Archive for October, 2011

Older Entries »
h1

One Take on the Top 10 Issues Facing Nursing

October 31, 2011

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

So I’ve been in Dallas at the Sigma Theta Tau International (STTI) biennial meeting. The venue is the Gaylord Texan, a large, climate-controlled resort under a glass dome—as you leave your building and walk “outside,” you’re really not. Don’t believe the flowing stream or flowers or gardens (all real) along the walkways, or the Longhorn steer (fake) behind a fence that stands outside my building—you’re still inside. And to make it even more surreal, there are Christmas holiday decorations everywhere, including a gingerbread house the size of a small hotel room. It will be strange to step back in time to Halloween when I get back home.

A daunting list. There are a few thousand people here for the meeting, way too many sessions to choose from (20 different topics for each concurrent session period), plus rows of posters and exhibit booths. And of course, great networking. One lively session I attended was standing room only—and that’s after any floor space had been occupied by people sitting cross-legged. It was a discussion of the top 10 issues facing nursing, led by STTI’s publications director Renee Wilmeth (she’s not a nurse, which probably makes her less biased). The issues were compiled from responses provided by 30 nursing leaders, and were presented in question form:

  1. Is evidence-based practice (EBP) helpful or harmful? (Amazing how many interpretations there were of EBP, some of them—as I know from our EBP series—quite incorrect.)
  2. What is the long-term impact of technology on nursing?
  3. Can we all agree that a bachelor’s degree should be the minimum level for entry into practice? (General agreement here, despite concerns regarding the adequacy of financial support for achieving this goal.)
  4. DNP vs PhD: separate but equal? (Not much discussion—I think no one wanted to really get into this.)
  5. How do nurses get a seat at the policy table?
  6. How do nurses cope with the growing ethical demands of practice? (This generated the most discussion, especially around whether society should provide unlimited costly care to those whose personal choices contribute to their health problems.)
  7. How do we fix the workplace culture of nursing?
  8. What role do nurse leaders play in the profession?
  9. What are we doing about the widening workforce age gap?
  10. How do we make the profession as diverse as the population for whom it cares?

Your turn: would you agree that these are the ‘top 10’ issues? What’s missing? What’s here that shouldn’t be?

Bookmark and Share

Posted in ethical issues, nursing students, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 11 Comments »

h1

Legacy of the Living Legends: Slackers Need Not Apply

October 27, 2011

By Shawn Kennedy, editor-in-chief

Earlier this month, I attended the American Academy of Nursing 38th Annual Meeting and Conference. With e-mails flooding my inbox and a full meeting agenda over the next few days, I was thinking of skipping the 2011 Living Legends event that took place on the first evening. Thankfully, an old friend, nurse historian Sandy Lewinson, talked me into going—it was one of the more memorable nursing events I’ve attended.

The academy honors “Living Legends” in recognition of the multiple contributions these nurses have made to the profession and the impact these contributions have made on health care in the United States and abroad. This year’s honorees are shown in the photo, from left: May L. Wykle, Meridean L. Maas, Ada Sue Hinshaw, Suzanne Lee Feetham, and Patricia E. Benner.

Credited with such achievements as creating a nursing taxonomy on nursing error, building the science of pediatric nursing in the context of the family, conducting ground-breaking nursing research, developing and implementing professional nurse governance in employing organizations, promoting policy change, and addressing the nursing shortage, these nurses join 77 other nursing notables who’ve been so honored since the first class was named in 1994. Read the rest of this entry ?

Posted in nurses, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 2 Comments »

h1

Changes in Latitude: Comparing Health Care Systems with Nurses Down Under

October 26, 2011

By Peggy McDaniel, BSN, RN, who writes the occasional post for this blog and currently works as a clinical liaison support manager of infusion in Australia, New Zealand, and Asia Pacific.

latitude lines/ wikimedia commons

I recently found myself sitting on a boat, enjoying a “sausage sizzle,” dressed as a pirate no less. In Australia, a party that includes barbecued meat usually includes sausage; thus the name. The pirate theme was an added bonus. As an American and a nurse, I was pleasantly surprised to find myself seated at the same table as two Australian nurses. What were the chances of that? The conversation that evening gave me some insight into the Australian health care system, which I am just getting familiar with.

Comparing health care systems. Once we all realized we were experienced nurses and shared the belief that quality patient care should always be the primary focus of health care, the conversation turned to cost. In Australia, there is a public health option that all Australians can access. It is paid for by taxes. If you choose to do so, you can also purchase a private plan to supplement this public option. I have yet to determine what part, if any, employers play in paying for health care or private insurance. However, a sick Australian will always get care and not incur a lifetime of debt for that care within their public health care system.

My fellow nurses were amazed to hear that in the U.S., you may not have health insurance for a variety of reasons. One of the nurses purchases private insurance as a “backup” to public care. She used this coverage for an elective procedure, chose her own surgeon and private hospital, and was able to schedule the procedure in a timely manner. This same nurse admitted that if you need a new hip or knee and you only have public coverage, you may have to wait for up to a year. However, if you have cancer and need treatment, it will start promptly after diagnosis, whether or not you have private insurance or not.

