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E-Cigarettes: Incomplete Restrictions, Mixed Blessings, Still Many Unknowns

November 21, 2014

By Michael Fergenson, senior editorial coordinator

E-liquids and

E-liquids and and e-cigarette, via Wikimedia Commons

As e-cigarette use continues to increase among youth, cigarette use gradually decreases. Meanwhile, many questions remain about the safety of e-cigarettes.

According to a recently released CDC report, “Tobacco Use Among Middle and High School Students—United States, 2013,” current cigarette use among middle and high school students (that is, having smoked a cigarette at least once in the past month) dropped from 2012 to 2013 (from 3.5% to 2.9% for middle school students; from 14% to 12.7% for high school students).

In contrast, current e-cigarette use, still far less common than use of cigarettes, is on the rise, at least among high school students. The percentage of high school students who reported using e-cigarettes jumped from 2.8% in 2012 to 4.5% in 2013.

Still, it would seem that some students are replacing traditional cigarettes with e-cigarettes, and it’s no surprise that they are doing so.

  • E-cigarettes are easier to get. The FDA has recommended a national ban on selling e-cigarettes to minors, but such a federal ban has yet to be enacted. (In the meantime, as many as 41 states have enacted varying restrictions of their own.)
  • E-cigarettes come in various flavors, including candy flavors thought to be geared towards youth (such as marshmallow, butterscotch, peanut butter cup, peppermint bark).
  • E-cigarettes can be advertised on television, while regular cigarettes cannot.
  • Further, one of their main selling points is that their use doesn’t make a person smell like smoke. This makes it easier for teenagers to hide their use from parents and teachers. Read the rest of this entry »
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Always a Nurse

November 19, 2014

By Janice M. Scully. The author worked in psychiatric nursing for four years before becoming a physician. After 20 years as a physician, she retired to pursue a career as a writer. For more information, click here.

The author's parents

The author’s parents

Nurses have to be resilient and resourceful—Florence Nightingale,  of course, is the template. My mother, Betty, was a smart and practical woman, the oldest of three siblings. She attended nurses’ training in the 1940s while the Second World War raged overseas. I have a photo of her as a young woman just out of high school, dressed in her starched uniform, standing by Binghampton (NY) City Hospital, her alma mater.

According to her, the lives of young nurses back then were not unlike the lives of nuns. After lights out in the dorm, the dorm mother would walk through and shine a light on each bed, as a night nurse on a medical ward at 2 AM might do. But instead of observing for signs of life, dorm mothers were checking to be sure the young female nurses were in their beds. Sometimes they weren’t.

Although the students might not be allowed out at night, they had a great deal of responsibility during the day. Nurses did everything for the sick, even the hospital laundry. They gave bed baths and back rubs in the course of comforting the sick.

During the war, even the most inexperienced nurses had grave responsibilities. When my mother was a new graduate, with few nurses and physicians on the home front, she was placed in charge of a woman’s surgical unit, admitting the fresh post-ops almost single-handedly, taking orders, hanging blood transfusions, managing wounds. A new medication, called penicillin, was available in the hospital, but so expensive that any nurse dropping a vial accidentally, as my mother did, would get severely reprimanded.

My mother had stories. One day a woman admitted for a surgical disorder became suicidal and jumped out of a hospital window, only to return to women’s surgical in a body cast. To my mother, this was a particularly horrifying case.

Her hospital nursing career was short, as were many women’s careers in the aftermath of the war. Though she quit hospital nursing in 1946 when my father returned from the navy—feeding customers in the family restaurant they built together—in a sense, she always took care of people.

Mom ran the kitchen, Dad the bar. Salesmen would follow her around with their clipboard—and I would follow, too, listening to her ordering cans of string beans and pickle slices, cases of chicken.

She had five children within seven years. Our family lived upstairs over the restaurant and my mom balanced both worlds. It wasn’t easy, which is something I appreciate now more than I could when I was a child.

But it seems she never forgot she was a nurse. During my frequent bouts of strep throat, in soft whispers she would confer with the family doctor by phone and, before I knew it, I could hear the glass syringe and needle boiling on the stove in a little metal pan. Then she’d draw up the penicillin from a vial she kept in the refrigerator. I would cringe in my room, waiting for the shot that was sure to come in my backside. But it always made me well, ridding me of my fever and throat pain.

Mom would also give neighbors their prescribed shots of this or that, such as vitamin B12, as if running a sort of mini-clinic in the restaurant kitchen. She volunteered to help a neighbor administer a daily exercise routine prescribed for her infant with Down syndrome. My mother was always, in a sense, a public
health nurse. Read the rest of this entry »

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How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

November 17, 2014

By Sylvia Foley, AJN senior editor

“I think [palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

Table 5. Five Main Thematic Categories with Associated Subcategories

Table 5. Five Main Thematic Categories with Associated Subcategories

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview. Read the rest of this entry »

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As the VA Regroups and Recruits, The Words of Nurses Who Served

November 14, 2014

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. The AJN articles linked to in this post will be free until the end of December.

