Archive for November, 2010

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On the Road to the Future of Nursing

November 29, 2010

By Shawn Kennedy, interim editor-in-chief  

by wfyurasko/via Flickr

I’m writing this on the train to Washington, DC, heading to the National Summit on Advancing Health through Nursing, which is taking place November 30 and December 1. This is the next step of the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing (see my October 8 blog post) and will launch the Campaign for Action—the plan for implementing the recommendations of the Institute of Medicine’s report, The Future of Nursing. (You’ll be able to access the webcast and a live chat of webcast users on November 30 here.)

If you haven’t read anything about this initiative, do so. If you’re a nurse and plan to be working for the next 10 years, the recommendations from this report, if implemented, will affect you in some way. Expect to see changes in the following areas, to name just a few:

  • how and where nurses practice
  • undergraduate and graduate curricula
  • licensing and certification criteria
  • reimbursement policies
     

Other nursing initiatives have come and gone, some more successful in achieving their goals than others. AJN will cover the progress of this initiative as it attempts to evolve from a written report to an active process that creates sustainable change. As a start, in the December issue, now available at ajnonline.com, AJN brings you a guest editorial by Susan Hassmiller, director of the Initiative on the Future of Nursing. There’s also a summary and analysis of the report in AJN Reports, and a podcast interview with Marla Weston, CEO of the American Nurses Association, discussing the recommendations. And I’ll be posting updates here on the blog.

The weight of the IOM, the Affordable Care Act mandating health reform, the aging of America, and the numbers of Americans living with chronic diseases—all have come together to create the “perfect storm” for significant change. This is perhaps the best opportunity nursing will have in our lifetime to become a decision maker in shaping health care delivery in this country. Here’s hoping . . .

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Posted in media depictions of nursing, nursing shortage, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 1 Comment »

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Turkey, Sweet Potatoes, and Living Wills

November 24, 2010

By Christine Moffa, MS, RN, AJN clinical editor

by controltheweb/via Flickr

When I was growing up, my family spent Thanksgiving dinner at my grandmother’s house. She was a star in the kitchen, with cooking and baking skills beyond compare. However, while she made a chocolate cream pie to kill for, her knack for turning every conversation into a newsfeed of various neighbors’ illnesses, symptoms, and near-death experiences, if not actual deaths, stood out more. She did this so much that my brother began referring to her as Grandma Kevorkian.

It turns out that death-and-dying discussions on Thanksgiving might not be such a bad thing, according to Engage with Grace, a nonprofit organization that promotes end-of-life discussions. In 2008 they launched a blog rally timed with Thanksgiving weekend, for bloggers to get the word out about end-of-life discussions. The idea is to have the conversation when most of the family members are together, and the Thanksgiving holiday is a perfect fit. There’s a five-question tool available on the site that can be used as a conversation starter, as well as other resources.

While talking about these topics could potentially clear a room, it’s a lot worse to be sitting at a family member’s bedside in the ICU and not knowing what to choose for them because they didn’t let you know in advance.

For additional information on end-of-life discussions and options, see the AJN articles “Life-Support Interventions at the End of Life: Unintended Consequences,” by Shirley A. Scott, MS, RN, CT, and “Stopping Eating and Drinking,” by Judith K. Schwarz, PhD.

And if you raised this topic at your Thanksgiving meal this year, or at another opportune moment, write in and let us know how it went.

Happy Thanksgiving!

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Posted in legal issues, nursing perspective, palliative care, patient perspective | Tagged , , , , , , | 3 Comments »

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Time to Pause and Commit to Act

November 24, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Of all the holidays, Thanksgiving seems to me to be the most pure—it began way before the greeting card folks thought of it and commercialized it. And it was born out of something that often gets lost during the course of our busy days—connecting with others and saying thank you for what they do or what they mean to us.

Christine Moffa, AJN’s clinical editor, and I were discussing the holiday at a staff meeting, saying how we had never minded working on Thanksgiving. Patients, visitors, and colleagues—everyone was in a friendly, appreciative mode. Most hospital cafeterias served turkey dinners to the staff, so everyone was happy about that—and everyone got to have a real dinner break for a change!

