews, Brazil nuts are gonna be high in fat as well. And so I really focus on a lot in nutrition and making sure that it's a balanced nutrition, making sure you have a lot of antioxidants, and yes that's gonna be a lot of fruits and vegetables for sure, but making sure you have adequate sleep and exercise, too, to just kind of help you sleep. All of these play a role in the immune system, and so yes, we want to make sure that we have a good immune system, if for whatever reason somebody is exposed to COVID-19.

Those were all really great points you made, it's really important during this time. Christy, thank you so much for joining us. Now let's hear from some of our other MJH Life Sciences brands on their latest headlines.

The Role of Nurse Practitioners During COVID-19

Sara Hunt, DNP, FNP-C, PHN, demonstrates the proper way to wash your hands using WHO guidelines.