American Heart Month: Education, Awareness Crucial to Fight Heart Disease

February 11, 2016
beating heart still

© American Heart Association

In 1964, President Lyndon B. Johnson proclaimed the first ever American Heart Month: “It is essential to the health and well-being of our nation that our citizens be made aware of the medical, social, and economic aspects of the problem of cardiovascular diseases, and the measures being taken to combat them.”

The tradition has continued every February since then, and the need to raise awareness about cardiovascular health remains urgent: heart disease is the number one killer of both men and women in the United States. According to the Centers for Disease Control and Prevention, approximately 610,000 Americans die of heart disease each year.

Women may be particularly at risk, both because the warning signs of heart disease can be different for women than for men and because of common misconceptions about heart disease risk, such as the idea that heart disease only affects men or older adults. Cardiovascular disease (CVD) kills one in three American women—but the American Heart Association (AHA) says 80% of those deaths could be prevented with education and action. The AHA’s Go Red for Women campaign offers many resources to help women learn about risk factors, symptoms, and prevention of heart disease, heart attacks, and stroke. Read the rest of this entry »


Workplace Bullying: One Medical Center’s Nurses Assess and Respond

February 9, 2016
photo by Ronald Keller

photo by Ronald Keller

Bullying against or by nurses has gotten a lot of attention in recent years. Aside from the suffering bullying inflicts on its victims, research tells us that bullying (which takes a number of forms, from overt insults to more subtle acts that undermine and demoralize) can also endanger patient safety and quality of care.

As described in our February article, A Task Force to Address Bullying (free access until March 1), recently a large Magnet-designated academic medical center in the Northeast developed an initiative to evaluate and address the issue at their institution. In order to first measure the problem, the task force developed a confidential online survey.

The survey had a 38% response rate. Here are some of the findings about who’s doing the bullying, who’s suffering it, and how its victims are affected by it:

 . . . . two-thirds (66%) of respondents reported having experienced or witnessed bullying in the workplace; and ‘bullies’ were most frequently identified as staff nurses (58%), followed by physicians (38%), patient care technicians (34%), and nurse managers (34%). Among the individuals who reported having been bullied, more than half experienced the following personal consequences: loss of confidence (63%), anxiety (59%), and diminished self-esteem (50%); and more than half experienced the following work consequences: decreased job satisfaction (83%), decreased teamwork and collaboration (72%), and impaired communication (63%)

When asked how they dealt with the bullying, 58% of participants said they discussed the situation with family or friends, 53% ignored the bully, 42% spoke to their nurse manager, 41% confronted the bully, and 30% considered resigning.

It’s obvious that bullying is far too common, and highly damaging in a number of ways. The task force developed a plan to address bullying, sharing the survey results with hospital staff and starting a slogan-based program called the Be Nice Champion program. Central to the plan was promotion of “third-party intervention,” not to confront the bully but to support the victim and short-circuit the isolating effects that being bullied can have. Read the rest of this entry »


‘A New Antibiotic’: What Restores a Patient’s Will to Recover?

February 5, 2016
Illustration by Pat Kinsella. All rights reserved.

Illustration by Pat Kinsella. All rights reserved.

A little bit of levity when writing of serious topics can be good medicine. This month’s Reflections essay, “A New Antibiotic,” reminds us of how important it can be for hospitalized patients to be kept in touch with their lives and loves beyond hospital walls. In this story, author Judith Reishtein, a retired critical care nurse and nursing professor, finds herself willing to bend the rules a little for one patient. Here’s how it starts:

Sally had been a patient on the step-down unit all winter. After her open heart surgery, she developed an infection in her chest. The infection required another surgery and four more weeks of ventilator support as her open chest healed. Because she was not moving enough, she developed clots in her legs. Because of the DVTs, she had activity restrictions, which led to another bout of pneumonia. One complication led to another, with more medications that had to be carefully balanced. We tried not to do anything that would create a new problem while curing an existing one.

Now she was finally getting better, but her energy lagged behind. Did she still have the will to heal? I worried about that; I had seen too many patients slide from lassitude into the grave. I wasn’t sure if she could recoup her energy and will to live; but her daughter Trudy knew exactly what would strengthen her spirit…..

We hope you’ll read the rest of this short, free access essay, and see how it turns out. There’s a deeper truth hidden here, whatever your take on this nurse’s compassionate decision to allow a certain type of visitor on the unit.—Jacob Molyneux, senior editor 



Hospital Shootings: Unacknowledged Job Hazard?

February 3, 2016

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Active_shooter_post_illustrationRecently, while preparing for work, I received the following text from a coworker already at the hospital:

We’re on lockdown
Armed gunman
Stay home, they announced “active shooter now outside building”

Shocked, barely able to comprehend the message, I texted back:

Are you safe?

She texted back that she and others were in lockdown in the cafeteria. Numbly, I switched on the TV, looking for more information, but found nothing. Not a single report of the event on any station. Turning to the Internet, I found a single tweet referring to an event in progress. Feeling helpless, I texted my husband and daughter and then called my mom, letting them know I was at home, safe, just in case they heard something. Then I waited.

