Archive for July, 2011

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Caught in the Crossfire: The Debt Crisis and a Child’s Shooting in the Bronx

July 29, 2011

By Shawn Kennedy, AJN editor-in-chief—The one good thing about commuting into Manhattan is that I have plenty of time to listen to the news on the radio. This morning, there were two stories that topped local news and gave me food for thought while I negotiated traffic.

One, of course, is the current debacle in Congress over passing a bill to raise the debt ceiling, a necessary move to prevent the country from defaulting on payments. It was expected that a bill put forth by Republicans would have been passed in the House of Representatives on Thursday evening, but Speaker John Boehner did not put the bill forward because he couldn’t garner enough votes from a handful of conservative Republican colleagues who feel the bill doesn’t go far enough in limiting spending and are therefore unwilling to compromise.

What’s ridiculous about all the posturing around this bill is that if it passes in the House, the Democrats in the Senate have already said they will vote it down. So the Republican holdouts aren’t about outcomes, but about appearances. And it’s wasting time we don’t have. As everyone knows by now, a solution needs to happen by August 2. The financial markets have been showing the stress for the last five days (and if you think it doesn’t pertain to you, think retirement accounts, college funds, etc).

And it’s not just the U.S. financial markets—markets around the world are down. Some say that even if Congress does come to its collective sense and pass a bill that will prevent default, the loss of confidence in the stability of our economy has already damaged us in the world market.

The second story reported on the shooting of a five-year-old boy in Bronxdale, which is considered to be one of the safer areas of the Bronx. Apparently the boy was walking with his mother when the firing started, and he was shot in the leg. The news report on the radio said police suspected he was caught in gang crossfire.

I couldn’t help comparing the similarity in the two stories—rival gangs inflicting needless injury while they fight over turf, seeking power, and control. The five-year-old boy and the American people—just collateral damage. The boy, the news said, is expected to fully recover. I wonder if the same can be said for the rest of us.

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Posted in children's health, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 2 Comments »

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Getting Osteoarthritis on Nurses’ Radar

July 27, 2011
Osteoarthritis of the left knee. Note the oste...

Osteoarthritis of the left knee. Image via Wikipedia

By Shawn Kennedy, AJN editor-in-chief—Louise Murphy, an epidemiologist at the Centers for Disease Control and Prevention (CDC) gave these stunning statistics to an audience gathered in the conference center at the Hospital for Special Surgery in New York City last week:

  • Twenty-seven million U.S. adults (pdf) suffer from osteoarthritis (OA), mostly in the hands, hips, and knees.
  • Data from the National Ambulatory Medical Care Survey 2006–2007 showed that OA was the reason for 12.3 million visits to primary care providers, 85 thousand ED visits, and 921 thousand hospitalizations in 2009.
  • In 1997, there were 400,000 total knee or total hip replacements; that number had increased to 900,000 by 2009.
  • One study put lifetime risk by age 85 at one in two for knee arthritis (two in three for obese individuals), and one in four for arthritis of the hip.

The audience included over 45 nurses, physicians, physical therapists, and other health professionals. We met July 14 and 15 to identify what keeps patients from accessing health services and from getting evidence-based care for OA. This ‘state of the science” project is a collaboration among AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses.

The missing nursing perspective. In 2010, the CDC and the Arthritis Foundation published “A National Public Health Agenda for Osteoarthritis,” which details a three-year plan to reduce the disease burden of OA by promoting evidence-based treatment to delay onset or reduce progression of the disease. What became apparent was the absence of nursing participation in this effort. While there are many nurses who do provide care for patients with arthritis, that care is usually at the point where patients are having joint replacement surgery, or it’s incidental to other care patients are seeking. Read the rest of this entry ?

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Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect

July 26, 2011

By Medora McGinnis. Medora is a student at Bon Secours Memorial College of Nursing in Richmond, Virginia, and the 2011-2012 Imprint Editor of the National Student Nurses’ Association (NSNA). This is her first post for this blog. 

There was a time when the majority of all nursing programs were diploma programs, emphasizing practice over theory. They were largely based out of hospitals and proved very well suited for this training. Popular among students, they provided the majority of the nursing workforce well into the 1950s. But these programs began to lose popularity as they were supplanted by other forms of training. At the same time, patient care was shifting and hospital care costs were exploding. By the late 1970s, 40 diploma programs were closing their doors every year.

