Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

April 23, 2014

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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A Tale of Two Dangerous Products

April 21, 2014
Holding On / D'Arcy Norman, via Flickr

Holding On / D’Arcy Norman, via Flickr

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration.

There are two news stories I’ve been chewing on lately. One made it to the front page of my New York Times almost every day for a while, and the other I saw just once in the paper’s international news section several weeks ago.

The blockbuster story involves a single company that covered up a problem with an important part in one of its products. Ten years passed and a number of people died before they finally informed the public about the problem. The products with the flawed part have now been recalled, and the company is embroiled in an investigation and likely to face lawsuits and massive fines.

The far less publicized story is about a growing body of research exposing a problem that results in similar levels of harm. Unlike in the first story, the crucial ‘part’ that affects the product’s safety is human labor—and the detrimental effect of mismanagement of this labor is likewise injury or death. The link between the product flaw and its effects is well established, but there has been no public outcry, product recall, or lawsuit. The story barely made it past the gates of major media, and although the evidence linking this problem to dire results is strong, few industry players are acting on it. Read the rest of this entry »


Telehealth as ‘Disruptive Innovation’ in Nursing

April 18, 2014
A patient uses telehealth equipment to communicate with his nurse. Photo courtesy of Janet Grady.

A patient uses telehealth equipment to communicate with his nurse. Photo courtesy of Janet Grady.

“Telehealth: A Case Study in Disruptive Innovation” is a CE article in AJN‘s April issue. The author, Janet Grady, vice president of academic affairs and chair of the Nursing and Health Sciences Division at the University of Pittsburgh in Johnstown, Pennsylvania, describes the concept of disruptive innovations in nursing and delves into the evolving field of telehealth as a current example.

The article considers the following:

  • uses and potential uses of telehealth in chronic and acute care, home care, and rural medicine, and the evidence supporting its use.
  • obstacles to wider use and acceptance of telehealth, which include cultural resistance within nursing, licensure issues across states, reimbursement challenges, and the need to adapt nursing curriculum to these new ways of delivering care.
  • forces that drive or obstruct disruptive innovations like telehealth.

Here’s the article overview:

Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation—particularly those “disruptive innovations” that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.

And here’s a snapshot of some uses already being made of telehealth, an umbrella term that encompasses a broad range of activities: Read the rest of this entry »


Anxiety Apps: New Fad or Worth the Download?

April 16, 2014

photo3By Amy M. Collins, editor

Today there’s an app for everything. There are find-your-keys apps, map-the-stars apps, even an app to help you hone your stapling skills. And apps exist to help patients with every kind of health care need, from managing diabetes to prenatal care. Usually, in an attempt to keep my smartphone use to a minimum, I avoid jumping on the trendy app bandwagon. But recently I came across an article touting an app to reduce anxiety. As a long-term, mostly recovered sufferer of chronic anxiety and panic, this article piqued my interest (and my skepticism).

While certainly not the first app developed to reduce stress, this particular app—called Personal Zen—has been tested by researchers who found that participants with relatively high scores on an anxiety survey showed less nervous behavior after using the app than those in a placebo group, according to a study published in Clinical Psychological Science. Developed by psychologist Tracy Dennis, a professor at Hunter College in New York City (and, it should probably be noted, one of the study’s lead authors), the app incorporates the concept of cognitive bias modification to get the user to shift their focus from a threatening stimulus to a nonthreatening one. More studies are needed to see if such an app would have the same success in those with clinically diagnosed anxiety.

And there are literally hundreds of other apps catering to those with anxiety (click here for a Healthline article on the 17 “best” antianxiety apps; and here are more from Google Play).

Is it really that easy? If only antianxiety apps were available when I was first diagnosed over a decade ago. Back in that particular Stone Age, I had limited choices: antianxiety meds, talk therapy, alternative methods, or a combination of these options. I chose therapy and alternative methods and embarked on a 10-year quest to control the disorder instead of vice versa. I read books, employed relaxation techniques, joined groups, and challenged myself to face situations that caused anxiety. Employing these tactics eventually brought me to a place where I could live relatively anxiety free without medication. Read the rest of this entry »


Nursing Students and Then Some – In Opryland, Revisiting AJN’s Long Connection With NSNA

April 14, 2014

Revisiting AJN’s long connection with this vibrant student nursing association. 

