Archive for December, 2010

Older Entries »
h1

Career Change in 2011? Ask the God of Gates, Doors, and Beginnings

December 30, 2010
Bust of the god Janus, Vatican museum, Rome

Bust of the god Janus, Vatican museum, Rome. Image via Wikipedia

By Peggy McDaniel, BSN, RN, infusion practice manager

I’ve never been much for New Year’s resolutions. I guess it’s because I know I won’t keep them—or at least recognize that my track record has been less than stellar. I’ve made the usual promises to myself: eat less, exercise more, learn a new craft, spend more time reading and less time on the Internet . . . and so on.

It seems as if such promises are made with tongue in cheek—even, possibly, made to be broken. So many resolutions are about self-improvement; I suppose that’s a good thing, except we don’t tend to follow through. The yoga classes I attend are always packed from January 2 through approximately March 15, then attendance slowly tapers back to the usual attendees. Do we feel we’ve been successful if we hang in there for a month, two or three months?

I’m not sure I’ve ever made a New Year’s resolution I really planned on keeping.

According to Wikipedia, the Roman ruler Julius Caesar changed the celebration for New Year’s from March to January 1 in 46 B.C. The day was “dedicated to Janus, the god of gates, doors, and beginnings,” who happened to have a face on both sides of his head. This signified the ability to look back and forward at the same time.

That’s something worthwhile—looking back at what we can and should change while looking forward in expectation and taking the opportunity do so. Other cultures celebrate New Year’s on different dates, based on their own calendars. No matter where or when, the idea of a new year, or a new beginning, is celebrated in a variety of ways around the world and has been for thousands of years.

As a nurse, what does the start of a New Year mean to you? This year will find me fulfilling a long-time dream to work in another country. Read the rest of this entry ?

Posted in nursing perspective, professional identity | Tagged , , , , , | 6 Comments »

h1

Year-End Reindeer Dreams

December 29, 2010

By Peggy McDaniel, BSN, RN, infusion practice manager

As a long-time pediatric nurse who’s spent many a Christmas at the hospital, I have special memories, many of which still make me smile years later. Some of these are bittersweet, as suffering and pain do not stop for such days. One of my favorite shifts involved a little boy and some reindeer antlers. 

I was working a 12-hour night shift as a traveler in a small community hospital. We got a call from the ED to admit a four-year-old boy who was extremely anemic due to unknown causes. When this child arrived, I realized he was very ill and probably would only spend Christmas Eve night with us. He needed to be stabilized, then would move on to a regional children’s hospital for further diagnosis and treatment. Read the rest of this entry ?

Posted in children's health, nursing perspective | Tagged , , , , | 2 Comments »

h1

December 23, 2010

Posted in Uncategorized | 2 Comments »

h1

The Slow Old Days

December 22, 2010
Christmas cards with angels, scandinavian “nis...

Image via Wikipedia

By Maureen “Shawn” Kennedy, interim editor-in-chief

On this past Monday at Slate, writer Kate Julian, lamenting that her mailbox was devoid of cards this season, asked, “Did Facebook Kill the Christmas Card?” She went on to detail all the ways people can connect online nowadays, making a case that the traditional “here’s what I’ve been doing all year” card is going the way of the little black address book and pocket calendar.

I’m not so sure we can put all the blame on Facebook. In my own case, I was (and still am) unprepared. I just know Christmas came earlier this year—I don’t know how they did it, but somehow the calendar seemed to do one of those Star Wars hyperspeed jump things, where lights whiz by and you’ve jumped light years ahead. I remember Halloween, and then there was Thanksgiving . . . but wasn’t that just last week?

Or maybe it only seems that way because with technology we can now work more efficiently and be more productive in less time. But where IS all this time I’m saving with technology?

This time of year makes me think of childhood Christmases, but not so much my own. My mother grew up in a small New England town during the 1930s; it was always cold and snowy. It was a mill town and no one had money to spare, so gifts were homemade and simple—jams, breads, cakes, knitted and crocheted items, and maybe a lap cover. It was less about gifts and more about the gesture of giving something that was useful and meaningful; there was lots of visiting and “dropping in” and spending some time catching up.

Now we can e-mail and text and post updates, and we probably know more about friends and strangers today than we did before—but I wonder, is it the stuff worth knowing? Do I really care about what Mary’s doing on Saturday, or what kind of car Jim bought? What about how they’re doing since their parents died? When was the last time we had a real conversation?

I think most of the time I’ve saved is now spent online. I think I just found my New Year’s resolution.

I have to confess, I sent e-cards this year. They were homemade, though . . .