The year is now 2011, and there are less than 40 diploma programs nationwide. I am a senior nursing student in one of these programs, and have been a part of their transition from the diploma to the four-year BSN. My graduating class will be the last of the diploma graduates, and many of us plan to continue our education and quickly complete an RN-to-BSN program. Why? Certainly to maintain our momentum, and to be competitive in today’s workforce. But the undertone in the nursing community, especially among young and new nurses, is that the BSN is required in order to earn respect. Read the rest of this entry ?

Posted in continuing education, nursing students, professional identity | Tagged , , , | 19 Comments »

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Children, Swimming Pools, and Preventing Death by Drowning

July 20, 2011
A boy in a children's swimming pool.

Boy in children's swimming pool/image via Wikipedia

By Shawn Kennedy, AJN editor-in-chief—Most children love water, from splashing in puddles to throwing rocks into streams to just playing in the bathtub (a favorite activity of one of my boys was to stand on a chair at the kitchen sink and “wash dishes” with mounds of bubbles). Keeping them away from potentially dangerous situations around water requires constant vigilance when they’re young and repeated warnings as they get older. But often that’s not enough. Too many children drown or nearly drown each year in backyard swimming pools. U. S. Centers for Disease Control and Prevention data shows drowning as the second leading cause of death from unintentional injuries among children ages one to 14.

Last Friday, there was an especially heart-wrenching story: one-year-old twin boys both drowned in a backyard pool in Northern California. Their mother found them, pulled them out of the pool, and tried to revive them but was unsuccessful. I can’t imagine the depths of her grief.

We tend to think that it’s only the large, in-ground swimming pools that pose a hazard. But a recent study in Pediatrics documents that danger persists for all pools, including small backyard portable pools (wading pools, inflatable pools, soft-sided pop-up pools, etc). It looked at drowning and near-drowning (“submersion events”) in these types of pools from 2001 to 2009 and tallied 209 drownings and 35 near-drownings among children under 12.

Not surprisingly, the majority occurred in younger children: 94% were children under five; more than half were boys. And 73% happened in the child’s own backyard. While the description of the type of pool was only reported in about a third of the cases, 41% of the described pools were described as “wading pools.” The authors call for a consumer-education campaign “to make consumers aware of the dangers of portable pools because these small, inexpensive, consumer-installed pools may not generate the same sense of risk as an in-ground pool. “

This study serves as a reminder to parents and grandparents and anyone who cares for children that any body of water—including two inches in a bathtub, a low toilet, or the ankle-deep water at the ocean’s edge—can be dangerous, depending on the age of the child.

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Posted in children's health, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 1 Comment »

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The Five Most Popular Articles at AJN

July 18, 2011

Amanda Geer, AJN administrative coordinator—We look at the statistical views and visits of users at AJN‘s home page to determine our most viewed articles, how many visitors listen to our podcasts, what day of the week we get the most traffic, and a number of other categories to make sure we keep up to date on what matters to our readers. We also look at what our users search for. Some of the most common keyword(s)/phrases are evidence-based practice, research, diabetes, cancer, and stroke. We also look at our most popular articles. For the last few months, the following five articles have dominated our top 10 chart (in an upcoming post, we’ll look at the most popular articles on this blog):

Posted in nursing perspective, pain control | Tagged , , | Leave a Comment »

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Drunk on Water, Drug Shortages, Understanding Health Care News, Plus Nursing Blog Posts of Note

July 15, 2011

by LeeBrimelow/via Flickr

The water myth: A physician, writing in the British Medical Journal (abstract only), has looked at the evidence for drinking eight glasses of water a day and says the oft-recommended practice is “debunked nonsense,” a myth the bottled water companies have been only too happy to exploit and that many respected health care organizations and experts continue to support. Maybe common sense reasoning is also partly to blame—after all, the idea seems to make sense. And all that water certainly conjures images of purification, which is inevitably appealing in a world of pervasive toxins, chemicals, food additives, and the like, and in a time when fewer people in any given Western country practice the same or similar religious sacraments or rituals, practices that may—among other functions—have once served a similar “purifying” psychologic purpose.

