Archive for February, 2010

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The Power of No

February 26, 2010

. . . . What really struck me about the meeting, however, was the inability of Republicans to explain how they propose dealing with the issue that, rightly, is at the emotional center of much health care debate: the plight of Americans who suffer from pre-existing medical conditions. In other advanced countries, everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited genetic disorder, or even, in some states, having been a victim of domestic violence can make you uninsurable, and thus make adequate health care unaffordable.

One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case of American exceptionalism. But what’s the Republican answer? Mr. Alexander was strangely inarticulate on the matter, saying only that “House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer.” He offered no clue about what those ideas might be.

That’s from “Afflicting the Afflicted,” Paul Krugman’s NY Times column about the health care reform summit that took place yesterday. It really is bewildering that so many elected officials can simply refuse to engage one of the major issues of our time. How can their supporters not begin to wonder at this as they themselves in ever greater numbers go into medical bankruptcy, are forced to choose between basic medications for chronic illnesses, and spend days on end struggling with insurance companies over every simple claim they make? Didn’t any of the naysayers notice the increases in insurance premiums announced this week, for example, with some major plans raising premiums by as much as 35%?

Nurses: Are your patients’ lives really improving? Are they getting any easier? Don’t they deserve a sincere effort to solve their problems, rather than more posturing designed to win votes in the next election cycle?

-Jacob Molyneux, senior editor/blog editor

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Notes from the Web

February 25, 2010

Here are a few items of interest on today’s Web as these huge wet snowflakes actually start to accumulate on rooftops here in NYC and the horizon (New Jersey, that is, across the thin wedge of the Hudson River you can see from AJN offices) closes steadily in:

Kim at Emergiblog has a nice post dealing with changing her mind about whether or not she wanted to get a BSN.

And this post by Anne Dabrow Woods at In the Round (excerpted below) got our attention for its honesty about the difference between treating a condition in the hospital and treating it at home in a family member—and also because it put a human face on an article we ran in our February issue about ostomy complications and management.

My oldest daughter was diagnosed with ulcerative colitis when she was 7 years old and despite aggressive treatment for her disease; she required a total colectomy, temporary ileostomy, and an ileo-anal anastamosis when she was 12. As a nurse I thought I was equipped to care for her ileostomy; was I ever wrong. I had experience taking care of hospitalized patients with ostomies, but I quickly learned caring for someone who is active is a totally different story.

In his most recent post, Anonymous Doc is as usual thoughtful and honest (except for that anonymity thing, of course . . . which does, whatever its drawbacks, kind of free him up as a writer). He moves from considering the fairly superficial question of whether it’s appropriate for him to suggest that a sweating patient take off her sweater to some related but perhaps deeper questions:

More than once, I’ve made a comment that’s probably too casual when we’re talking about running some blood work. Like, “I hope they don’t find [whatever].” As a fellow human being, I hope they don’t. As a doctor, am I supposed to acknowledge hope, and uncertainty? Shouldn’t I say something like “there’s an x% chance they’ll find [whatever],” or say nothing at all, and wait until they find what they’re going to find, and not scare the patient needlessly? I don’t know. They don’t train us (much) in actual patient interaction. We’re expected to pick it up, to know things automatically.

Also of significance this week, the House passed legislation to “strip health insurers of their federal antitrust exemption.” In other words, insurers may soon have to do a better job pleasing customers rather than abusing them—or face stiff competition from competitors who are willing to do so instead.

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The Job Description Doesn’t Say You Get to Choose Your Patients

February 24, 2010

He was a pedophile, just released from jail after 20 years. His diabetes required two different types of insulin. He had acute renal failure and a recent ileostomy.

“They didn’t know what to do with him,” the previous nurse said, “so they dumped him on our doorstep.”

The Reflections essay in the March issue of AJN tells one nurse’s story of holding fast to her responsibility to provide compassionate and quality care to all patients, whatever they may have done in the past, whoever they might be. We hope you’ll click the link above, read it, and let us know your thoughts (the best version to read is reached by clicking through to the PDF version).

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Revamping CE

February 22, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

I finally got to the bottom of my inbox. There I found a transcript of a Webcast I had listened to back in December. I had forgotten about it and am amazed that there wasn’t more buzz around it because there’s a call for a drastic overhaul of continuing education for health professionals.

