Eating Disorder

Page 18 • New Hampshire Nursing News July, August, September 2018

Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Reprinted with permission of the American Nurses Association

1. What is the assignment? Clarify the assignment. Do not assume. Be certain

that what you believe is the assignment is indeed correct.

2. What are the characteristics of the patients being assigned?

Do not just respond to the number of patients; make a critical assessment of the needs of each patient, his or her age, condition, other factors that contribute to special needs, and the resources available to meet those needs. Who else is on the unit or within the facility that might be a resource for the assignment? Do nurses on the unit have access to those resources? How stable are the patients, and for what period of time have they been stable? Do any patients have communication and/or physical limitations that will require accommodation and extra supervision during the shift? Will there be discharges to offset the load? If there are discharges, will there be admissions, which require extra time and energy?

3. Do I have the expertise to care for the patients? Am I familiar with caring for the types of patients

assigned? If this is a “float assignment,” am I crossed- trained to care for these patients? Is there a “buddy system” in place with staff who are familiar with the unit? If there is no cross-training or “buddy system,” has the patient load been modified accordingly?

4. Do I have the experience and knowledge to manage the patients for whom I am being assigned care?

If the answer to the question is “no,” you have an obligation to articulate limitations. Limitations in experience and knowledge may not require refusal of the assignment but rather an agreement -regarding supervision or a modification of the assignment to ensure patient safety. If no accommodation for limitations is considered, the nurse has an obligation to refuse an assignment for which she or he lacks education or experience.

5. What is the geography of the assignment? Am I being asked to care for patients who are in

close proximity for efficient management, or are the patients at opposite ends of the hall or on different units? If there are geographic difficulties, what resources are available to manage the situation? If my patients are on more than one unit and I must go to another unit to provide care, who will monitor patients out of my immediate attention?

6. Is this a temporary assignment? When other staff are located to assist, will I be

relieved? If the assignment is temporary, it may be possible to accept a difficult assignment, knowing that there will soon be reinforcements. Is there a pattern of short staffing, or is this truly an emergency?

7. Is this a crisis or an ongoing staffing pattern? If the assignment is being made because of an

immediate need on the unit, a crisis, the decision to accept the assignment may be based on that immediate need. However, if the staffing pattern is an ongoing problem, the nurse has the obligation to identify unmet standards of care that are occurring as a result of ongoing staffing inadequacies. This may result in a request for “safe harbor” and/or peer review.

8. Can I take the assignment in good faith? If not you will need to get the assignment modified

or refuse the assignment. Consult your individual state’s nursing practice act regarding clarification of accepting an assignment in good faith. In understanding good faith, it is sometimes easier to identify what would constitute bad faith. For example, if you had not taken care of pediatric patients since nursing school and you were asked

Brion W. Moss, MS Nutrition, Special BS Nutrition, National Council of Strength and

Fitness Personal Trainer, National Council of Strength and Fitness Sports Nutrition Specialist, New York City Health and Mental Hygiene Food

Handlers License and National Restaurant Association ServSafe Certified

Reprinted from Georgia Nursing May, June, July 2018

Chocolate is enjoyed by people of all ages, ethnicities, religious groups and since the conception of human civilization (more than likely). Chocolate companies do target different age groups. Children enjoy sweets, so candies are made colorful and appealing to the eye. Adults enjoy chocolate just as much, but chocolate companies create nicely colored boxes and wrappings to appeal to a specific holiday or ones birthday. For example, Valentine ’s Day (red wrappings and heart shaped treats), Easter (solid chocolate rabbits and brightly colored eggs filled with chocolate) and people’s birthdays (chocolate cake with some sort of frosting). Companies even appeal to people that are a little bit more health conscious by using dark chocolate.

The Hershey’s Company makes no health claims. However, it does state “Natural Source of Flavanol Antioxidants” on its Special Dark Chocolate Bar. This is not completely wrong; being that dark chocolate is a rich source of flavanols. Cocoa Powder (usually made from cocoa beans) is 100% cocoa and it is full of flavanols. Flavanols are a sub-class of flavanoids that are supposed to have positive effects on health in human beings. The flavanols found in dark chocolate/cocoa powder are epicateechin, catechin and procyanidins (an oligmers).

These flavanols have been studied and results show they have protective factors against Cardiovascular Disease and possibly Type II Diabetes. As stated “the composition of cocoa flavanol-containing foods products can improve endothelial function, platlet reactivity, and reduce blood pressure”(1). However, current recommendations of these snack items suggest people should only eat these treats once in a while. This is due to the fact that chocolate products are full of added sugars and saturated fat. According to the National Cholesterol Education Program/American Heart Association “individuals older than 2 years of age consume a diet that provides < 30% of energy from fat, < 10% from saturated fat, and < 300 mg of cholesterol a day to reduce the risk of coronary heart disease” (3).