Drug shortages: The Wall Street Journal Health Blog has reported on two surveys that suggest that “unprecedented” drug shortages are being experienced by most hospitals. The reasons are multiple: shortage rumors that prompt hoarding, FDA actions that halt production, lack of a crucial ingredient, poor inventory management, and others:

All treatment categories were affected, hospitals said, with 80% or more respondents experiencing shortages of surgery/anesthesia, emergency care, cardiovascular, gastrointestinal/nutrition, pain or infectious disease drugs. And 66% of hospitals reported shortages of cancer drugs. Some 47% of hospitals reported experiencing a shortage of at least one drug on a daily basis.

What the study really said: The following resource isn’t new, but with more and more people getting health care news from the Internet, network television, newspapers, or from TV personalities like Oprah and Dr. Oz, it’s more important than ever for us all, whether health care journalists or nurses, to know a bit more about judging the quality of the evidence out there for certain treatments, tests, and drugs. HealthNewsReview.org offers some excellent tools for understanding what’s true, possibly true, and a complete distortion of the facts, with short primers on everything from causation vs. association, absolute vs. relative risk, and phases of drug studies to commercialism and much more.

Nursing blog sampler: Emergiblog had a nice post about a week ago about the practical challenges involved in treating the increasing numbers of children whose parents are unable to control them (or, as she puts it, “kids seem to be the adults in some families”). For something on the light side, Nurse Ratched’s Place has a post called “Treadmills, Hot Guys, and Nurses.” The gist is that everyone needs a little motivation, whether in the gym or while working a long nursing shift, and maybe a little old-fashioned objectification is just the thing (but not, of course, underwritten or endorsed by AJN!). Notes of a Nurse-To-Be has a post (ok, a couple weeks old now) on the particular kind of mental fatigue she experienced during her first mental health rotation. Read the rest of this entry ?

Posted in children's health, nursing students, writing and nursing | Tagged , , , , , | 5 Comments »

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Patient and Family Cell Phone Use Can Seem Intrusive, Until It’s Not

July 13, 2011

Oh no, here comes another Dad with a Bluetooth.

My colleague and I roll our eyes at each other in frustration. Another self-important junior executive who must be in touch with everyone in the world while his wife labors unsupported, I mutter with dismay as I rise from my chair to greet our newest birthing couple.

I have to coach myself: Change your attitude. Change your attitude, as I weigh the mom and escort the couple to the birthing room. Dad-to-Be proceeds to spread out his equipment on the dresser in front of the window while Mom-to-Be, in obvious distress, changes into a gown in the bathroom.

That’s the engaging beginning of “Before the Signal Fades,” this month’s Reflections essay in AJN. The essay traces an unexpected path from complaint to something much deeper. Click the link to read the entire essay (and click through to the PDF version for a nicer reading experience). What’s your take on patient use of cell phones, cameras, smartphones, and the like?—JM, senior editor

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Posted in nursing perspective, patient perspective | Tagged , , , , , , , | 4 Comments »

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New Medical Residents and Patient Mortality – Does the ‘Nurse Effect’ Lessen the ‘July Effect’?

July 12, 2011

By Shawn Kennedy, AJN editor-in-chief—Last week, a post on the New York Times Well blog discussed whether mortality rates in hospitals are worse during July when new interns and residents begin their clinical training. It described findings from three studies, with the final conclusion, “Though the debate continues, most studies have not found a spike in hospital mortality rates in July.”

It was common thinking in hospitals when I worked clinically—“Never be sick enough to have to go to a hospital the first two weeks of July, and NEVER, EVER need surgery during that time”—and I’d venture that many people still believe it, despite what studies may report. (And, as I write, I see that ABC News is reporting on a new review of 39 studies, published in the Annals of Internal Medicine, that does support the existence of the July Effect. Click the image below for the ABC article and videos.)

I remember working in the ED when the new residents on call would come to see patients, their “whites” impeccably spotless and starched, with new blank index cards in their pockets, looking eager and anxious to finally be getting to the real work of their profession. By mid-August, they all seemed a bit haggard, the whites rumpled and the pockets torn a bit, bulging with notes-filled index cards clipped together, tourniquets and empty blood tubes, the Merck Manual and usually a big stain from a leaky Bic pen.