Both nurses asserted that the care for acute and emergent issues is of high quality in the public hospitals. They were able to give me examples of how the system works, from a personal and work perspective.

As in the U.S., hospitals here in Australia are struggling with the rising costs of health care. The public hospitals in each state utilize their group buying power to purchase supplies and equipment, which helps keep costs down. The private hospitals often have a bit more polish and shine, but all the hospitals strive to give Australians high quality care and the nurses I’ve met are passionate about that goal.

Imitate the American system? One of the nurses I chatted with exclaimed, “Our politicians keep telling us that we should be more like the American system, but I think that’s a mistake. What do you think?” Admittedly, I have much to learn about Australian health care, but so far I have to agree with her. As an American who has gone without health insurance because I was rejected due to preexisting conditions and was not employed full-time, I thought this system sounded pretty reasonable. The Australian nurses certainly felt that anything less would be unacceptable. Read the rest of this entry ?

Posted in health care reform, international nursing, nursing perspective | Tagged , , , , , | 36 Comments »

h1

The Dance of Empathy

October 25, 2011

By Peggy McDaniel, BSN, RN. An infusion practice manager currently based overseas, Peggy has written for this blog a number of times in the past.

by Augustin Ruiz, via Flickr

Although it’s only late October, this time of year finds me pondering holidays past, which were often spent working at a hospital. As a younger nurse, I worked in a neuro-trauma-rehab unit at a large children’s hospital. We had a strong primary nursing model and often cared for the same patients throughout their stay, which could last days, weeks, or months. Memories of patients from that unit and others occasionally come back to mind at this time of year, often spurred by holidays.

One of my first assignments was a beautiful youngster who had suffered a brain injury. It was a difficult case and the family spent many hours on our unit, helping me provide basic care and praying for a recovery. But after more than three months, the child’s strong and previously healthy body stopped fighting and the child passed away, with family at the bedside.

Years later, after being away from this facility, I returned for a short stint as a per diem on the float team. I dropped in to work when and where needed, days or nights. Many of the same people I’d loved working with were still there, and I often floated up to my comfortable “home base.”

One evening, after a long 12-hour day, as I was getting ready to tape report in the lounge behind the nurse’s station, I realized that voices out at the desk sounded familiar. I heard a voice ask, “Does anyone remember my child?” This voice, uttering a child’s name that I couldn’t forget, drew me from the lounge and around to the other side of the desk. The mother and two siblings were there, with a big fruit basket and flowers to leave for the nurses. We hugged and chatted. They couldn’t believe I was there—they had come every year for this anniversary and found fewer and fewer nurses who remembered the person they would never forget. I told them it was a sick call that had brought me in to that unit, and said that for some reason I had been thinking about their family that evening. Though it had been more than 12 years, they weren’t surprised, and I supposed I wasn’t really either.

We touch people as nurses. We provide intimate care such as bathing, dressing, and feeding. We also inflict pain with our touch, although it is done for a reason, with care and concern. How do our patients touch us? Do we let them in just enough so that we can provide emotional support along with the required physical care, somehow without losing our focus and ourselves? Read the rest of this entry ?

Posted in children's health, nursing perspective | Tagged , , , | 4 Comments »

h1

Air Force Trauma Nurse: Teacher, Winner of Bronze Star

October 20, 2011

Team treating casualties in Ghazni, Afghanistan

Air Force nurse Major Kari A. Miller is currently the director of the nurse trauma program and the chief of the critical care nurse program for the U.S. Air Force Center for Sustainment of Trauma and Readiness Skills (C-STARS) in Baltimore, where she helps train military medical personnel who are preparing to deploy, with a focus on teaching trauma assessment, treatment, and skills.

Maj. Miller removing patient's boots

Says Miller: “My C-STARS colleagues and I work directly with the staff of R Adams Cowley Shock Trauma Center [at the University of Maryland], where we see over 8,000 patients per year. The center has an excellent survival rate of 97% and our nurses and physicians are fully integrated with the civilian staff here.”

Capt. Staley (front right), Maj. Miller (center), Capt. Hernando (rear)

The photos here show Major Miller and her team during deployment in Ghazni, Afghanistan, in September 2010, when she earned a bronze star for leadership and performance and courage under fire. The team members earned an Army Combat Action Badge for care under fire. The photos on this page show the team treating American casualties received after an improvised explosive device detonated and the vehicle rolled over. Says Miller: “I believe we had three or four casualties with that incident and all had minor injuries. We did fly a couple of them to Bagram for further evaluation and treatment but no fatalities.”—Jacob Molyneux, senior editor

Posted in combat nursing | Tagged , , , , | 1 Comment »

h1

CMS Proposing New Hospital Regulations—How Will the Changes Affect Your Delivery of Care?

October 18, 2011

The below information on proposed changes has been shared with AJN by Jeannie Miller, MPH, RN, Deputy Director, Clinical Standards Group, Office of Clinical Standards and Quality (CSG/OCSQ) of the Centers for Medicare and Medicaid Services (CMS).

