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So You’re a Nurse With a Story to Tell…

January 30, 2015

Madeleine Mysko, MA, RN, coordinator of AJN’s monthly Reflections column, is a poet, novelist, and graduate of the Johns Hopkins Writing Seminars who has taught creative writing in Baltimore for many years.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

Whenever I meet someone new who happens to be a nurse—in both clinical and social settings—I wait for the right moment to mention my work at AJN on the Reflections column. It’s not only that I’m proud of the column. It’s also that I’m forever on the lookout for that next submission—for a fresh, compelling story I just know is destined to shine (accompanied by a fabulous professional illustration) on the inside back page of AJN.

“I imagine you have a story or two to tell,” I’ll say to a nurse I’ve just met—which is the same thing I say, whenever I have the chance, to nurses I’ve known for years. I mean it sincerely; given the vantage point on humanity that our profession affords, I actually do believe that every nurse is carrying around material for a terrific story.

The response I usually get (along with a wry smile, the raising of eyebrows, or a short laugh) is, “Oh yes. I have stories.”

But then—even as I’m mentioning the Reflections author guidelines, even as I say warmly that we’re eager to read—I can sense the backing away.

“Sure,” the nurse will say. “I’ll check it out . . . but the thing is, I’m not exactly a writer.”

Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

How to explain it?—how to explain that we aren’t so much looking for nurses who are good writers as we’re looking for essays well written by good nurses.

If you’re still with me in this scenario (and especially if you’re someone not exactly inclined to sit down before breakfast on your day off and pen a gem of an essay) maybe you could let me know what you think of this pitch: Read the rest of this entry »

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AJN in February: Rapid Response Teams, Complications of CHD Repair, Managing Type 2 Diabetes, More

January 29, 2015

AJN0215 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Rapid response teams (RRTs) are teams of expert providers who can be called on in an emergency to treat patients before their condition deteriorates. The success of an RRT depends on whether it is activated properly, a task that often falls to staff nurses. The original research article, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis,” describes the factors affecting nurses’ decisions to activate RRTs. This CE feature offers 3 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Long-term complications after congenital heart defect (CHD) repair. Nurses often encounter patients with complications that occurred years after CHD repair. “Long-Term Outcomes After Repair of Congenital Heart Disease: Part 2” reviews four common CHDs, their repairs, common long-term outcomes, and implications for nurses in both cardiac and noncardiac settings. This article offers 2.5 CE credits to those who take the test that follows the article.

Making nurses full partners in reforming health care. The Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, suggests that nurses should be full partners in reforming health care in this country. “A Bold New Vision for America’s Health Care System” is the first in a series that will revisit the report’s recommendations and the progress that has been made toward making them realities. Read the rest of this entry »

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Ebola Still Deserves Our Attention

January 26, 2015

By Shawn Kennedy, AJN editor-in-chief

Photographed by Centers for Disease Control and Prevention’s (CDC) team member, and EIS Officer, Dr. Heidi Soeters during Guinea’s 2014 Ebola outbreak, this image depicts what resembled a garden of red- and green-colored gloves propped up on sticks in order to dry after having been washed in a hyperchlorinated solution, thereby, killing any live Ebola viral particles. The pink-colored gloves were merely inside-out red gloves with their interiors exposed. The image was captured on the grounds of Donka Hospital, located in the country's capital city of Conakry/CDC

Taken by Dr. Heidi Soeters during Guinea’s 2014 Ebola outbreak, photo depicts red- and green-colored gloves propped on sticks to dry after being washed in a hyperchlorinated solution./CDC

It’s sad but not surprising that Ebola has all but disappeared from the headlines. After all, it’s not an imminent threat here anymore. There’s no more news hype—no “you heard it here first” messaging each day to grab headlines.

While the numbers of new cases and deaths appear to have abated in most affected countries, the World Health Organization (WHO) emergency committee on the 2014 Ebola outbreak recently cautioned that “the event continues to constitute a Public Health Emergency of International Concern” and concluded:

“the primary emphasis must continue to be on ‘getting to zero’ Ebola cases, by stopping the transmission of Ebola within the three most affected countries [Sierra Leone, Guinea, and Liberia]. This action is the most important step for preventing international spread. Complacency is the biggest risk to not getting to zero cases.”