Vietnam Women's Memorial, courtesy of Kay Schwebke

Vietnam Women’s Memorial, courtesy of Kay Schwebke

A scandal earlier this year about suppressed data related to long wait times for appointments tainted the credibility of the Department of Veterans Affairs. On this Veterans Day week, the new secretary of Veterans Affairs has been using incentives and promises of culture change to promote new hiring initiatives for physicians and nurses. The focus as always should be on the removal of the barriers many veterans face in obtaining timely, high quality care. Naturally, a number of these veterans are nurses themselves.

To commemorate those who have bravely cared for our country, and who deserve the best of care in return, we’ve compiled a few quotations from nurse veterans who’ve written for or been quoted in AJN about their experiences in successive conflicts through the decades. Thank you for all your service, and for what you carry daily—as nurses, veterans, and patients.

World War II
“I remember walking through cities leveled by bombs, looking at the hollow eyes and haunted faces of a devastated civilian population. Since September 11, I see those same hollow eyes and haunted faces on the nightly news.”
—Mary O’Neill Williams, RN, “A World War II Army Nurse Remembers,” as told to her daughter. Published September 2002

Korea
“The challenges and responsibilities of combat nursing far exceeded the normal scope of nursing practice. Army nurses independently triaged casualties, started blood transfusions, initiated penicillin therapy, and sutured wounds. They monitored supplies and improvised when necessary. . .They often cared for 200 or more critically wounded soldiers in a standard 60-bed MASH; off duty, they provided food and nursing care to the local populace. Some managed to be innovators on the cutting edge of nursing practice. The nurses of the 11th Evacuation Hospital helped to pioneer the use of renal dialysis nursing and were among the first to support patients who had hemorrhagic fever using a first-generation artificial kidney machine.”
—Mary T. Sarnecky, DNSc, RN, CS, FNP, “Army Nurses in ‘The Forgotten War,’” November 2001

Nurse Lynne Kohl during Vietnam War. For more information, see article link to right.

Nurse Lynne Kohl during Vietnam War. For more information, see article link below.

Vietnam
“The guys loved the helicopters because, whenever the helicopter was coming in, their lives were going to be saved. . . But helicopters to the nurses meant, ‘Oh my God, how many are coming in?’. . . That’s when we had to run to the ER, get them out of the chopper, get them triaged, get them to where they needed to be. So for us, helicopters meant that people’s lives were at stake. We needed to move fast.”
—Diane Carlson Evans, RN, as told to Kay E. Schwebke, MD, MPH, in “The Vietnam Women’s Memorial: Better Late Than Never,” May 2009. (See also a collection of free podcasts on AJNonline.com that include short poems written and read aloud by nurses who served in Vietnam and an author interview about the creation of the Vietnam Women’s Memorial.) Read the rest of this entry »

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Ebola Changes You: Reflections of a Nurse Upon Return from Liberia

November 12, 2014

By Deborah Wilson, RN. The author is currently an IV infusion therapist with the Berkshire Visiting Nurses Association in Pittsfield, Massachusetts, and is completing her BSN at UMass Amherst. In October, she returned from Liberia, where she worked with Doctors Without Borders at a 120-bed Ebola treatment center. Names of patients mentioned in the article have been changed to protect patient privacy.

At the cemetery, newly dug graves

At the cemetery, newly dug graves

I have recently returned from Liberia, where I worked as a nurse for six weeks along with a dedicated team of physicians, nurses, and other professionals, treating 60 to 80 Ebola patients a day. My 21-day transition time is recently over and, although I am back at work and school, my heart is with the West African nurses who I worked with for those weeks in September and October.

I worked in a town called Foya, managing a 120-bed Ebola treatment center (ETC). During the first two weeks, I wondered if I would last. In the grueling heat, dressed up in all that personal protective equipment (PPE), constantly sprayed with chlorine, each day I was haunted by the question of whether I’d somehow gotten infected.

It all took its toll. Twice a shift the nursing team would put on PPE and enter the confirmed Ebola isolation area. People lay on mattresses on the floor, vomit and diarrhea everywhere. In our bulky gear, double-gloved, goggles fogging and sweat running out of every pore, we would insert IVs, push meds, try to help someone eat a little something, tell the hygienists that a body needed to be removed to the morgue.