 

On December 4, the Institute of Medicine released a report, Redesigning CE in the Health Professions, which is the result of consensus recommendations by (what else?) a group of experts.

The experts were harsh in their criticisms, claiming that there are “major flaws in the way CE is conducted, financed, regulated and evaluated.” They also noted conflicts of interest and varying regulations from state to state, and pointed out that the scientific basis of CE is underdeveloped and lacks an interdisciplinary format.

You can read the full report online—but briefly, it calls for a federal “blue ribbon panel” to develop an interprofessional, independent Continuing Professional Development Institute to provide oversight to ensure reforms, new processes and accountability. 

Changes are coming . . . and it’s about time.

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Color Me Wrong – Medication Errors and Color Coding

February 19, 2010

By Peggy McDaniel, BSN, RN

There has been a recent push by some manufacturers to promote color coding for product identification. Of course, even with the best intentions, these color-coded products have not reduced the incidence of medical errors and may actually promote errors.

The February Nurse Advise newsletter from the Institute for Safe Medication Practices (ISMP) (click here to subscribe to the newsletter) reports a medication error in which a nurse injected oral medication from an oral syringe into a Bard PowerPICC (percutaneously inserted central catheter). The PICC line is manufactured in a purple color and may have been confused with an enteral feeding system from Covidien, which is the same shade of purple. Even though the nurse was using an oral syringe, she was able to hold it up tightly enough to the open female luer of the PICC tubing to inject the oral medication intravenously. This error highlights both a “misconnection” and a color-coding confusion.

Read the rest of this entry ?

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‘Jenny’s Daydream’: February’s ‘Art of Nursing’ Disturbs the Quiet

February 17, 2010

Into the sun by Steve Punter, via Flickr

By Sylvia Foley, AJN senior editor

“Stuck to the chair, locked door, locked window, / watching for wrens and sparrows, Jenny closes her eyes.” These lines open “Jenny’s Daydream,”  the poem featured in this month’s Art of Nursing (please click through to the PDF). The daydream is no idyll; though Jenny “remembers sparse blue and yellow flowers” and “herring gulls sunning on the pier, peaceful,” she’s also “waiting for / God’s voice to disturb the interstellar quiet.” Why? The answer, at once harrowing and poignant, might surprise you.

Karen Douglass, a writer and retired RN, has been published in many literary and mainstream magazines, including Sunken Lines, The Other Voices International Project, and Yankee. Her most recent collection is The Great Hunger (Plain View Press, 2009).  Douglass also blogs about writing and life at KD’s Bookblog.

And if you’re a poet or a visual artist, we hope you’ll consider submitting to Art of Nursing. Read this blog post for details. Guidelines can be found here. Still have questions? Write to the Art of Nursing coordinator (me) at sylvia.foley@wolterskluwer.com.

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Nurses Under Fire: Cleared in Texas, Embattled in California

February 16, 2010

By Shawn Kennedy, interim editor-in-chief

By now you’ve probably heard that last Thursday Anne Mitchell, the Texas nurse who found herself fired from her job and on trial after reporting a physician for what she felt was poor medical practice (see our report in the October 2009 issue) was found not guilty (her colleague, Vicki Galle, had her case dismissed prior to trial). It only took the jury about an hour to exonerate Mitchell of criminal charges and uphold her right to advocate for patients. (Day-by-day reports from the trial were made available on the Texas Nurses Association  (TNA) Web site.)

The case garnered national attention—at its core was a nurse’s right (duty, really) to safeguard patients in her or his care. It seemed a no-brainer, and almost incredible that the case even came to trial. Last Friday, I spoke with TNA president Susan Sportsman, PhD, RN, who agreed, saying she was surprised the case went forward, especially after the state medical board agreed that what the nurses did was appropriate. Sportsman said, “This is the role of nurses—it’s required that we report what we see to safeguard patients. This nurse was just doing her job, what she was supposed to do.”

Like nurses everywhere, Sportsman was “delighted and ecstatic” about the verdict. Sportsman noted a guilty verdict would have discouraged nurses and others from coming forward about poor care out of fear of losing their jobs and facing prosecution.  Perhaps more chilling would be the result that nurses would be powerless and without support to protect patients from unsafe care. (See JParadisi’s excellent piece on this on her blog.)