It also seems that at Thanksgiving we’re still in the “giving” mode, maybe because it’s early in the holiday season. My first request-for-your-support e-mail this season came from photographer Ed Kashi; it’s one I’m glad he sent. Ed is an incredibly talented megastar of documentary photography (in my humble opinion); we’ve been fortunate to have some of his work grace our covers (July 2007 and our 2008 Family Caregiver supplement, as examples) and articles. His e-mail was about an online auction of photographs called Commit to Action, a collaborative project by VII Photo (a photo agency) and Doctors Without Borders/Médecins Sans Frontières (MSF) to generate funds for MSF work around the world.

The e-mail contained images from another one of their projects, Starved for Attention, in which VII Photo members documented child malnutrition around the world. These images are sobering, especially on the day before Thanksgiving when most of us are consumed with food preparations.

I encourage you to visit these sites. While bidding on the photographs may be out of reach for many, there are two beautiful posters available for a nominal donation. You can at least sign the petition urging world leaders to provide more food aid.

Somehow, in this time when we pay farmers not to grow food, no one, least of all a child, should die from lack of food.

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Posted in advocacy/political action, children's health, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , , | 1 Comment »

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AJN Webnotes: Anatomizing Medical Errors; Insurance Rebates; Social Media and Nurses

November 22, 2010

The most popular article in last week’s New England Journal of Medicine did not tout the discovery of a novel gene, nor describe a cardiology clinical trial with a clever acronym as its title. Rather, it was the report of a case in which a surgeon at the Massachusetts General Hospital performed the wrong operation on a 65-year-old woman.

So begins a nicely engaging summary post at The Health Care Blog of the main points of an NEJM article describing how a medical error occurred—and yes, nurses play a major role in the story too. 

Feel like your insurance company spends too much time trying to weasel you out of your money? Kaiser Health News reports today that the Affordable Care Act may soon result in a little payback, in the form of rebates:

Millions of Americans might be eligible for rebates starting in 2012 under regulations released Monday detailing the health care law’s requirement that insurers spend at least 80 percent of their revenue on direct medical care.


“I have nothing listed under my work experience, yet Facebook somehow knows where I work,” cries Not Nurse Ratched, in a post called “Latest Facebook creepiness rant.” Such surprises are worth considering for anyone who might forget that information has a life of its own on the Web. Speaking of social media and nurses, A Nurse Practitioner’s View gives a quick survey of social media networking platforms available to nurse practitioners, then makes this important observation about participation:

It’s obvious that social (and professional) networking sites aren’t going anywhere anytime soon (FaceBook touts 500 million uses). However, there needs to be increased participation and discussion for them to be meaningful before people give up on them altogether – at least from a professional standpoint.

Which is a good lead in to this: please leave us a comment. We’d like to know what you think. Or yes, you can visit our Facebook page (click image above) and let us know your opinion there.—JM, senior editor/blog editor

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Posted in health care reform, patient safety | Tagged , , , , , , , | Leave a Comment »

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Anti-Antibiotics Week

November 18, 2010

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

Not only is antibiotic resistance dangerous and expensive, it’s on the rise. Unfortunately, cold and flu season can make people so uncomfortable they’ll do anything to feel better, including insisting that their health care provider write a prescription for a medication that can’t help them. In an effort to change this, the CDC and FDA have teamed up for the 3rd annual Get Smart about Antibiotics Week (November 15–21). You can check out their websites for various patient education materials and other resources to promote awareness at your facility.

For more information on antibiotic resistance and the Get Smart campaign, look at these articles published in AJN:

“Acute Respiratory Infections and Antimicrobial Resistance,” by Ann Marie Hart, PhD, RN, FNP, Alison Patti, MPH, CHES, Brendan Noggle, MPH, Erica Haller-Stevenson, MPH, CHES,and Lisa B. Hines, MPH, CHES

“Is Your Patient Taking the Right Antimicrobial?” by Mary C. Vrtis, PhD, RN

Sometimes it’s hard to not give in to the pressure when a patient expects a prescription at the end of a visit. What do you tell your patients or friends and family when they insist they need an antibiotic for cold or flu symptoms?

