Archive for October, 2009
AJN Health Care Reform Poll
October 30, 2009“Pitiable Indeed” – AJN Archives Reveal Nurse’s Firsthand Account of 1918 Flu
October 28, 2009
The above is an excerpt from a North Dakota nurse’s vivid and painful letter to the editor about the Spanish influenza, published in the December 1918 issue of AJN. To read the entire letter, click here (and then click on the PDF link in the upper right corner of the page) or click on the excerpt itself. We’ve combed through our archives for articles dealing with various influenza epidemics and threats of epidemics, and found some fascinating material that puts what we’re currently going through in some perspective. To see the entire collection of articles, covering 1918 to the present, click here. (Note: some articles are free and some are accessible only to AJN subscribers. The older articles are available only in PDF format.)
A Nursing Student Learns the Trick of Reassurance
October 27, 2009
I wasn’t sure why Mary Sue was in long-term care, but I could tell she had dementia. She spent most of her time in a recliner near the nurse’s station, asking anyone who walked by why she couldn’t go back to bed.
“It isn’t time yet, Mary Sue,” the staff would reply. I asked one of the nurses why they didn’t just take her back to bed. “When we do,” she told me, “she asks to return to the chair. Out here we can keep an eye on her. She can look out the window. She smiles more often.”
But I had yet to see a smile. This was my first rotation as a nursing student, and I tried to use techniques I’d read about to distract Mary Sue: towel folding, cards, books. But she remained on target, reaching out to me and repeating her request with a distraught look on her face. . .
Read the rest of the November Reflections essay, written by a nurse looking back on her first nursing school rotation five years ago. The basic human need for reassurance is shared by all of us, whether we are patients or providers. What do you do to stay centered during the day, to remind yourself of your own value, to focus on what really matters . . . or just to stay in the game?
From Flu Vaccine to Abortion Rights: The Same Argument?
October 26, 2009By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
bv alvi2047/via flickr
There’ve been articles, blog posts, a court ruling in New York State halting mandatory H1N1 vaccinations for health care workers, and last week a suspension of the mandatory vaccinations by Governor Paterson (who explained the decision in terms of the vaccine shortage). Earlier this month, we ran a poll on this site related to whether or not nurses and other health care workers who work as direct caregivers should be mandated to receive the flu vaccine. In reading the poll results, I notice that many of the arguments against mandatory vaccination focus on the right to decide about one’s own body—a powerful argument, indeed.
It did make me wonder: do those who stand by this reason for not getting an H1N1 vaccination shot (or nasal mist) recognize that this argument—that one has a right to determine what happens to one’s body—is the same argument used by women who want to choose whether to have a baby or not? At the very least there’s an interesting parallel, even if some people I’ve pointed this out to don’t seem to agree. I’d like to know if others feel there is a difference—and if so, what?
Sudanese Rumors of Ebola Outbreak a ‘Cry for Help’ – Is the Obama Administration Listening?
October 23, 2009By Shawn Kennedy, MA, RN, interim editor-in-chief
Reuters reported Thursday that there is no Ebola outbreak after all in the southern Sudan. Rather, the rumors were started by local administrators and representatives of the Sudan People’s Liberation Army (SPLA) “to draw attention . . . to the acute lack of medicine” in the area, according to Kuol Diem Kuol, an SPLA spokesperson. According to Reuters, the false rumors that 20 soldiers and three of their wives had died were successful in bringing health personnel to the area to investigate . . . and to provide the desired medicines.
I can’t help thinking that conditions must be really really bad if the Sudanese people went to the lengths of staging a hoax to receive health care. After all, this is a people that has withstood some of the worst brutality in recent memory from civil wars and the genocide in the Darfur region. Read the rest of this entry ?
Why Don’t Drug Labels Make the Actual Harms and Benefits Clear?
