Thanksgiving in the ICU: Woven into the Tapestry of Traditions

November 25, 2015

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.) 


I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great joy. I work with people I care about and like so much that I look forward to spending a holiday with them. And at the end of the day I’ll be going home, where my family will be waiting for me, and I’ll hug my kids and count my blessings all over again.

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Imagery: A Safe, Simple Practice Available to All Nurses

November 23, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by Ramon Peco/via Flickr

by Ramon Peco/via Flickr

“In our quest to keep up with the latest medical advances, we often forget that the healing art of imagery is available to each of us,” writes nurse practitioner Laurie Kubes in this month’s AJN. In “Imagery for Self-Healing and Integrative Nursing Practice,” Kubes explores some of the evidence supporting this technique and illustrates how it can enhance both patient care and our own self-care.

Imagery builds upon the quiet reassurance and support that we routinely provide to patients in our efforts to make them comfortable and relaxed. The more deliberate practice of imagery engages the power of imagination for deeper relaxation and a potentially more healing experience. And all we need in order to do this, as Kubes notes, is an open mind, a basic knowledge of the practice, and time to dedicate to it.
Read the rest of this entry »


Top Health Story Picks of AJN Contributing Editors for 2015

November 19, 2015

By Diane Szulecki, AJN associate editor

Kelley Johnson by Disney | ABC Television Group via Flickr

Nurse and Miss America contestant Kelley Johnson by Disney | ABC Television Group via Flickr

With the end of the year steadily approaching, AJN asked its contributing editors, editorial board members, and staff to share what they consider to be the most significant health care and nursing-related headlines of 2015 so far. Now it’s readers’ turn. See the top picks below and feel free to leave a comment to share your thoughts and additions to the list.

Clinical/Care Issues

  • The growing patient experience movement and the limitations of patient satisfaction measurements
  • The rise in chronic diseases due to lack of prevention efforts and unhealthy lifestyles
  • Substance abuse, including alcohol, prescription drugs, heroin
  • Vaccinations and issues regarding public trust of vaccines

Professional Issues

  • Nurses’ responses to critical comments made on The View and related ongoing discussion about the nursing profession’s image
  • Challenges and trends in nursing education: the shift toward advanced practice as a career path for many nurses and rapid growth in the number of DNP programs and applicants
  • Workplace stresses: staffing issues, moral distress, strain caused by an aging population with multiple comorbidities, plus an increase in the number of insured due to the Affordable Care Act

U.S Health Care and Health System Issues

  • Gun violence as a critical public health issue
  • Lack of adequate mental health care
  • Health care used as a political wedge by feuding political parties
  • Issues surrounding access to health care, including health equity and culturally sensitive care

Global Health Issues Read the rest of this entry »


Recognizing and Managing Late or Long-Term Complications in Adult Allo-HSCT Survivors

November 17, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Everybody, myself included, thought he was going to die. Another nurse on another floor had administered his stem cell transplant a few weeks prior, but as his primary nurse I was now in charge of managing its aftereffects.

Ben (not his real name, and some details have been changed) was one of the many young patients I’d cared for who suffered from a violent course of complications following allogeneic hematopoietic stem cell transplant (allo-HSCT). Intractable diarrhea and skin sloughing led to graft-versus-host-disease’s usual sequelae: wounds, drug-resistant infections, looming sepsis. The walls of his bladder, scarred and irritated by the myriad of toxic drugs he’d been given, bled. One day, while I slept at home between night shifts, he lost so much blood that they rushed him to the OR. The treatment—never before performed—stopped the bleeding. But it left him in excruciating, around-the-clock pain.

Between regular doses of Dilaudid and PCA pump pushes, he cried out to me, “I can’t do this. I don’t want this anymore.” I couldn’t blame him—his cancer fight raged on endlessly. Watching his boyishly handsome face grimace with so much pain, I remembered other young allo-HSCT patients’ faces, some of them peaceful only in the postmortem.

As it turned out, Ben survived his ICU stay. I heard about his discharge to the bone marrow transplant unit after I returned from a vacation. I lost touch with him, in the way that most ICU nurses lose touch with their patients (as though the unit is earth and the floors are outer planets, foreign and unknown, impossible to visit). I hope he’s home now, though, and a part of me believes he is—living, joining the growing population of allo-HSCT survivors.

As I read Kara Mosesso’s November CE article in AJN,Adverse Late and Long-Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors (the first of several articles from Memorial Sloan Kettering Cancer Center about cancer survivorship care), I thought of Ben and was glad to be reminded that people like him do survive. While the current population of allo-HSCT survivors is fairly small, it’s growing, and by 2020 may reach around half a million worldwide.

It seems that all nurses—whether caring for allo-HSCT patients in the acute phase, like me, or in the chronic phase in an outpatient setting, must become familiar with the multifaceted long-term care of this population of patients. The table below, from the article, lists various late and long-term allo-HSCT treatment effects and their risk factors. Visit the article link above for more context, sources, and more.

