Archive for August, 2010

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Fighting HIV–AIDS with Public Health Billboards: September ‘Art of Nursing’

August 30, 2010

By Sylvia Foley, AJN senior editor

Public Health Billboard, Guinea-Bissau (detail)

On a recent trip to the capital of Guinea­-Bissau, Dawn Starin noticed numerous public health billboards urging people to get tested for HIV or to practice safer sex by wearing condoms. One of the six poorest countries in the world, according to the Central Intelligence Agency’s World Factbook, Guinea-Bissau faces an ongoing epidemic of HIV and AIDS. Prevalence is especially high in urban areas and among pregnant women and sex workers. Starin, a writer and a research associate in the department of anthropology at University College London, UK, was struck by the bright colors and larger-than-life figures in the billboards, and photographed several, including the one featured in the September Art of Nursing.

Are the billboards effective?  Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

Starin has also photographed public art by Thongleum Damviengkum, a mixed-media artist whose work appeared in the April Art of Nursing. Damviengkum’s often witty pieces, intended to raise public awareness about HIV and AIDS and address the stigma associated with having the disease, are on display at a restaurant in Bangkok, Thailand. “Humor is important if you want people to listen,” he told Starin.

As always, Art of Nursing is free online (you’ll need to click through to the PDF files). We invite you to have a look and tell us what you think in the comments.

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Posted in art and nursing, HIV/AIDS, international nursing, public health nursing | Tagged , , , | 7 Comments »

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Neither Crime Nor Demeanor

August 25, 2010

By Marcy Phipps. Marcy is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN, and she has contributed several thoughtful posts to this blog in recent months (here’s the previous one).

by Van Der Elst/via Flickr

My patient’s ICU stay was short, as his injuries were fairly unremarkable. Far more striking were the circumstances of his admission; he’d been injured while committing an appalling act of grisly violence. An armed police officer stood sentry at his bedside, and the nature of his crimes gave him a sinister notoriety among the medical staff.

“Alleged” crimes, I should say.

But it was difficult to give him the benefit of the doubt. I’d read the paper and seen the crime scene photos on the news.  The media’s case against him made his innocence hard to fathom, and as a police officer’s daughter I found myself inclined to prejudice. I not only planned on, but also counted on disliking him, at least on some level. Although I would certainly provide care to this man, I exempted myself from caring about him as an individual.

I was surprised to find his demeanor dramatically different than my expectations. He was soft-spoken and retiring, exceedingly polite and appreciative.

I don’t mean to imply that we chatted. Our conversations were limited to his physical condition and general plan of care. He never acknowledged the officer at the bedside or spoke of his alleged crimes, and neither did I.

It’s possible that I was being charmed by a deviant mind. But at the end of the day I not only didn’t dislike him, I was left with a sincere hope that he finds peace, regardless of his past, his actions, or whatever his personal demons may be. The sympathies I developed for him unsettled me, given my initial repulsion, and I’m humbled by the reminder that in the wishing of peace for another, neither their crimes nor demeanor should matter.

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Posted in ethical issues, nursing perspective | Tagged , | 3 Comments »

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On the Nurses Walk

August 23, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Sydney Harbor

As some of you may have seen by my tweets over the last week or so, I was in Australia attending a meeting, the International Academy of Nurse Editors gathering in Coolum (August 11 to 14). We discussed editorial and publishing matters—interesting if you’re “in the biz,” but I imagine most nurses would roll their eyes if I discussed it here.

(Side note, to those interested: there was much discussion about the use and misuse of journal rankings and impact factors and the sustainability of society and clinical practice journals if journal rankings are to be the primary factor in deciding where one should publish one’s work. As long as faculty tenure and promotion are tied to publishing in higher-ranked research and “scholarly” academic journals—and for a thought-provoking discussion on how one defines “scholarly,” see this 2006 editorial (click through to the PDF version) by AJN’s editor-in-chief emeritus, Diana Mason—researchers and scholars will seek to publish in those places, as opposed to in clinical journals that are more widely read by practicing nurses. You’ll hear more from us soon on that discussion.)

Sydney: a proving ground for nurses. So, as long as I was halfway around the world, I took some vacation time and traveled from Coolum to Melbourne and then to Sydney before coming home. Read the rest of this entry ?