Within an hour, the same coworker texted again:

All clear!

I stared at my phone, not knowing what to do. I went to work.

The resolution of the shooting situation was heartbreaking. However, no patients or hospital staff were harmed. The outcome could have been much worse.

That evening, local media coverage of the crisis remained scant to the point I nearly felt I’d imagined it. It was as though it never happened.

We were lucky. Our shooting occurred outside, on the hospital grounds—as do 41% of hospital shootings, according to a study in the Annals of Internal Medicine. However, 59% occur inside hospitals, endangering patients and staff. Furthermore, the rate of occurrences, inside or out, is increasing.

Hospital staffs have trained for years to handle fire, child abduction, and disasters, man-made or natural. However, the realization that hospitals are soft targets, similar to schools, shopping malls, and movie theaters, dawns more slowly.

Managing a rapidly evolving and unpredictable crisis can be beyond our control. To stay and protect patients may prove impossible. Some coworkers may or may not choose to stay with their patients; you will have to decide whether or not to abandon them too. Ethical choices may come into play—I for one struggle with the concept of abandoning patients. Teachers live with this fear on a daily basis.

According to the 2015 document, Active Shooter Planning and Response in a Healthcare Setting, from the Healthcare and Public Response Sector Coordinating Council, there are a number of ways to prepare a hospital in practical terms for an active shooter situation, and also to understand the kinds of decisions that may become necessary: Read the rest of this entry »


Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

February 1, 2016

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

MarcyPhipps_Flight_NursingI’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market crowded with live chickens and full of fruits and vegetables I’d never seen.

But the ‘rightness’ I felt was owed entirely to the experience I had at the foreign hospital. Read the rest of this entry »


AJN in February: Latino RNs in the U.S., Nurse Bullying, Hypoglycemia in Older Adults, More

January 29, 2016


On this month’s cover, nurse Sarah Carruth comforts a young patient at Children’s National Medical Center in Washington, DC. This photo is the second-place winner of AJN’s 2015 Faces of Caring: Nurses at Work photo contest, in which readers worldwide submitted candid photos of nurses on the job.

When the child’s parents had to leave the room and he became unsettled, Carruth held him and comforted him with a stuffed toy. She says the photo captures the important type of quiet moment that often gets lost in the bustle: “It can be so busy that you forget about the times when you get to show that you care.”

Having worked as a pediatric nurse for 15 years, Carruth knows that meeting the emotional needs of children is a crucial aspect of caring for them. “It’s not just about giving medicine and assessing vital signs,” she says. “They need the time to be loved.”

Some articles of note in the February issue:

Original Research: Latino Nurses in the United States: An Overview of Three Decades (1980–2010).” Latinos are underrepresented in the nursing workforce. The authors of this article find that while the overall number of Latinos has grown dramatically in the U.S. over the 30-year study period, the number of Latino nurses has not. As the Latino population in the U.S. continues to increase, nursing education programs and institutions will need to do more to ensure that Latinos are adequately represented in the nursing workforce. To help achieve this, the authors make recommendations for increasing access to and improving nursing education for Latinos.

CE Feature: Hypoglycemia: A Serious Complication for the Older Adult with Diabetes.” Hypoglycemic events occur at an increased rate among older adults with diabetes. While hypoglycemia can often be easily treated, the physiologic, sensory, and cognitive changes of aging can inhibit the body’s warning symptoms of low blood glucose and impair the ability to recognize such symptoms when they occur. This article examines the risk factors, symptoms, and treatment of hypoglycemia in older adults with diabetes, and emphasizes the role of nurses in educating older patients in preventing hypoglycemic events and recognizing their warning signs.  Read the rest of this entry »


Neither Snow, Sleet, Hail, nor Major Blizzard: Business as Usual for Nurses

January 28, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyThe snowbanks in the New York area are already starting to melt, but it’s worth noting that this past weekend’s massive storm was business as usual for nurses. The New York Daily News carried a story earlier this week of a practical nurse who got a babysitter for her daughter and then walked through the height of a recent blizzard to get to her job at a nursing home.

Chantelle Diabate, who works at the Hebrew Home in Riverdale, New York, walked a mile in the snow and wind to get to work. She has been working there for six months as an LPN and said she knew they’d need her because many staff would be unable to get there. She stayed through the weekend.

by doortoriver, via Flickr

by doortoriver, via Flickr

AJN’s publisher, Anne Woods, works every Saturday as a cardiothoracic NP in a hospital near Philadelphia. With the imminent arrival of the storm on Friday afternoon, Woods went to the hospital that afternoon and spent the next 36 hours there as the only NP on duty in critical care. About 100 other staff stayed through the night, too. Woods noted that the camaraderie was uplifting, with physicians pitching in alongside nurses. Monday, Woods resumed her publishing work.

At the National Institutes of Health (NIH) in Maryland, on a pediatric bone marrow unit, the children were looking wistfully out at the falling snow of the blizzard. Given the conditions, it wasn’t safe for them to go outside, but nurses went out, filled up tubs with snow, and the young patients spent the afternoon making snowmen.
Read the rest of this entry »


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