By Maureen Shawn Kennedy, MA, RN, editor-in-chief

Opryland critters

Opryland critters

I’ve said it a number of times over the years, most recently in my editorial in the April issue of AJN: the National Student Nurses Association (NSNA) is a vibrant organization and produces one of the most well-organized annual meetings in nursing. This year, it broke attendance records, drawing approximately 3,200 students and faculty advisors to the Opryland Hotel in Nashville, where I spent part of last week.*

Supporting NSNA since its founding. The American Journal of Nursing has been a supporter and and sponsor of the NSNA since the organization began in 1952. The NSNA offices used to be part of the AJN offices at one time, and before NSNA had its own publication (Imprint), AJN published “The Student Pages.” We sponsor Project InTouch, an award given to the student who recruits the most new members for the organization. This year, winner Joanna Laufer from East Carolina University, Greenville, North Carolina, recruited 130 new members; overall, this initiative brought in over 1,600 new members this year. Impressive.

Impressive, and sharp dressers too! The students I met—mostly junior and senior nursing students—were also impressive. They were enthusiastic, eager to learn, and professional. I have to say this group as a whole was better dressed than many attendees I’ve seen at other nursing conferences—they clearly got the message about what business casual meant; I rarely saw anyone in jeans.

The students’ major concern was of course, finding a job in this tight market. And there were few recruiters other than the military services among the couple of hundred exhibitors—most were schools of nursing and companies with educational products for passing the licensing exam. Many speakers reinforced the message that the tradition of working in a hospital for a year before working in other settings is not necessary (and likely never was), and students seemed a bit relieved to hear that. But more jobs will be opening in primary care settings and preventive care services; senior care centers and long term care will grow along with the aging population, so jobs will be there, too. And while it might be tough now to get a job in a hospital, the market will be very different in a few years as older nurses retire. Read the rest of this entry »


What Advice Would You Give a New Nursing Student? Our Readers Respond…

April 9, 2014

KarenRoushBy Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

My daughter Kim is starting nursing school next month, so last week I asked AJN’s Facebook followers for the best piece of advice I could give her. The response was overwhelming: over 600 people offered wisdom, encouragement, and tips for success. I went through and read them all and the following is an attempt to synthesize the advice.

Of course, with so many responses, there were many valuable pieces of advice I had to leave out, from the practical to the profound, such as:

sit in the front of class, stick to your principles, invest in good shoes, choose clinicals that push you out of your comfort zone, be early for everything, celebrate the small victories, get a really good stethoscope up front, believe in yourself, pick the hardest patient you can at clinical, audiorecord the lectures, be truthful and committed to your work, eat healthy, get to know your instructors, coffee and chocolate!

And finally: look into the eyes of your patients and be sure they know you care. Every patient, every time.

(Oh, and not to leave out the lighthearted—Don’t hold your nose in clinicals. The teachers frown on that.)

Below are five areas of advice that stood out:

1) “Take a good picture of your friends and family and put it on your desk, because that’s all you’ll be seeing of them for the next two years.” There were many variations on the idea that nursing school “takes 100% dedication.” You need to warn your family and friends that they won’t be seeing you for a while, get rid of your TV, sleep when you can, learn good time management, and be prepared to spend Saturday nights with your books . . .

2) “Study, study, study, and study some more.” Respect the quantity and degree of difficulty of the material you will have to learn. There were a lot of ideas about how to optimize your studying—chief among them was to get in a study group and to study NCLEX questions from the beginning. Others were to read ahead, not procrastinate, use flashcards, attend practice and review sessions, and have a study partner or buddy system. Having a study buddy, though, is only a small part of the importance of friendships with your fellow students . . . Read the rest of this entry »


The Blame Game

April 7, 2014

By Jacob Molyneux, senior editor

TheBlameGameIllustrationThe Reflections essay in the April issue of AJN is called “The Blame Game.” It’s by a nurse who finds herself visiting a family member in the hospital during her shift break at the same hospital. In her distress, she gets little relief or reassurance from the harshly judgmental nurse she encounters.

The vividly told episode raises the question: can the act of casting judgment on another person diminish our ability to see these people as complete human beings, whatever their failings? And also this question: what is the proper attitude of nurses toward their patients?

Please give it a read and see what you think. Is this nurse’s attitude an exception, or more common than it should be, as the author suggests? Here’s a brief quote from near the end:

There seems to be a dangerous epidemic of clinicians blaming patients for their health issues. As a nursing student, I saw more and more of this attitude. The health care profession seems to have evolved a culture of accusation and attack against patients, a group we should be empowering and protecting.

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