As of the latest figures (Jan 21), there have been a total of 21,724 documented cases and 8,641 deaths worldwide—almost a 40% mortality rate. Among health care workers, there were 828 cases and 499 reported deaths.

Yet as communities are struggling to get back to normal routines (Sierra Leone, one of the hardest hit countries, with over 10,300 cases and 3,100 deaths, announced it will reopen schools in March for the first time in eight months), the rest of the world seems to have moved on, comfortable that the global threat has been mitigated.

The response of many governments and private organizations that poured resources into the hard-hits areas was laudable, and we saw how knowledgeable health care workers with the right equipment quickly made a difference.

But now what? What of the conditions—lack of health infrastructure, inadequate equipment, too few health care workers educated about Ebola and community health practices—that allowed the Ebola infection to spread unchecked for so long? The first WHO report on the Ebola outbreak was on August 29, 2014, but at first, the rest of the world remained unperturbed, seemingly viewing Ebola as an a problem specific to Africa. Read the rest of this entry »

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Nursing Perspective: Why I Work in Corrections

January 23, 2015

By Megen Duffy, BA, BSN, RN. Her blog is Not Nurse Ratched.

Michael Coghlan/Flickr

Michael Coghlan/Flickr

When I go to work, I go through a metal detector (did you know Danskos contain metal?), and all my belongings are scanned or gone through. I check out keys and a radio, and then I go through a series of sally ports to get to the medical area. I count every needle and pair of scissors I use. I never see patients without an armed guard nearby, and a good portion of my patients are cuffed and shackled. I’m on camera from the second I get out of my car.

Welcome to prison, nursing style!

“Why?” people ask me. “Couldn’t you get another job? Aren’t you scared? Didn’t you like the ER?” I worked in critical care/emergency nursing for a long time, and yes, I did like it. I brought those skills with me to corrections, where they are a lock-and-key fit. A surprising number of corrections nurses are ex-ER nurses. The same personality types work well in both settings.

Corrections nursing involves phenomenal nursing autonomy and uses many of the skills I honed in the ER:

  • quick triage
  • multitasking
  • sorting out who is lying from who is sick
  • knowing which assessments are the most important for each situation

The atmosphere tends to be quirky to chaotic and requires imagination, flexibility, and an ability to string together solutions to problems that no one has ever seen before. Particularly in jails, you never know what is going to come through the door. A jail booking area is exactly like ER triage.

I like that; I like having a job where strange things are bound to happen. I like seeing things that most people never see. I like knowing that things could get hairy at any time and that I have to be on my game all the time. Read the rest of this entry »

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Cassandra’s Refusal of Chemo: Nurse Ethicist Ponders Ethics of Forcing Treatment

January 21, 2015

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scalesThe case of Cassandra, a 17-year-old female in Connecticut being compelled by the court to undergo chemotherapy for Hodgkin’s lymphoma, has aroused interest in the media and among bioethicists, who have offered mixed conclusions. (Here’s a recent update on Cassandra’s legal status.) For example, Ruth Macklin concludes that the actions taken to force the treatment were not justified, while Arthur Caplan concludes that compelling her to have the chemo is justified. Both are scholars of the highest order.

I agree with Caplan that she should be given the chemotherapy, but my purpose here is to illustrate that perspective plays an often unacknowledged role in ethical analysis. When feelings and personal perspective go unacknowledged, the analysis loses credibility and depth.

The principles in conflict in this the case are straightforward for ethicists: respect for autonomy versus beneficence.

As a society, we value control over personal choice, that is, autonomy, which would mean honoring Cassandra’s decision to forgo the chemo. The chief justification for overriding a patient’s autonomy is that the patient lacks decision-making capacity because she is a minor.

However, we also value doing what is best for patients—beneficence —and this means giving the chemo. Within the principle of beneficence, the “best” course of action is the one my training and experience as a nurse tells me will result in improved health, more function, and better quality of life.