Posted in Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged , , , , | Leave a Comment »

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When Timely Nurse Removal of Urinary Catheters Reduces UTI Rate

August 19, 2010

By Christine Moffa, MS, RN, AJN clinical editor

Ever since we started the Cultivating Quality column at AJN, manuscripts featuring evidence-based quality improvement projects have been pouring in. There is a lot of great work being done at the bedside by practicing nurses, and this column provides the opportunity to share their ideas with others.

Lancaster General's CAUTI rates, fiscal yrs 2007-2009 (click to enlarge)

This month’s Cultivating Quality installment, Reducing Rates of Catheter-Associated Urinary Tract Infection, comes from Joyce Wenger, MS, RN, the infection control performance improvement coordinator at Lancaster General Hospital, Lancaster, PA. According to the CDC, urinary tract infections (UTIs) account for more than 30% of hospital-associated infections, and almost all are “caused by instrumentation of the urinary tract.” Nursing staff were able to reduce catheter-associated urinary tract infection (CAUTI) rates using a three-pronged approach “beginning with education, progressing to tests of new and better products, and ending with the nurse-driven protocol for catheter removal.”

That last part is my favorite. In most facilities a doctor or nurse practitioner has to write an order before a Foley catheter can be removed from a patient. Patients may end up spending several days at increased risk for UTI because of an unnecessary urinary catheter in place. This hospital came up with a plan to give nurses the autonomy to remove them—which makes sense, since they’re the ones checking the patient daily. The team at Lancaster General created the following list of criteria that patients need to meet in order to maintain a Foley catheter. If not, then the nurse can remove it.

A nurse keeps the Foley catheter in place if

  • a urologist is on the case; the catheter cannot be removed without the urologist’s approval.
  • a physician has ordered that the catheter not be removed (the medical reason to continue or criteria for removal should be documented).
  • a physician has documented “medical necessity” within the last 24 hours.
  • the patient is unresponsive or comatose.
  • the patient is receiving palliative or hospice care.
  • the patient has received IV sedation within the last 12 hours.
  • the patient has received IV inotropic agents within the last 24 hours.
  • there is an order for IV diuretics to be given every six or fewer hours.
  • the patient is undergoing ultrafiltration.
  • acute or worsening renal failure is evident (that is, there has been a creatinine level increase of 1 mg/dL or more above the admission or baseline level).
  • surgery has been performed within the last 24 hours.
  • a pressure ulcer might be soiled if the catheter is removed and the patient is incontinent.

But I’d recommend reading the entire article and seeing how these interventions compare to those at your facility. We’d love to hear what you think about it.

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Posted in infection control, patient safety | Tagged , , , | 1 Comment »

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Dog Days of August Blog Roundup

August 18, 2010

What are nurses blogging about this August? (And why do they call these the “dog days”?) A random sampling of what crossed our desks:

by dennis and aimee jonez/via Flickr

The labor and delivery RN who writes the blog At Your Cervix has a nice short post this week on a team of nurses working together to avert a potential catastrophic event.

Artist, writer, nurse, JParadisiRN has a new post that takes the Steven Slater flight attendant incident as a jumping-off point to discuss what drives nurses crazy and unnecessarily slows down work flow. Her answer, in this post at least: waiting for the physician’s order.

Nursetopia writes of a few of her favorite things about being a nurse. (Preprinted physician order forms are one of them, to refer back to the previous post mentioned… So is working on Christmas Day.)

GuitarGirl RN asks why, why, why about the patients who come to the ER where she works. Why do they believe the Internet over the advice of their physicians? Why do they see a crisis when nothing is happening? And so on…

Ok, and just to balance things out, here’s one from Anonymous Doc, who asks why people in the end stages of terminal illness go on believing in long-shot treatments, and physicians go on giving them, despite the fact that he’s never seen a single one result in a miracle. In other words, when is hope justified, and when is it less so. But that’s to get at the heart of what makes us human. No easy answers, and he doesn’t try to give easy answers…

Lastly, closer to home (home being New York City for AJN), nurses and other former employees of beloved, much needed, but now closed St. Vincent’s Hospital in Greenwich Village have filed suit for full release of records revealing management’s role in the hospital’s financial failure.—JM, senior editor

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Posted in nursing perspective, patient safety | Tagged , , , | 2 Comments »

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A Nurse So Cold

August 16, 2010

Al is weak, frail, and most important, scared. At 55 years of age, after 34 years providing care, she finds herself in a major medical center— on her back, staring at ceiling tiles. The woman who’s always had skin as pure as a china doll now ironically has a porcelain hip. She’s just 36 hours out from a total hip replacement, and she knows something is wrong. She feels her heart pounding, she can hear the beating in her ears, feel the pulsing on her pillow. She rings the call bell to ask for the nurse to check her. An hour comes and goes, and no one comes to her room.