There seemed to be two kinds of new residents: first, there were those who recognized that they were new to this world and that experienced nurses had a lot of knowledge about hands-on care, clinical technology, and how to get things done in a hospital bureaucracy—these were the men and women who truly wanted to learn and do right by their patients. Read the rest of this entry ?

Posted in nursing perspective, patient perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 3 Comments »

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Giving Noise a Red Light

July 8, 2011

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

This stoplight noise meter showed up at the nurse’s station last week.

I have to admit—we didn’t take it too seriously, at first.

It looks like something you could buy in a novelty shop, shelved next to lava lamps and strobe lights. And it’s modifiable; buttons and dials on the back of the gadget allow not only for sensitivity adjustments, but also give the option of changing the type of alarm that sounds when a noise infraction is detected. The default alarm warning is a soft-spoken, female “quiet, please!” that can be translated into Spanish, French, or German—but there’s also an option for a shrill siren, which seems ridiculous, considering that much of the cacophony of critical care is owed to noisy alarms and ringing phones.

We even discovered how to record our own admonishments (which opened the door to countless mischievous possibilities . . . not that we’d indulge in that sort of thing, of course).

In seriousness, noise reduction is vital to promoting a healing environment. In a recent article in Critical Care Nurse, the links between sleep deprivation and altered physiologic processes specific to the critical care population are reviewed. Noise reduction guidelines and recommendations from both the World Health Organization and Joint Commission are also discussed.

Our unit already implements scheduled “quiet time”—blocks of time several hours long during which we dim the lights and try to minimize noise, activity, and procedures. We do our best to promote uninterrupted rest periods, but in a busy nursing unit with an open floor plan, it’s rarely really quiet. I’m pretty sure I wouldn’t be able to sleep there.

In the midst of the pace and stressors of a typical day in critical care, we’re often preoccupied with issues that weigh more heavily on our minds than peace and quiet. On that note, and with service excellence and patient outcomes at the forefront of everything we do, a stoplight noise meter (although laughable, at first) serves its purpose well. It’s a good reminder of a high priority, even if it does look like a toy.

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

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Feel the Power (What Nursing Can Learn from the Dancing Man)

July 5, 2011

By Shawn Kennedy, AJN editor-in-chief—Writing in a recent blog post on NursingTimes.net (a UK-based site), Mark Radcliffe poses this question:

“Do you, as a nurse, feel you have any collective power to influence policy? Are we as well versed as other professional groups in articulating loudly and clearly why nursing needs to be the foundation stone of any health service?”

I thought it was a good question for us here in the United States. Most U.S. nursing associations, nurse executives, and deans are invested in politics. The recent Institute of Medicine Report on the Future of Nursing is the most recent example of how nursing is collectively trying to influence health policy.

But I still wonder how many nurses involved in direct care feel that the politics of health is something they need to pay attention to. It seems that it’s only when it becomes part of the job, directly affects one’s ability to perform a job, or has an impact on one’s financial well-being that many people get involved.

When I was a young nurse, I and many in my cohort didn’t pay attention to things like politics or getting involved in associations. We were new and intent on acquiring skills and becoming competent in our jobs, and politics seemed esoteric and something we needn’t be concerned about.

But within two years, I found myself in court on a workmen’s compensation claim for an illness I’d contracted from a patient. I was going to be out of work for four to six weeks and was concerned how I was going to manage rent and other bills. However, because my professional association had fought for and won compensation for job-related illnesses, I received full pay while I was on medical leave. It opened my eyes to what collective action could do.

Nurses, especially those at the point of care, seem to come together readily enough to protect our rights as workers. But it doesn’t seem to go much further than that. Direct care nurses need to add their voices, support (and that includes financial support), and energy to the organizations  and initiatives that are campaigning for our collective rights to practice as professionals, unencumbered by policies and  laws that ignore the evidence of our value.

All nurses play a part in the politics of health—the question is, do we prefer to be mute bystanders and recipients of others’ rules and policies, or become the drivers and shapers of a new movement? (Since it’s July, see the video below for a somewhat frivolous take on becoming part of a movement.)

You can get involved: go to thefutureofnursing.org for ways to play a part.

Posted in advocacy/political action, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 1 Comment »

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