So how did I go from wondering how I would make it through my six-week assignment to now actually considering going back? It was thinking about the nurses and teams who are still there going in every day, never having a 21-day transition period like mine to look forward to, all with colleagues and family who died during this devastating outbreak.

With staff at the 120-bed Ebola clinic in Foya

With staff at the 120-bed Ebola clinic in Foya

Our lives were in each other’s hands—we helped each other dress in PPE and double-checked each other before going in. Talking with one patient, I said, “we must look really weird,” and he laughed, which made us all laugh.

But there was not much laughter in the area for confirmed cases. We never knew who would live or die; sometimes the healthiest would suddenly be dead. We delivered babies who were so small and premature—I think about the young 19-year-old mother dying only an hour after her little boy had been placed in a white body bag and given a name so he could be identified in the morgue. I find myself wondering what her and her son would be doing now if there had been a way to save her.

I wonder about Joy, whose love and dedication to her husband touched all of us deeply. Daily she would come to the fence with his favorite food and George would come out and sit on the other side. When he got too sick to come outside, we dressed her in PPE and took her in, where she prayed with him. We all rejoiced when a pregnancy test revealed that Joy was pregnant, then saw her nearly immobilized with grief the next day when George died. Joy’s cries and sobs as the psychosocial team sat with her is something I still wake up to. I wonder how she is doing and where she is now. Will she have a boy or girl and what will she tell him/her about George?

The Liberian nurses still call me on the phone. They tell me that there is not one case of Ebola now in the ETC! Many have to go back to the health clinics where they worked before. All of them lost colleagues because, when sick people came to their clinics, they had no gloves, masks, or chlorine to protect them. Will they have basic protective equipment now?

They also haven’t been paid for September or October. The Liberian Ministry of Health keeps saying that they will get paid, but I fear that this outbreak has wreaked such havoc on the economy that they have risked their lives, working in conditions we will never have to endure, perhaps only to also risk earning no income as well for their efforts.

My three-week transition involved learning the news of the two nurses in Texas who were infected caring for Thomas Eric Duncan, of physician Craig Spencer testing positive in New York City and Kaci Hickox being locked up in an unheated New Jersey tent with no shower. At times I thought I would go mad—watching as a collective insanity gripped our nation about a virus unlikely to ever take hold in the U.S., I yearned for the day when we could instead turn our attention to what I believe this terrible epidemic in West Africa could really be teaching us: Read the rest of this entry »

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Focusing Nurses on Long- and Short-term Health Needs of Veterans and Their Families

November 11, 2014

By Shawn Kennedy, AJN editor-in-chief

I’m always humbled when I speak with veterans or families of veterans. The commitment to duty of the military and the sacrifices their families make—long periods of being single parents; nerve-racking times wondering after the well-being of a spouse or child; missed birthdays, graduations, and milestones—never cease to amaze me.

served2Last October, nurse Linda Schwartz, at the time commissioner of Veterans Affairs for Connecticut, spoke at the American Academy of Nursing (AAN) meeting about the health needs of veterans.

As we pointed out in a blog post about the meeting, she emphasized “the importance of knowing whether a patient has a military service history because many health issues may be service associated. For example, toxic effects from depleted uranium and heavy metals such as those found in ordinance or from exposure to agents like Agent Orange may not manifest themselves for years.” Read the rest of this entry »

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A Nurse’s Legal Duty to Discern Potential Harm and Protect Patients

November 7, 2014
Illustration by Janet Hamlin for AJN.

Illustration by Janet Hamlin for AJN.

By Jacob Molyneux, AJN senior editor

The November installment of AJN’s Legal Clinic column by nurse and attorney Edie Brous, “Lessons Learned from Litigation: The Nurse’s Duty to Protect,” describes a case in which nurses were held responsible for not adequately protecting a sedated patient from a sexually predatory physician. The case description begins this way:

NX was a young woman who underwent a laser ablation of genital warts at Cabrini Medical Center in New York City. While still under the effects of general anesthesia, she was transferred to a small, four-bed section of the recovery room. Shortly after her admission to the recovery room, the nurses admitted another patient to a bed two feet away from NX. The curtains were not drawn and there were no patients in the other two beds.

A male surgical resident, Andrea Favara, entered the recovery room wearing Cabrini scrubs and Cabrini identification. Residents were not directly assigned to the recovery room and were seldom called there. The nurses knew all of NX’s physicians but did not know Favara; he wasn’t one of NX’s physicians . . .

The details that follow are disturbing. After describing the case and the failure of nurses to confront this unknown physician or actively monitor his interactions with the patient, Brous sketches the ensuing legal machinations, as well as the ultimate decision of an appeals court. Some of the main take-home points for nurses are as follows: Read the rest of this entry »

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