Bookmark and Share

Posted in Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 2 Comments »

h1

‘The Birthplace’: Showcasing a Collaborative Practice Model

December 21, 2010

By Sylvia Foley, AJN senior editor

Megan Tudryn, RN and expectant mother, undergoes a contraction. Photo by Alice E. Proujansky; all rights reserved.

Photojournalist Alice E. Proujansky reports in AJN this month on The Birthplace, a collaborative care practice model at Baystate Franklin Medical Center in Greenfield, Massachusetts, where a team of five nurse midwives, three obstetricians, and 35 nurses attend some 400 to 500 births annually. Except for preterm and other higher-risk deliveries, the nurse midwives manage all deliveries and monitor fetal and maternal health. Patients complete detailed birth plans that afford them various care options. Physicians are called in only when necessary; as one nurse midwife told the author, “There’s an awful lot that we can do on our own.”

How well does the model work? The Birthplace has lower-than-usual rates of medical interventions such as episiotomy, epidoral anesthesia, and cesarean section. The patients have greater autonomy and decision-making capabilities. And the practitioners “relish the collaborative approach,” says Proujansky, who interviewed several clinicians and patients for the article; her photographs appear alongside the text and on the December cover. Proujansky’s last piece for AJN, a photo essay on a Dominican maternity ward, appeared in our December 2008 issue; read it here.


Bookmark and Share

Posted in children's health, nurse practitioners, nurses, nursing innovations, patient perspective | Tagged , , , , | Leave a Comment »

h1

‘At the Night Camp’: How Assumptions About Patients Can Blind Us

December 17, 2010

The entire time he was with us he kept looking around, eyes darting back and forth and toward the truck he’d driven, which he told me wasn’t his own. He shifted uneasily in his chair, and I felt the impulse to try to comfort him and tell him we could help.

That’s an excerpt from “At the Night Camp,” the December Reflections essay in AJN. The essay, by Meg Sniderman, a student in the MSN program at Emory University School of Nursing in Atlanta, takes a wry, honest look at the ways we can imagine whole lives for those around us based on their cultural identifiers, yet often miss the most obvious things about these patients . . . the things that make them just like us, despite apparently vast cultural differences.—JM, senior editor/blog editor

Bookmark and Share

Posted in nursing perspective, nursing students, patient perspective | Tagged , , , , , | Leave a Comment »

h1

Amazing and Disheartening: How We Continue to Fail Family Caregivers

December 15, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Recently, as part of an ongoing collaborative initiative on supporting family caregivers with AARP (see the comprehensive, and free, AJN supplement called State of the Science: Professional Partners Supporting Family Caregivers), I listened to a group of family caregivers talk about what it’s like to care for sick parents and relatives at home. 

Most of the caregivers were in their 60s and retired, and now found themselves doing the back-breaking work of being on call 24/7, attending to everything from bathing and feeding to chauffeuring to health care appointments, paying the bills, and running the household—sometimes two households, if they lived apart from the person for whom they provided care.

It was amazing and disheartening to listen to them—amazing in terms of the lengths they went to make sure they were doing the right things, and disheartening because they were mostly on their own, with little support from the health care system. And this was right from the start; all said that information to prepare for the transition from hospital to home had been lacking. For the most part, families looked to the family physician to answer questions about what they would need to do at home—nurses were hardly mentioned.

What They Said

  • All said they could have used better preparation before discharge; all agreed that there was little time to ask questions and that health care was “less about quality, and more about the numbers—they rush you in and out.”
  • Being able to practice care procedures like changing a dressing or giving an injection was a big wish: “I would have liked to watch them do it, and then have had them watch me do it to make sure I was doing it right.”
  • They would have liked information on nutrition and alternatives to medication—many were concerned that their loved ones were on too many medications.
  • They all complained about battles with insurance companies to get the care that was prescribed but sometimes denied.
  • Caregivers also said that, with so many different people coming and going, they couldn’t differentiate among health care providers. One said, “It could have been the janitor with a clipboard discharging my mother, for all I knew.”
  • Many said that they researched everything on their own, using textbooks and the Internet to find out what they needed to know.
  • Another frequent subject was the stress and burden of assuming care responsibilities, and the need to “get away for a break.”

I left there feeling depressed—at how badly our health care system fails the majority of people it’s supposed to help . . . and at how invisible nurses were to these caregivers while their loved ones were in the hospital.

What they said they needed most to ready them for caregiving was what nurses used to do to prepare patients for discharge: teaching patients and family members about dressing changes, medications and diet, etc.; helping them arrange for follow-up like home health care; and making sure they had prescriptions and knew when to make a follow-up appointment (or, sometimes, just making the appointment and sending caregivers home with a day or two of medications).