October 22, 2009By Jacob Molyneux, blog editor/senior editor
How can we know if a drug really works? Gary Schwitzer, publisher of HealthNewsReview.org (an incisive Website that grades the quality of health news reporting) addresses this question on his blog this week by drawing attention to a recent perspective piece published in the New England Journal of Medicine (NEJM). It’s called “Lost in Transmission — FDA Drug Information That Never Reaches Clinicians” and it states the problem clearly:
The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated — and relatively little would be needed — to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.
The most direct way that the FDA communicates the prescribing information that clinicians need is through the drug label. Labels, the package inserts that come with medications, are reprinted in the Physicians’ Desk Reference and excerpted in electronic references. To ensure that labels do not exaggerate benefits or play down harms, Congress might have required that the FDA or another disinterested party write them. But it did not. Drug labels are written by drug companies, then negotiated and approved by the FDA.
One example given in the NEJM article is the sleeping pill Lunesta:
Clinicians who are interested in (Lunesta’s) efficacy cannot find efficacy information in the label: it states only that Lunesta is superior to placebo. The FDA’s medical review provides efficacy data, albeit not until page 306 of the 403-page document. In the longest, largest phase 3 trial, patients in the Lunesta group reported falling asleep an average of 15 minutes faster and sleeping an average of 37 minutes longer than those in the placebo group. However, on average, Lunesta patients still met criteria for insomnia and reported no clinically meaningful improvement in next-day alertness or functioning.
What is the real benefit of a particular drug? You may not find it in the label.
FDA approval does not mean that a drug works well; it means only that the agency deemed its benefits to outweigh its harms. Read the rest of this entry ?
Genomics, Technology, and Nursing: A “Focus on the Whole Person”
October 21, 2009
UK National DNA Infographic/ by blprnt_van, via Flickr Creative Commons
By Diana J. Mason, PhD, RN, editor-in-chief emeritus. Mason often writes for this blog about policy and research issues.
Last week, I attended the annual conference of CANS, the Council for the Advancement of Nursing Science, the “research-facilitation arm” of the American Academy of Nursing. The title of the conference was “Technology, Genetics and Beyond: Research Methodologies of the Future.”
‘Genomics’ vs. ‘genetics.’ I’m not a genomics researcher but I found the sessions enlightening in two ways. First, I admit to struggling with the terminology (and jargon) of the field. I was reminded today that the correct term for the field is “genomics,” since “genetics” refers to the study of single genes and thus limits the focus of study mostly to rare diseases. Genomics looks at associations among genes in the whole person—a shift in perspective that was enabled by the mapping of the human genome.
Targeted interventions. The second enlightenment came from keynote speaker and senior nurse researcher Christine Miaskowski, a dean and a professor of physiological nursing at the University of California at San Francisco School of Nursing. She noted that this shift to a focus on the whole person is what makes nurses and nursing research essential to the field. She gave an example from her own research looking at fatigue among people with cancer. When all patients are grouped together, it looks as if there is little variation across time. But when you diagram each patient’s changes in levels of fatigue, there is actually huge variation. By looking at the genetic composition of individual patients, she’s been able to determine who might respond best to a specific intervention that appears to have no effect when all patients are considered together. Such close examination of patient characteristics can help nurses and other health care providers to better tailor their interventions for the individual patient.
Ethical issues in research. That said, Suzanne Feetham, a nurse who has been a leader in advancing health care professionals’ understanding of genetics and genomics, talked about the ethical issues involved in conducting such research. Read the rest of this entry ?
TCAB: What’s Your Hospital Doing to Improve Care?
October 20, 2009
By Diana J. Mason, PhD, RN, AJN Editor-in-Chief Emeritus
November 2009 report cover
What makes a “good hospital”? A patient might have the best surgeon in the world; but as any nurse will tell you, that patient will die unless the surgeon has a top-notch nursing staff to ensure that the patient is well prepared for the surgery and well supported during the recovery period. Too many hospitals have lost their understanding of what’s essential to ensure great clinical and financial outcomes. In such hospitals, nurses aren’t included in decision making, have little local authority, are penalized for identifying factors that lead to poor care, and can’t claim excellent team relationships.