The NCEP/AHA also puts “Milk Chocolate …in a listing of foods categorized as “decrease, limit, avoid” (3). The excessive intakes of these nutrients are linked to the aforementioned diseases, obesity and some cancers.

Another recommendation to fight heart disease and diabetes from health professionals is; eat at least 5 fruits and vegetables a day (two fruit and three vegetables). They have other flavanoids (that act as antioxidants), vitamins and minerals that fight disease. Fruits and vegetables are also full of fiber so the sugars that they do have are burned at a moderate pace. Fiber also keeps your bowels moving. Other sources of flavanols found in chocolate are red wine and black tea. However, “dark chocolate contains catechins at an average of 0.535mg/g, 4 times that of tea (139mg/L)” (6). Cocoa Powder contains “phenols that inhibit LDL oxidation by 75%, whereas red wines inhibited LDL oxidation by 37-65%” (6). As was stated earlier, they are a source of saturated fatty acid; but it is mostly stearic acid. This fatty acid is metabolized into oleic acid and mono-unsaturated fatty acid. Unsaturated fatty acids are healthy fats, good for the heart.

A study was done where subjects were given a high- carb snack (a fig bar or graham cracker and juice) at first for a 21 day period. Then one milk chocolate bar a day for 21 days was given as a substitute for a high-carb snack. This was in addition to subjects following a Step1 diet (eating a diet designed to reduce cholesterol). This diet developed by the NCEP/AHA contained a balance between fruits and veggies, 29% of energy from fat, 55% of energy from carbs and 16% energy from protein.

This study revealed, having a high-carb snack increases the chances of having a coronary heart disease. Whereas a milk chocolate bar for a snack offers protection from coronary heart disease. This was because the milk chocolate bar shifted the amount of energy taken from fat (energy from fat <30% to 34%). Researchers believe the type of saturated fat coming from milk chocolate is stearic acid (mostly) and mono-unsaturated fatty acid. The study also showed a higher level of HDL-cholesterol when the milk chocolate bar was administered, the high- carb snack reduced HDL-cholesterol levels (increasing chance for coronary heart disease). These dietary patterns, show that content of fat is important and a “high-carbohydrate (eg, low-fat) diet, lowers HDL cholesterol whereas a high-fat (eg. high in monounsaturated fatty acids) does not” (3). Other studies were done, where subjects ate both a typical American diet (total fat 33-34%, and saturated fat 15- 16%) free of foods that contain the flavanols found in

Nutrition Message – How Bad is Chocolate, Really? dark chocolate and cocoa and a typical American diet plus dark chocolate and cocoa powder. Subjects were given a total of 38g of flavanols from dark chocolate and cocoa powder. These were dispersed over the course of a day in the form of cookes, brownies etc. They were switched from one diet to the next and the results showed LDL oxidation slowed significantly. This means LDL-cholesterol had time to perform its function and return to the liver before it was oxidized by free radicals increasing your chances for heart disease.

Another study administered 100g of dark chocolate and 90g of white chocolate to 15 healthy subjects. The dark chocolate had 500mg of flavanols and white chocolate did not. An increase of nitric oxide was observed with dilated blood vessels and caused endothelial cells to become more insulin sensitive. White chocolate had none of the aforementioned effects.

In light of these effects I would recommend incorporating dark chocolate, cocoa powder, and even milk chocolate into a well-balanced diet. These individuals were given one to two pieces of a chocolate product a day, not an excessive amount (anything over two pieces of a chocolate product). Keeping in mind too much of anything can cause harm to one’s health. A diet full of fruits and veggies, lean sources of protein, and whole grains combined with exercise will benefit an individual in the long run.

References 1. Allen, Robin R. et al. Daily Consumption of a Dark

Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol. JND. 2007. 725-730.

2. Dillinger. Teresa L. et al. Food of the Gods: Cure for Humanity? A Cultural History of Medicinal and Ritual Use of Chocolate. ASNS.2000. 2057s-2071s.

3. Kris-Etherhorn, Penny M. et al. Effects of a Milk Chocolate Bar per Day Substituted for a High-Carbohydrate Snack in Young Men on an NCEP/AHA Step 1 Diet. AJCN. 1994. 1037s-1042s.

4. Grassi, Davide.et al. Short–Term Administration of Dark Chocoalte is Followed by a Significant Increase in Insulin Sensitivity and a Decrease in Blood Pressure in Healthy Persons. AJCN. 2005. Vol5. 611-614.

5. Josse, Andrea. Et al. Increased Consumption of Dairy foods and Protein during Diet – and Exercise–Induced Weight Loss Promotes Fat Mass Loss and Lean Mass Gain in Overweight and Obese Premenopausal Women. JN. 2011. 1626-1633.

6. Wan, Ying. et.al. Effects of Cocoa Powder and Dark Chocolate on LDL Oxidative Susceptibility and Prostaglandin Concentrations in Humans. AJCN. 2001. 596-602.

Copyright of Nursing News is the property of New Hampshire Nurses' Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.