How did we lose these things? How did it come to be that these discharge preparation activities became dispensable? What next might we give away because there’s no time? Is there a “line in the sand” that we won’t cross?

Bookmark and Share

Posted in home care nursing, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 11 Comments »

h1

When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

December 14, 2010

By Sylvia Foley, AJN senior editor

Coffee Time (detail) / by S.M. Drawing used with permission of family.

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two of these drawings illustrate the article (a detail from one is shown above). The authors also profile one facility’s approach to pain assessment of its patients. And they discuss collaborative team solutions with AJN interim editor-in-chief Shawn Kennedy in this podcast interview.

Have you  faced the challenge of assessing pain in patients like S.M.?

Bookmark and Share

Posted in art and nursing, audio interviews, continuing education, nurses, nursing perspective, pain control, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 3 Comments »

h1

Dr. Oz’s Sexy ‘Nurses’: Here We Go Again

December 8, 2010

By Shawn Kennedy, AJN interim editor-in-chief

In the “what could he have been thinking?” category, Mehmet Oz, MD, wins first place—well, at least, for now. I’m sure someone else will come along soon and take his place.

In case you’ve been MIA the last month, Oz became a target for nursing ire when, on his November 4 show, he danced with several women who were wearing nurses’ uniforms revealing red lingerie. The segment apparently had nothing to do with nurses, but rather weight loss through dancing. (So of course that would make one think of nurses with red lingerie???)

I’m hoping it was a case where he “just didn’t think”—rather than that he thought that the segment might possibly offend nurses but decided to go with it anyway. Dogged by a letter-writing campaign spearheaded by Sandy Summers of the nursing image advocacy and watchdog group, The Truth About Nursing, and from criticism from other nursing groups like the American Nurses Association, Oz apparently released a statement on December 6 apologizing, according to various news reports. However, one can’t find it anywhere on his Web site or on the Web, for that matter.

It’s always interesting to see the level of offense colleagues and others feel. Comments posted on news sites carrying the story ranged from “oh geez, when did everyone get so freaking sensitive about everything?” and “I am a nurse and I can honestly say this doesn’t bother me one single bit. Some people really need to get a grip on life” to “I like Dr. Oz, but I have to agree, it was poor taste.” I have to say the majority of comments I read did not view this as something worth making a fuss about. In fact, The New York Daily News included a poll asking if the segment was offensive: 51% of respondents voted “of course not, it’s just a joke”; 22% voted “absolutely, he shouldn’t have done it”; and 26% voted “who cares?”

I myself am torn at times as to which battles are worth making a ruckus about, but not this time. The Dr. Oz Show—and yes, it is a TV show, so it’s first about entertainment and ratings—is purported to be about health teaching; it refers to Oz as “America’s doctor.” Oz has millions of viewers who take their cues from him. In this instance, he clearly pandered to entertainment and crowd pleasing.

So I wonder about his credibility—what else does he not think through thoroughly? Does he really carefully think about the health information he shares with his audience, or is that something staffers prepare and he just delivers? Oz blew it, and I’m grateful for Sandy Summers and other individuals and groups that watch out for nursing and raise awareness

When the Dr. Oz show was being developed, I received a call from someone on the staff asking if I (meaning AJN) would help promote the show. I told him I couldn’t do that; I said I could write a review about it, but only after seeing several segments to judge the content and I couldn’t guarantee it would be favorable. He kept trying to “sell me” on the show, how it was going to be different and couldn’t I write something before it aired so nurses would at least watch. I made him a deal: I said I would write something to urge nurses to watch if they had a nurse co-host, because THAT would be different to see. Stammer, silence, thank you for your thoughts, we’ll take that under consideration, yada yada.

What message would it send to viewers if Oz had a nurse co-host, as a colleague? I challenge TV health programmers to be different—nurses are (for the 9th consecutive year) the most trusted profession. When are you guys going to get it?

Bookmark and Share

Posted in media depictions of nursing, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 3 Comments »

h1

Today’s Notes from the Nursosphere

December 7, 2010
Image of Japanese Attack - Pearl Harbor, Hawai...

Image via Wikipedia

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011″ (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, ”reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

I’m not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people’s homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to handle scenarios encountered in Federally Qualified Health Centers (FQHCs). The residency lasts 1 year and appears to be a wonderfully structured program and setting.

Just a few items of interest. As always, we welcome your comments.—JM, senior editor/blog editor 

Bookmark and Share

Posted in combat nursing, electronic medical records, health information technology (HIT), nurse practitioners, nursing perspective | Tagged , , , , , , , | Leave a Comment »

Older Entries »
Follow

Get every new post delivered to your Inbox.

Join 291 other followers