Nurses seem to be coming under fire lately—witness the lawsuit California anesthesiologists have filed against their governor. According to the petition (available on the American Association of Nurse Anesthetists’ Web site), the anesthesiologists charge that, in following Medicare policy allowing a state to “opt out” of the physician supervision requirement, the governor is acting outside of California law in allowing nurse anesthetists to practice without physician supervision. It’s another case that bears watching (and rallying!) by all nurses, not just CRNAs. Nurses have a right to practice within the scope allowed under the law and for which they are qualified; a challenge to one nursing group should be a challenge to all of us.

What’s your take on these issues? Will the Mitchell case (despite the verdict in her favor) discourage potential whistle-blowers among nurses? And should physician groups really be attempting to restrict nurses’ scope of practice?

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The Mindfulness Antidote to V-Day

February 12, 2010

By Christine Moffa, MS, RN, AJN clinical editor

by Foton28/via FlickrI can’t resist acknowledging that dreaded day that’s coming up this weekend. Whether you are a believer in Valentine’s Day or a skeptic who thinks it was created by greeting card companies and florists, you can’t escape it. There are commercials all over TV, signs in every drug store, and now a movie with it in the title (which I had planned on seeing, until I read some reviews). My personal feeling has been that it makes single people feel lonely and pathetic and people in relationships disappointed with the ones they have. Not to mention that it’s impossible to get a good meal at a decent restaurant. A friend of mine who’s a social worker told me she’s thankful it falls on a weekend so she will be spared dealing with back-to-back appointments of heartbroken clients. 

This is the perfect time to practice my latest self-help discovery: mindful self-compassion. Christopher K. Germer, author of The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions (pardon the shameless product plug; neither I nor AJN has been paid off in any way!), posted an exercise on his blog during the holidays this past December that I think is a good fit for getting through this weekend (if you or someone you know finds it difficult). He suggests:

If you feel lonely […], see if you can stop and name the experience (“I’m terribly lonely”) and give yourself the kindness you might be hoping to receive if you were with someone who cared about you. Think what your best friend would say to you if she or he knew you were lonely. Or think what you might say to a loved one under similar circumstances. Let the holiday be an opportunity to practice self-compassion. Can you prepare a nice meal for yourself, get some needed exercise, write an email to an old friend, or plan a trip that you always wanted to take? Or can you just curl up with your dog or cat and read a great book?


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DSM-V Draft Ready for Public Comment–What’s It To Nurses?

February 12, 2010

As many of you know, a draft of the proposed DSM-5 is just out and it’s bound to stir plenty of comment and controversy. First, I’ve got to congratulate the DSM-5 crafters for making the draft public and for seeking public comment. That’s right: the APA wants to hear from members of the public, not just medical professionals. So let them know what you think.

Meanwhile, let me offer some preliminary comments:

1. Internet addiction isn’t included, which is fine by me and likely will save the APA much sniggering and criticism.

2. Bipolar disorder type 3 or subthreshold bipolar disorder is not included either and that is definitely a victory for critics like me who’ve long held that the softening of mood disorders–such as with bipolar disorder type 2–has led to millions of Americans being overdiagnosed and overmedicated.

Read more of this post at Furious Seasons, a thoughtful blog belonging to a health care journalist who has long suffered from mental illness (I can’t seem to link directly to the specific post, but at least for today it’s still at the top of the blog’s landing page).

We draw your attention to his observations because we’re interested in how nurses—perhaps especially psych nurses, but all nurses, or, for that matter, nurses who are patients—may be reacting to the release for public comment of a draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Your thoughts are always welcome here; we also hope to cover this in more detail in the journal in the coming months.

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Weathering the Storm in PR

February 11, 2010

By Shawn Kennedy, AJN interim editor-in-chief

As I’m writing this, I’m lucky enough to be in Puerto Rico, out of the record-setting snow storm that just hit the Northeast (and further south as well). But I’m still following the news of the storm and “real life” (sun and sand in February is so not real life) and trying to keep up with work e-mail a bit so it won’t overwhelm me when I get home (it will anyway).

Which brings me to my point: how difficult it is to shake off real life today and just relax. As I’m sitting here in the hotel lobby using the Internet connection, I see at least a dozen other people on laptops and another dozen or so on cell phones. As I look out the large windows to the palm trees and blue sky, I realize there is something definitely wrong with the picture—I’m not out there stocking up on Vitamin D. I’d better go—for health reasons, you understand.

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