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Posted in advocacy/political action, infection control, patient perspective, public health nursing | Tagged , , | 3 Comments »

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An NP Prepares: When ‘Normal’ Is Better Than ‘Fine’

November 17, 2010

By Jen Busse, MPH, RN, who is currently working as a nurse while studying at Columbia University College of Nursing to be a family nurse practitioner. She’s also an intern at the Center for Health, Media and Policy at Hunter College in New York City.

As I walked toward the school of nursing’s skills laboratory, my hands were sweating and my heart pounded. Today was the day of nurse practitioner school when I would learn how to perform a pelvic exam—on a living person. What if I couldn’t find the cervix or said the wrong thing? Or, worst of all, what if I hurt someone?

I peered through the door and a group of women looked over and welcomed me in. Other students began coming into the classroom, which was set up with 10 or so exam tables surrounded by hospital curtains. We were split into groups of threes, with two instructors each: our gynecological teaching associates (GTAs), or “pelvic models.” My hands shook uncontrollably now. As an RN, I’ve had numerous experiences with patients in potentially uncomfortable situations, such as placing Foley catheters or giving complete bed baths. But this just didn’t seem the same; somehow, it’s more personal.

With two of my classmates I approached the exam table. Our two GTAs were there, one sitting and the other standing, both smiling warmly. The area was already set up, intimidating metal speculum and all. One of the GTAs skillfully walked us through the exam while the other acted as a patient. Her actions were slow and deliberate, with special attention paid to ensuring that her “patient” felt comfortable and in control of the situation. She encouraged us to “empower” the patient by having her pull back the sheet for the exam on her own and then hold a mirror to better be a part of the examination. She stressed that the places where the patients placed their feet were not stirrups, but foot rests. Read the rest of this entry ?

Posted in nurse practitioners, nursing perspective, nursing students, patient safety, writing and nursing | Tagged , , , , | 6 Comments »

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What Does Rappelling Down a Canyon Wall Have to Do With Nursing?

November 15, 2010

Alice Facente, a clinical educator in Connecticut, has published two Reflections essays in AJN in the past year: “The Dirtiest House in Town” and “At Her Mercy.”  Her last post on this blog can be found here.

The author rappelling down a canyon wall.

We just returned home from Moab, Utah, where our 20-something son lives and works. His 50-something parents decided to visit him—we hadn’t seen him in many months. He earns his living as a mountain guide, leading people on extreme mountain-climbing adventures.

We just wanted to see him, not fulfill any fantasies of becoming daredevils. But we were game to see what he did for a living. He took us on a three-mile hike through incredibly gorgeous canyons and rock formations. It was strenuous, but we were able to keep up. When we came to the edge of a cliff, with the bottom of the canyon “only 100 feet down” or so, our son took off his bulging backpack—which we’d mistakenly assumed was full of snacks—and pulled out harnesses, ropes, helmets, and gloves. He then told us there was no way down except to rappel.

Did I mention I am afraid of heights? Since my son was well aware of my (very reasonable) fears, he had neglected to tell us his plans. It took a little coaching and a lot of coaxing, but he calmly talked us down that first mountain cliff—rappelling for the first time ever. My husband went first, and then it was my turn. I was terrified at first, but halfway down a feeling of calm settled over me. If I was going to die, this was after all a pretty beautiful place. Read the rest of this entry ?

Posted in nursing perspective, professional identity, writing and nursing | Tagged , , | 3 Comments »

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Today is Veteran’s Day . . .

November 11, 2010

By Shawn Kennedy, Interim EIC of AJN

 . . . and unfortunately, because of conflicts in Afghanistan and Iraq, there will be many more veterans of war and its brutality. And there will also be many more families who struggle with the stress of having a family member deployed, often to dangerous places.

