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Remembering Nurses Who Served the Wounded and Dying and Those Who Died Themselves

May 22, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Normandy American Cemetery, France. Photo by Karen Roush

Normandy American Cemetery, France. Photo by Karen Roush

So many of us look forward to Memorial Day weekend as a welcome long weekend and official start of summer. But there are many for whom Memorial Day (the last Monday in May) is a reminder of loved ones who died in military service—and that includes a significant number of military nurses who cared for the wounded in various wars.

We’d like to take this occasion to remind us all of the real meaning of this day and to honor the sacrifices of our colleagues. While it’s hard to find specific numbers of nurses who died in wars, one can extrapolate from what’s known about women who died, since most women who served in combat areas from the start of the 20th century through the Vietnam War were nurses.* Read the rest of this entry »

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Critical Care Nursing in San Diego (or was it Las Vegas?)

May 20, 2015

FullSizeRenderBy Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

I’ve written before about the American Association of Critical-Care Nurses (AACN) annual meeting, the National Teaching Institute (NTI). As a former critical care and emergency nurse, I’ve attended it almost annually. And I’m always amazed at how each year they step it up with new twists. One year, it was the helicopter and full MASH unit in the exhibit hall. Then AACN went to the TED talk style of keynote presentations. Last year, they had a contest for members to apply to be the guest co-master of ceremonies. So, what might possibly be a new twist in this year’s opening session?

I was sitting with leaders of the Canadian Critical Care Nurses Association, one of whom had never been to NTI before and had been told by her colleague that it would be unlike anything she had seen before. She couldn’t have been more on target—even by NTI standards. The session opened with a DJ and loud techno-rock music, followed by a very fit and energetic dance troupe and pop singers. Then, down from the ceiling came four acrobats and a bare-chested man spinning above the stage, along with a dozen or so men and women running up and down the aisles with large, lighted balls that the audience began batting around, all to the techno music. Was I really at a nursing meeting? Everyone was certainly awake and energized!

San Diego

San Diego

Awards. Pioneering Spirit awards were given to Paul Batalden (for his work with the Institute for Healthcare Improvement and at Dartmouth) and researcher Ann Rogers, and the Marguerite Rogers Kinney Award for a Distinguished Career was given to Joanne Disch (educator and former American Academy of Nursing president and AARP board chair). Some notable moments: Batalden said one piece of advice he would give is to “avoid working with jerks”; Disch received a rousing ovation when she told how she almost didn’t get into graduate school “because she partied too much as an undergraduate.”

‘Focus the flame.’ On a more serious note, AACN president Teri Lynn Kiss addressed the “growing community of exceptional nurses” (AACN membership is at a new record high of 104,000), speaking about her experiences over the past year as president, during which her theme, “Focus the Flame,” guided her work. Read the rest of this entry »

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AJN Collections of Note: From Women’s Health Issues to Assessment Tools for Older Adults

May 18, 2015

By Jacob Molyneux, senior editor

'Nuff Said by ElektraCute / Elektra Noelani Fisher, via Flickr.

Elektra Noelani Fisher/ Flickr

It’s easy to miss, but there’s a tab at the top of the AJN home page that will take you to our collections page. There you can delve more deeply into a wide range of topics—and find many options for obtaining continuing education credits in the process.

For example, you’ll find a collection of recent continuing education (CE) feature articles devoted to women’s health issues, such as menopausal hormone therapy, cardiovascular disease prevention for women, and issues faced by young women who are BRCA positive.

The patient population in the U.S. continues to age. To gain confidence in meeting the needs of these patients, nurses can consult our practical collection of articles and videos devoted to the use of evidence-based geriatric assessment tools and best practices.

For the more creative side of nursing, we have a collection of 20 visual works and poems from our Art of Nursing column.

For those concerned with potential legal issues, it’s a good idea to have a look at the three CE articles from our Legal Clinic column on protecting your nursing license.

For would-be authors and those interested in applying knowledge to practice more effectively, there are step-by-step series on conducting a systematic review and on how nurses can implement evidence-based practice at their institutions. Read the rest of this entry »

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Atrial Fibrillation: What the Newest Guideline Means for Nurses

May 15, 2015
Figure 1. Normal Sinus Rhythm and Two Types of Atrial Fibrillation. Images courtesy of ECGGuru.com.

Figure 1. Normal Sinus Rhythm and Two Types of Atrial Fibrillation. Images courtesy of ECGGuru.com.