The Centers for Medicare and Medicaid Services (CMS) has proposed revisions to the hospital Conditions of Participation, the criteria hospitals must meet to be reimbursed for services by Medicare/Medicaid. The changes are needed to remove unnecessary and burdensome regulations that create barriers in care delivery. The changes, if adopted, include:

  • Broadening the concept of “medical staff” to include other practitioners, including APRNs, PAs, and pharmacists, practicing within their scope of practice and in accordance with state law.
  • Changes in nursing care planning to allow for a stand-alone plan or an integrated plan with other disciplines.
  • Allowing medication orders by practitioners other than physicians where the law and hospital policy allows.
  • Allowing a program for patient or “support person” to administer some medications.
  • Calling for standing orders and protocols to be based on nationally recognized and evidence-based guidelines.

There is a 60-day comment period. The CMS would like your comments. The proposed regulation can be found in full via a link on this page near the bottom: http://www.cms.gov/CFCsAndCoPs/06_Hospitals. Or go directly to the PDF here.

To submit a comment, visit www.regulations.gov, enter the ID number CMS-3244-P, and click on “Submit a Comment.” 

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

h1

Nursus Paradoxus

October 17, 2011

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Black Hole Paradox/ Angel's Gate, via Flickr

We’ve been using a new piece of hemodynamic monitoring equipment in our ICU. Considered minimally invasive, it uses an arterial line to measure fluid balance status by measuring stroke volume variation (SVV). The derived values are useful in guiding fluid resuscitation, and are based on a principle with an interesting and contradictory name. Instead of pulsus paradoxus (variations in arterial pressure during spontaneous breaths), the SVV is calculated based on reverse pulsus paradoxus (variations in arterial pressure during mechanical, positive pressure ventilation).

I’m a “numbers” person. From a scientific perspective, I totally get this. But the concept of monitoring hemodynamics using a principle described as a reverse paradox is unsettling. I don’t want paradoxes, especially reverse paradoxes, to exist in nursing; I don’t need or want circular logic to confound and muddle my days. And yet, as I’ve considered paradoxes in general, I’ve found nursing-related situations that seem to fit the definition:

  • Administration of a benzodiazepine, intended to relieve agitation, which instead results in increased agitation.
  • Titration of an inotrope, with the goal of increasing cardiac output, with the unexpected outcome of decreased blood pressure.
  • The impression that a vented patient is relatively oriented, only to find out after they’re extubated that they’re actually completely disoriented.

Reverse paradoxes are harder to find, and I could only find one:

  • A patient is pronounced brain dead, so there’s death, and the family opts for organ donation, so there’s life, and then the organs are rejected prior to procurement . . . so there’s death.

It could be argued that none of my examples are really paradoxes. They’re adverse reactions, misinterpretations, or unfortunate events. Perhaps the only real paradox here is this: When Kussmaul suggested the name “pulsus paradoxus” in 1863, he was describing findings that are physiologically explainable today, and not considered paradoxical. I’ve been preoccupied with the reverse of a paradox that’s not really a paradox, and questioning logic in science, to no avail.

Science remains scientific, regardless of how much I overthink it.

 Bookmark and Share

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

h1

Toward a Less Painful Death: ICD Deactivation at End of Life

October 14, 2011

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

Lightning by snowpeak, via Flickr

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So it’s essential for providers and patients to talk about the possibility of deactivation, well in advance of such crises.

Russo, the coordinator of the pacemaker clinic at the Department of Veterans Affairs Medical Center in New York City, wanted to better understand why providers and patients weren’t discussing this possibility and to find ways to promote more timely discussions. Read the rest of this entry ?

Posted in audio interviews, continuing education, ethical issues, nurses, nursing research, pain control, palliative care, patient perspective | Tagged , , , , , | Leave a Comment »

h1

Nurses and Patient-Centered Research

October 13, 2011

By Shawn Kennedy, editor-in-chief

I’m immersed in nursing research and nursing leaders this week, attending (in order and immediately following one another) meetings of the Council for the Advancement of Nursing Science (CANS), the 25th anniversary concluding scientific symposium of the National Institute of Nursing Research (NINR), and finally, the American Academy of Nursing.

Wednesday was CANS and its focus on comparative effectiveness research. After an opening keynote by Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), who discussed the need to accelerate progress in improving U.S. health outcomes, a panel of nurses discussed different methodological considerations, from databases to competencies.

Research to help people make informed decisions. Especially interesting was a discussion of the Patient-Centered Outcomes Research Institute (PCORI), the research entity which was mandated by the 2010 Patient Protection and Affordable Care Act. Read the rest of this entry ?

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

h1

Domestic Violence Screening Matters

October 12, 2011

By Karen Roush, MS, RN, FNP-C, clinical managing editor

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. Read the rest of this entry ?

Posted in advocacy/political action, human rights, patient perspective | Tagged , , , , | 5 Comments »

Older Entries »
Follow

Get every new post delivered to your Inbox.

Join 291 other followers