In this month’s issue of AJN, Erin Gabany and Teresa Shellenbarger, authors of the feature article “Caring for Families with Deployment Stress,” note that “deployment was found to have a markedly negative effect on health and well-being, with spouses reporting loneliness, anxiety, and depression in 78.2%, 51.6%, and 42.6% of all cases, respectively.” And just this week, a study published in the journal Pediatrics reports that, among children ages three to eight, “[m]ental and behavioral health visits increased by 11% in these children when a military parent deployed; behavioral disorders increased 19% and stress disorders increased 18%.”

While nurses in the military may be aware of the demands and stresses on active duty military families, civilian nurses may not be—and they are the ones who are likely to see the families of the many reserve and National Guard troops now deployed. We’re pleased to be publishing Gabany and Shellenbarger’s article, and hope it will increase  awareness of the issues many families face and help nurses provide support to these families.  

Nurses, too, are being deployed in large numbers; many, like army nurse Major Christopher Vanfossen, author of our new series Letters from Afghanistan, leave behind spouses and children who must cope with their absence. (Listen to a podcast of Major Vanfossen’s wife, Kelly, describing how she and her four young children cope with her husband’s deployment.)

With two of her sons deployed to Iraq, and one soon to be returning there, Sharon Stanley, chief nurse and director of Disaster Health and Mental Health Services for the American Red Cross and an AJN editorial board member, told me you never get used to deployment and feel concern “every day, every hour” for loved ones in war zones.

We need to remember—and thank—military families on Veterans Day.

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Posted in audio interviews, combat nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , , | Leave a Comment »

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A Tough Act to Swallow

November 10, 2010

By Christine Moffa, MS, RN, AJN clinical editor

For most people, eating is a simple pleasure that they usually take for granted. However, for patients recovering from stroke or esophageal disease, getting food down is a pretty big deal. Patients with dysphagia are at increased risk for malnutrition (which can lead to impaired healing), dehydration, and aspiration pneumonia. Unfortunately, liquid, soft, and pureed diets are not only unappealing and unappetizing for many patients, but they also mean different things at different hospitals. Have you ever seen a health worker “prepare” a liquid diet tray for a patient by taking the milk, juice, and mashed potatoes and mixing them together, then wondering why it’s taking an hour to get the patient to eat it? Read the rest of this entry ?

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

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Why Do Needlestick Injuries Still Haunt Us 10 Years after Protective Legislation?

November 8, 2010

By Shawn Kennedy, AJN interim editor-in-chief

By ad-vantage / Vanessa Agressti, via Flickr

In 2008, a survey by the American Nurses Association (ANA) indicated that 64% of nurses reported a needlestick injury. That startling figure was reported by Marla Weston, CEO of the ANA,  in her opening remarks last week when the ANA relaunched “Safe Needles Save Lives,” its campaign for use of safe needles in the workplace. The campaign originally launched ten years ago and was instrumental in passage of Public Law 106-430, the Needlestick Safety and Prevention Act, which requires employers to “identify, evaluate, and make use of effective safer medical devices.” And while there have been inroads towards use of safer needle systems, the 2008 data show that much needs to be done. 

Speaking from experience. Karen Daley, the ANA president, has long been a leader in advocating for safer needle systems. She sustained a needlestick injury while working in the ER a decade ago and contracted hepatitis and HIV infection. Her home state, Massachusetts, has been in the forefront of legislation. According to Angela Laramie from the Massachusetts Department of Public Health, all hospitals in Massachusetts are mandated to use sharps injury prevention devices, maintain a log of any injuries, and submit an annual report to the state. Yet, state data show an average of 3,000 needlestick injuries yearly—and more than half of these are with devices that lack safe needle systems.

Why does this continue? Why can hospitals, clinics, and other workplaces that use sharps continue to not invest in safe devices when they are available and when, by law, their use is mandated? Nurses, does your workplace protect you from needlestick injuries?

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Posted in advocacy/political action, infection control, practice tips, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 8 Comments »

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