By Sylvia Foley, AJN senior editor

Atrial fibrillation, the most common chronic cardiac arrhythmia, affects an estimated three to six million Americans and can profoundly diminish their quality of life. Treatment guidelines for atrial fibrillation are frequently updated—a fact that “speaks to both the prevalence and the serious health care implications of the condition,” says Christine Cutugno, an experienced critical care nurse and educator. It can take time to determine just what has changed. She offers nurses ample guidance in one of this month’s CEs, “Atrial Fibrillation: Updated Management Guidelines and Nursing Implications.” Here’s a brief overview.

Atrial fibrillation is frequently associated with advancing age, structural cardiac dysfunction, and preexisting comorbidities. The most common complications, stroke and heart failure, result in significant morbidity and mortality. Indeed, atrial fibrillation is responsible for over 450,000 hospitalizations and 99,000 deaths annually and adds up to $26 billion to U.S. health care costs each year. Given the aging of the U.S. population, the incidence of atrial fibrillation is expected to double within the next 50 years. There is evidence that nursing intervention in patient education and transition of care coordination can improve adherence to treatment plans and patient outcomes.

This article reviews the recently updated guideline for the management of atrial fibrillation, issued jointly by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. It focuses on the prevention of thromboembolism and on symptom control, and stresses the importance of patient adherence to treatment plans in order to ensure better outcomes.

Nursing implications. Cutugno notes that both care coordination among providers and sustained follow-up care with patients are crucial, adding that “instructions delivered just once by a harried staff nurse or medical resident don’t begin to meet patient education needs.” She discusses recent research findings that support the use of care pathways and nurse-led follow-up care. To learn more, read the article, which is free online.

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Florence Nightingale: The Crucial Skill We Forget to Mention

May 13, 2015

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is that Florence Nightingale was a writer.

In fact, Florence was a prolific writer. She published hundreds of articles and books, along with letters and editorials, pamphlets and briefs. If she lived today, I’m sure we’d be reading her regularly on the op-ed pages of the New York Times.

Suppose Florence hadn’t been a writer? Think about it . . . what would we know of her theories without Notes on Nursing? What would have been lost if she hadn’t written about her work in epidemiology, her research on hospital design, her efforts to improve sanitation and lower rates of infection? It’s incalculable.

But all this wasn’t lost—because, along with all her other wisdom, she was wise enough to understand the importance of communicating through writing what nurses do.

Today nurses continue to do work that has a major impact on health care and patient outcomes. But how much of that is getting lost because nurses don’t think of themselves as writers, because they don’t see writing as a part of what nurses do?

I worked with a group of nurses at a medical center here in New York to help them write and publish articles about the quality improvement projects they had completed. I was amazed by the work they’d done—work that had changed patient outcomes, lowered readmission rates, and improved their own working conditions. Patients discharged from the transplant unit were now going home with more confidence and less fear. Patients with congestive heart failure were able to better self-manage their care, and thus stay home with their families instead of being readmitted to the hospital again and again. Fewer mothers were having C-sections because the OB staff were working as a more cohesive interprofessional team.

The issues they were addressing aren’t unusual. Transplant staff everywhere are struggling with how to prepare their patients for discharge when the hospital stay has grown so much shorter and their needs continue to be so great. I’m sure each of you have stories of poor teamwork that has negatively affected patient care. And there isn’t a hospital in the country that isn’t trying to get their readmission rates down—with efforts to do so placed on the already overburdened shoulders of its nurses. Read the rest of this entry »

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A Found Poem For Nurses Week

May 11, 2015
Badruddeen, via Flickr

Badruddeen, via Flickr

The poem below, originally published in our May 2005 issue, is by Veneta Masson, MA, RN. It’s a “found poem,” a form of poetry in which the poet assembles phrases selected from a source or sources. The lines here come “from actual posts to an Internet bulletin board,” but they could as easily be comments on AJN‘s Facebook page! The author is a nurse and writer living in Washington, DC (more about her work can be found here).—Jacob Molyneux, senior editor

Nurses Week—What Did You Get?
Hi, everyone! Just curious to see what you received for Nurses Week.