That’s from the August Reflections essay, titled “Miss Orienting Nurse.” The author is Linda Pellico, an assistant professor at the Yale School of Nursing, who tells of her chagrin at witnessing rote care provided to a hospitalized friend by a former student of hers. We hope you’ll read the essay and let us know your own experiences as a nurse or patient—or both. How many of us will someday have to rely on such cold and distant figures as the nurse and MD portrayed in this essay?-JM, senior editor

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Posted in nursing perspective, nursing students, patient perspective, professional identity, writing and nursing | Tagged , , , | 2 Comments »

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Sand, Surf, and CF

August 13, 2010

By Christine Moffa, MS, RN, clinical editor at AJN

Ever wonder how the staff at AJN decide what to put on our covers? We wanted an image that celebrated the summer, but we also wanted a tie-in with our CE feature. The August cover depicting children running down the beach at Sunny Shores Sea Camp, a four-day summer camp that caters to children with cystic fibrosis (CF) and their families, is a perfect fit. 

Some former colleagues once volunteered at the camp. Several years ago I was working on a pediatric floor where several of our patients had CF, ranging in age from toddlers to adults in their 30s. CF was long considered a childhood disease, due to a short life expectancy associated with it; even though life expectancy has drastically increased, these patients are still often treated on pediatric units, regardless of their age. This month’s CE, Original Research: Parents and Children with Cystic Fibrosis, is by Paula Harff Lomas, MAS, RN, CCRP, and Susan B. Fowler, PhD, RN, CNRN. According to Lomas and Fowler,

“More people with cystic fibrosis are living longer, reaching milestones like starting college, embarking on careers, and marrying. Many adults with cystic fibrosis are interested in starting families; one recent review notes that the number of live births to women with the disease has increased significantly. Thus, there’s a greater need for age-appropriate care in areas such as fertility and reproduction.”

The purpose of this descriptive study was to estimate the number of adults with CF who are parents of children with the disease. Of the 66 patients identified, 39 were first diagnosed after prenatal testing or their child’s diagnosis. The authors write: “The parents will need to come to terms with having a life-threatening illness and learning to adhere to a complex and time-consuming treatment regimen—while also facing these challenges with regard to their child.”

The nurse caring for CF patients who also have children with the disease can

  • act as liaison to other caregivers, such as the patient’s genetic counselor, pri­mary care provider, obstetrician, nurse midwife, and nutritionist.
  • offer psychological support or referral to a mental health provider.
  • refer the patient to the local cystic fibrosis care center.
  • explore various time-management techniques for time-consuming treatments.
  • encourage patients to adhere to treatment recommendations so they may serve as good role models their children.

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Posted in nursing perspective, patient perspective | Tagged , , , , , , | 1 Comment »

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Diabetes, Hypertension, Obesity. . .The Case of the Missing School Nurse

August 11, 2010

By Peggy McDaniel, BSN, RN

I was amazed by a MarketWatch article this week about the overall lack of school nurses. According to the article, the National Association of School Nurses recommends that one nurse be available for every 750 well children. Many states operate with ratios greatly exceeding that number. For example, in 2009 Michigan had one nurse for every 4,836 children. To give credit where it is due, that same year Vermont provided one nurse for every 311 students. As a nurse, and a parent, I find this data frightening. Not only are there fewer trained professional nurses available to our children every year, but approximately 30% of American children suffer from chronic conditions such as type 1 or type 2 diabetes, asthma, and high blood pressure.

by woodley wonderworks, via Flickr.

Having more nurses available to patients in an inpatient setting has been proven to promote better patient outcomes. I’m going to go out on a limb and suggest that the same is probably true for school nurses.

Lousy timing. This acute shortage of school nurses could not come at a worse time. With more families than ever feeling the pinch of the recession, children are not immune to the oft-reported outcomes related to our current overall economic condition. Less money can translate into fewer visits to health care providers and dentists, greater family stress, and even hunger, among many other things. School nurses not only help kids with cuts and bruises but also make referrals to dentists and other needed services. The article I mentioned above didn’t discuss the number of children with mental health issues in our public school system, but this factor adds another level of complexity to the care of our nation’s children, one that nurses are prepared to assist with.