The American Nurses Credentialing Center’s Magnet Recognition Program has helped to identify the factors that lead to excellence in nursing care, granting Magnet status to hospitals that provide such excellence. Now an initiative known as Transforming Care at the Bedside (TCAB) has provided the framework and tools for empowering bedside nurses to become agents for change. TCAB nurses work with other health care team members to improve care processes and effectiveness, focusing on four areas: the safety and reliability of care, teamwork and job satisfaction, patient and family satisfaction, and “value-added care.” (Increasing the amount of time nurses can spend with patients by decreasing the time they must spend charting or hunting for supplies would be one example of adding value to care.)
In November AJN is publishing a special report, Transforming Care At the Bedside: Paving the Way for Change, with the support of a grant from the Robert Wood Johnson Foundation (RWJF); it’s available online now. Read the rest of this entry ?
The eICU: Big Brother or Team Member?
October 19, 2009
Virtual Reality Headset Prototype (circa 1968). Photo by Pargon, via Flickr.
By Peggy McDaniel, BSN, RN
There is an intriguing new technology available to hospital ICUs. It’s called an eICU. At Alegent Health in Omaha, Nebraska, the “software feeds real time data for roughly 100 patients, including vital signs, laboratory tests, cultures, and pharmacy data,” to nurses and a doctor monitoring the eICU from off site. Using the data, the software sets off alerts that are noted by the eICU staff and passed on to the bedside staff. The bedside clinicians have said that the extra help has allowed them to focus on bedside care.
About two years into its use, an interesting side benefit of this remote monitoring system was noted by the hospital’s director of infection control. She realized that the eICU allowed her to monitor and promote compliance to practice bundles as well as to compile data to promote better antimicrobial measures.
The article reports that the staff initially felt a bit concerned about being watched by “big brother.” However, the hospital promoted the idea of the eICU as a “part of the team” instead of an intrusion, an approach that appears to have been successful.
As a nurse who works to improve compliance to best practices that reduce hospital-acquired conditions, particularly bloodstream infections, I feel this presents an amazing opportunity to promote patient safety. For example, when I perform hospital audits, I see poor compliance to hand washing and the cleansing of IV access ports. These two practices are proven to help decrease the spread of infection, but compliance remains low. Educating staff about why compliance matters does help, but results are often best when a “carrot and a stick” are both used to motivate staff.
What do you think of this type of technology? Do you feel this expensive technology will be readily adopted? Does it make you uncomfortable? Let us know what you think.
(For a different perspective on eICUs, one focused on the issue of inadequate nurse staffing, see this post from AJN‘s interim editor in chief, Shawn Kennedy.)
Bring Back the House Call
October 16, 2009By Christine Moffa, MS, RN, AJN clinical editor
by kafka4prez, via Flickr Creative Commons
What should be done about a person with a chronic medical condition who can’t make it to their primary care provider but isn’t sick enough to call 911?
Recently a case came to my attention of a woman in her 60s with a history of impaired mobility due to primary lymphedema of the legs, obesity, and some other chronic medical problems. One day while getting up out of bed she strained her back. The pain from the injury made it that much harder to tolerate any kind of physical activity. She was no longer able to climb up or down stairs. Since there was no way to leave her house without going down several steps, she couldn’t get the medical care she needed to treat the acute back pain or the wounds on her lower legs associated with the lymphedema. As the months passed, her leg wounds grew worse and her inactivity led to more inactivity. Although her husband and children were able to assist her in some capacity, they had no way to get her out of the home.
Prior to the her back injury, she’d routinely visited her primary care physician as well as a vascular surgeon—but neither felt comfortable ordering home care for her (nor did they offer any solutions). Without an order, a home care service couldn’t take her case. A trip to the emergency room wasn’t really what she needed, but aside from calling 911 there was no other way of getting her seen by someone with the privileges to prescribe either the medications or home care she needed. Read the rest of this entry ?