The chief justification for overriding beneficence is that a patient with decision-making capacity chooses to do otherwise. The ethically relevant controversies of this case include:

  • the nature of Cassandra’s decision-making capacity
  • the degree of benefit expected from the treatment
  • the degree of harm expected as a result of honoring her refusal

The law considers Cassandra, as a minor, to lack decision-making capacity. However, she would probably pass a clinical assessment of her decision-making capacity. Cassandra is about nine months from being 18, the age at which she would be assumed to have capacity. In similar cases, the law sometimes invokes the ‘mature minor’ doctrine and allows a teen with clinically determined decision-making capacity to make the decision. (Editor’s note: A 2007 AJN article by the author discusses a similar case; it’s free until February 28.)

Other facts supporting a choice to respect her autonomy are that her mother agrees with her refusal and that the patient published an articulate essay (log-in required) in the Hartford Courant describing her situation.

Arguments that might be made against choosing respect for autonomy over beneficence are that the reasons for refusing chemotherapy given by Cassandra and her mother, while understandable in terms of the desire to avoid chemotherapy’s side effects, seem shortsighted in terms of scientific facts about this disease and its treatment.

Read the rest of this entry »

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Long-Term Complications After Congenital Heart Defect Repair

January 19, 2015

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

Even those of us who don’t work in peds or cardiology are familiar with the amazing surgeries done to repair congenital heart defects (CHDs). After surgery, kids with CHDs are literally transformed, their glowing good health a reminder that medical miracles really can happen.

Sometimes, though, health problems develop many years after CHD surgery. These can be consequences of the original defect itself, or of the specific type of repair that was employed.

In this month’s CE feature, “Long-Term Outcomes after Repair of Congenital Heart Defects (part 1),” Marion McRae, an NP in the Guerin Family Congenital Heart Program at Cedars-Sinai Medical Center, Los Angeles, discusses the anatomy, physiology, and repair options related to six common CHDs: bicuspid aortic valve, atrial septal defect, ventricular septal defect, atrioventricular septal defect, coarctation of the aorta, and pulmonic stenosis. One of the types of congenital heart defects covered in the article is shown in the illustration.

Figure 3. Secundum Atrial Septal Defect and Transcatheter Occlusion. Secundum atrial septal defect is located in the center of the atrial septum (A). Blood usually shunts across the defect from the left atrium to the right atrium. The Gore Helex septal occluder is shown in a partially deployed position across the atrial septum (B). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Illustration by Anne Rains.

Figure 3. Secundum Atrial Septal Defect and Transcatheter Occlusion. Secundum atrial septal defect is located in the center of the atrial septum (A). Blood usually shunts across the defect from the left atrium to the right atrium. The Gore Helex septal occluder is shown in a partially deployed position across the atrial septum (B). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Illustration by Anne Rains.

Because patients tend to do so well after surgical repair, many eventually discontinue cardiology follow-up. This means that when problems do develop in adulthood, nurses in nonspecialty settings may be the first to evaluate patients’ cardiac changes. McRae’s succinct summaries of common CHDs and their long-term outcomes is a “primer” that guides us in the initial assessment of these patients. (All CE articles in AJN are free.) Read the rest of this entry »

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Calling All Nurses to Address Health Disparities

January 16, 2015

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.

The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.

The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.

The research on health disparities is stark and continues to increase. The Centers for Disease Control and Prevention’s Health Disparities and Inequalities Report–2013 found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.

But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way—lives that are often very different than our own.

I understand that it is human nature to be more comfortable with the familiar, but this is not what we are called to in nursing. More than 150 years ago, Florence Nightingale noted a strong link between a population’s health and its economic prosperity, and she called for all people to be treated equally.

My mother told me that when she first entered nurses’ training at New York City’s Bellevue Hospital School of Nursing in 1943, Director Blanche Edwards addressed the students on her conduct expectations for nurse trainees. Part of that lecture—and of the nursing culture absorbed by those being trained at Bellevue—addressed the equality of all human life and how she expected her nurses to treat everyone with equal care and attention. Read the rest of this entry »

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