As a parent of healthy kids, I didn’t worry too much about the availability of a school nurse. My daughters actually regretted the fact that I was not only a pediatric nurse, but also owned a medical grade thermometer—needless to say, you didn’t stay home at our house unless you were truly sick! My good friend has a daughter who was diagnosed with type 1 diabetes just prior to entering first grade. Read the rest of this entry ?

Posted in children's health, school nurses | Tagged , , , | 7 Comments »

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Taking Away Choice — The Wrong Answer to Domestic Violence

August 10, 2010

By Meg Stone, MPH. Stone is the executive director of IMPACT Boston, an organization that works to prevent violence and abuse by giving people the tools to protect their safety and advocate for healthy relationships and sexual respect in their communities. A long-time domestic violence advocate with a degree in public health, she has, in her own words, “a strong interest in raising awareness of the issues facing women who present to emergency departments with injuries related to abuse. My professional background includes training nurses and first responders in asking about domestic violence and documenting incidents of abuse on medical records.”

This post is longer than our usual, but we thought it was worth running in entirety. The names and identifying details of those mentioned have been changed.

by katietower/via Flickr

In the mid-1990s it was rare in most places for nurses and social workers to call domestic violence organizations when women came to the emergency department with injuries related to abuse. I only remember one call from a hospital social worker in the upstate New York town where I worked as an advocate at the local battered women’s program.

Carolyn, the director of the battered women’s service, called me at home on my day off. Nobody else was available, she said, so could I please please please go. The future of our relationships with hospitals depended on our ability to get there when they needed us. I was excruciatingly dependable, powerless against please please please. My trip to the hospital would be another example of a domestic violence organization held together by people who can’t bring ourselves to say no.

The social worker met me in the waiting room. As she led me through corridors past triage stations and hospital beds I tried not to look at any of the people with tubes in their noses or blood seeping through bandages on their heads. When we got to Helen’s room she was sitting on the bed with her arms tightly crossed. She looked only at the floor. All the information we had about the incident had come from Helen’s brother and his wife Renee, who had walked into the house and interrupted it.  Read the rest of this entry ?

Posted in advocacy/political action, ethical issues, patient perspective | Tagged , , | 1 Comment »

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Social Media and Nurses — Does Betty White Have a Point?

August 9, 2010

50 Social Media Icons/Ivan Walsh, via Flickr

By Shawn Kennedy, AJN interim editor-in-chief

I’ve been extremely busy and have had trouble finding time to write a post for this blog. And it’s not enough just to write a post—we’ve got to think about what should go on Facebook and what should be Tweeted, whether we should do a mention in the eNewsletter and if a topic deserves a spot on AJN’s home page. All this communication takes time.

When she hosted Saturday Night Live, the inimitable Betty White acknowledged all the fans on Facebook who were the driving force behind the campaign to have her become the host. She confessed she didn’t know what Facebook was, and said, “Now that I do know what it is, I have to say, it seems like a huge waste of time.”

Facebook and Twitter sort of remind me of the Valentine’s Day card exchange in grammar school—everyone bought boxes of 100 cards (actually, more like small, cheap postcards) so you could give them out and, hopefully, get as many in return. It was about the number of cards you could collect—even if they were from classmates you didn’t care about or even disliked. You felt good if you had lots of cards and people saw that you had lots of cards; getting just a few cards made you feel friendless.

I know why we at AJN are involved in all this e-media and social media—we want to connect with you, our readers and potential readers, and learn what’s important to you, what’s on nurses’ minds, so we can provide information that fits your needs and is important to your work. For the last 100 years, we’ve done this in print format, teaching videos, and conferences, but now there are many more venues for disseminating content. So we Tweet, blog, Facebook, comment, link, e-mail, and do everything we can to connect, deliver content, and get feedback. (Bonus: we have found some new columnists and authors through our e-efforts, and we’re constantly trading tips with other health care editors, journalists, and writers.)

But I’m still stymied about why so many nurses, who are extremely busy people, spend the time it takes to do all this connecting. Read the rest of this entry ?

Posted in nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 5 Comments »

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