Denim shirts with the company logo

Swiss Army–type knives with fourteen blades

Carnations in dollar-shop vases

One wilted rose

Soap on a rope

I think I’m worth more than this

A live band at the Holiday Inn

A potato bar luncheon

If you weren’t there, you got nada

Nothing

Not a thing

A PA announcement thanking the nurses

We dug out our caps & wore them all day
our VP of Nursing came to the unit and stayed for an hour
we sat with her & shared our stories of why we went into nursing

We got pizza one day (if you were there) and ice cream one day (if you were there)

Rolos, Skittles and M&Ms—give me the tools to do my job
instead of tote bags and candy

A drawing for some pretty cool prizes—movies, massages, a month off call

A bonus

We got to work overtime!

I presented my findings to the Executive Team and found out Tuesday
that they had approved another nurse . . . the best thing I   could have gotten

One of my patients agreed to an interview with a local paper
and our story made the front page

Read the rest of this entry »

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The Borders of Loss: An Early First in One Nurse’s Career

May 8, 2015

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is hers.

Peds Ward (2008), charcoal, graphite, flash, and acrylic. By Julianna Paradisi

Peds Ward (2008)/charcoal, graphite, flash, and acrylic/by Julianna Paradisi

Working in oncology, the topic of whether it’s crossing a boundary for nurses to attend the funeral of their patients comes up. Sometimes, however, we’re carried across that boundary by our heartstrings. The first patient funeral I attended was that of my first patient.

During Jack’s short life, he was the first assignment of many a new nurse on the pediatric unit where I was hired as a newly graduated nurse. He had lived in the hospital his entire life.

Jack was nearly ten months old when we met. Born with a congenital illness requiring multiple surgeries, he failed to thrive. A nasogastric tube snaked through his nose into his stomach so he could conserve the calories burned eating from a bottle or spoon. As Jack’s nurse, I mastered the skill of nasogastric tube feedings.

Most parents bond with their chronically ill babies, but it takes a big commitment on their part. Babies like Jack do not look like the pictures of healthy babies in magazines. They are cloistered in an isolette and connected to machines by feedings tubes and IV pumps. Weeks go by before they can be held.

Jack’s mother had all but abandoned him, a phenomenon sometimes occurring when children begin life with extended hospital stays. Susceptible mothers simply stop coming to visit. Phones calls to Jack’s mother were rarely returned; if they were, she vaguely promised a date and time for visits, but rarely showed.

Occasionally, a caseworker would locate her, and explain that Jack would be put into foster care for abandonment. This would prompt a string of visits. She’d bring a toy, and talk about taking Jack home. She learned to feed him by holding a 60 cc syringe skyward as formula trickled through the tube taped to the side of her baby’s face, and into his stomach. I wonder if she wished she could simply hold Jack as he bottle-fed, the two of them gazing into each other’s eyes, the way mothers expect to do?

But she was young; it was too much for her. After a few visits, she’d disappear again. In her defense, no other family visited in her absence—a clue to her lack of social support.

In this manner, Jack became the “child” of the pediatric nurses, raised by a tribe of women. We took turns caring for him. Day shift nurses bathed him, dressed him in clothing they bought, and stimulated Jack’s mind with brightly colored toys that rattled or squeaked. Night shift nurses bathed him again, dressed him in footed fleece pajamas we bought, and read bedtime stories while rocking Jack to sleep. He loved music and singsong rhymes. His dark eyes fought to stay open in his pale face until defeated by sleep.

Attempts at feeding Jack met with resistance. The effect of long-term use of an NG tube was Jack’s aversion to putting anything in his mouth, including food. To maintain nutrition, his doctors were forced to surgically insert a gastric tube into his belly. Bolus feedings caused Jack to vomit, so they were converted to continuous drip. Clamped to an IV pole, a feeding pump followed Jack wherever he went, down the pediatric unit halls.

Jack never gained enough muscle strength to learn to walk. At the nurses’ station he watched us work, seated in a walker on wheels he was never strong enough to move on his own. Often, he was sick.

At Christmas, Jack’s room was a kaleidoscope of gifts. Every pediatric nurse with young children brought them to visit, bearing gifts they’d wrapped themselves: “For baby Jack, spending Christmas in the hospital.” For many, it was their first opportunity for empathy.

Time went by, and no one claimed Jack. His condition stabilized, he began to gain weight, and discussions about his discharge began. None of us could bear the thought of Jack living with strangers in a home for medically fragile children, away from us, his family.

Not surprisingly, a nurse stepped up. She decided to become Jack’s foster mother. She began the rigorous process required by the state. She decorated a room for Jack. Read the rest of this entry »

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