Late and Long-Term Allo-HSCT Effects

(click to enlarge)

Read the rest of this entry »


No Longer Alone: Nurses Supporting Family Caregivers

November 13, 2015

By Susan C. Reinhard, PhD, RN, FAAN, senior vice president and director, AARP Public Policy Institute, chief strategist, Center to Champion Nursing in America; Elaine Ryan, MPA, vice president of state advocacy and strategy integration, AARP government affairs; and Trish O’Keefe, PhD, RN, NE-BC, interim president, Morristown Medical Center, New Jersey

Teaching a daughter to help her mother with range-of-motion exercises.

Teaching a daughter to help her mother with range-of-motion exercises

The public trusts nurses to care for them and to teach them how to care for themselves and for those they love. But a 2012 AARP/United Hospital Fund report funded by the John A. Hartford Foundation, Home Alone: Family Caregivers Providing Complex Chronic Care, shows there is a big disconnect. In this first nationally representative study of families providing complex care activities, almost half reported that they had provided medical/nursing treatments, including injections, wound care, administering multiple medications, managing colostomies, and giving tube feedings and nebulizer treatments—among many other tasks that nursing students find daunting when they are first learning how to do them.

Family caregivers are expected to step right in, with little to no instruction or support. Most (nearly 7 out of 10) of those they cared for did not get a home visit by a health care professional, despite multiple encounters with the health care system. Many of these family caregivers said they had to learn how to do complex tasks on their own. For example, close to 60% had to learn about at least some medications on their own. More than a third performed wound care on their own, but only 36% said a nurse or physician in a hospital had taught them, and only 25% had received teaching from a home care nurse. Many were worried about making a mistake or harming the person they were trying to help.

Family caregivers need more support. Recent research shows that in 2013 there were 40 million family caregivers who provided $470 billion in unpaid care to an adult with limitations in daily activities. About 50% to 60% of family caregivers have a full- or part-time job. One in three provides an average of 62 hours of care a week—and eight out of 10 of these “intense caregivers” perform complex medical/nursing tasks.

How can nurses help? No doubt many nurses are trying to meet this critical need to teach family caregivers. But we need a more comprehensive, fully supported approach. One step in that direction is the Caregiver Advise, Record and Enable (CARE) Act, which focuses on hospital admissions and discharges and has been described as a “commonsense solution to help family caregivers.” There are three parts that respond to requests from people around the country.

  • First, the CARE Act requires hospitals to permit the patient to designate a family caregiver who will be recorded in the hospital record (and hopefully engaged in the care team, including the discharge planning).
  • Second, the hospital must notify that caregiver when the patient is to be moved or discharged.
  • Third, the hospital must offer instructions on the medical/nursing tasks that are part of the discharge plan.

As of October, 33 state offices (OK, NJ, PR, ND, MS, NY, IN, VA, NM, MN, KS, CT, HI, NH, WV, MA, WI, MD, IA, IL, NV, CO, RI, OR, ME, TX, AR, AK, CA, AL, MI, DC, PA) had introduced the CARE Act; it has been signed into law in 15 states (the states in italics). In many of these states, nurses testified or provided letters of support to advance this legislation.

One health system’s efforts to better meet caregiver needs. New Jersey was one of the first to pass the CARE Act, in November 2014. Nurse leaders in the Atlantic Health System embraced this policy and went to work quickly to prepare for implementation in May 2015. Read the rest of this entry »


Check my Conduct: Committing to a Better Way to Act with Colleagues

November 10, 2015

Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.

Kindness quotation. Photo by Steve Robbins/Flickr

by Steve Robbins/Flickr Creative Commons

I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.

Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”

I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”

Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting tips I learned. But there’s still a problem. I’m concerned about Ms. S. and I’m uncomfortable that I’ve missed something. I think this is a safety issue.”

I recognized Emily’s use of the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS “CUS” words: Concern, Uncomfortable, and Safety, a tool designed to clearly communicate that a patient is at risk for harm when a first attempt to get a safety threat across to a member of the health care team doesn’t work. The initial irritation I’d felt turned to embarrassment, and I answered Emily’s explanation with, “Okay, let’s go see Ms. S.”

I followed Emily to her patient’s room where, together, we figured out the problem. Ms. S. was unharmed. Outside of the patient’s room, Emily thanked me and asked what she could do for me in exchange for the time I’d spent helping her. When nothing came to mind, she reiterated, “Please let me know if something comes up, because I’d happy to help you.”

My embarrassment grew in the presence of Emily’s team approach. With the potential safety threat averted, we carried on with our respective patient care responsibilities.

Reflect and Amend
For the rest of the shift, I couldn’t stop thinking about my outburst, which stood in glaring contrast to Emily’s professionalism. When I realized that a patient could have been harmed while I was resisting my peer’s call for help, I was horrified. I wanted to apologize to Emily. Read the rest of this entry »


AJN Quote of the Week

November 7, 2015

12227040_10153748364204204_5104056827782870848_nTo read the editorial in full: http://ow.ly/UlFoh


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