Year-End Take: A Hopeful Trend in U.S. Health Care?

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s […]

2016-11-21T13:11:06-05:00December 27th, 2011|health care policy, nursing perspective|3 Comments
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Top 10 (New) AJN Posts of 2011

Some of our posts, like this one from 2009 (“New Nurses Face Reality Shock in Hospitals–So What Else Is New?”) keep getting found and read. They remain as relevant today as they were when we posted them. Our top 20 posts for the year (according to reader hits, that is) include several others like this: “What Is Meaningful Use? One Savvy Nurse’s Take”; “Is the Florence Nightingale Pledge in Need of a Makeover?”; “Do Male Nurses Face Reverse Sexism?”; “Are Nursing Strikes Ethical? New Research Raises the Stakes”; and “Workplace Violence Against Nurses: Neither Inevitable or Acceptable.”

But putting aside these contenders (why do so many of them have questions in their titles?), here are the top 10 (again, according to our readers) new posts of 2011, in case you missed them along the way. Which doesn’t mean that these are (necessarily) our best posts, or a representative sample, or that many others didn’t hit home for various subgroups of readers.

While we all get a little tired of lists by this time in the year, we don’t really use them an awful lot here at Off the Charts. So please indulge us this once, and thanks to everyone who wrote, read, and commented on this blog in 2011.—Jacob Molyneux, AJN senior editor/blog editor

1. “Notes of a Student Nurse: A Dose of Reality,” by Jennifer-Clare Williams

2. “Placenta Facebook Photos: Nurse and […]

2016-11-21T13:11:07-05:00December 20th, 2011|healthcare social media|2 Comments
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Those Who Wait: Recent Work in ‘Art of Nursing’

By Sylvia Foley, AJN senior editor

“I held that stone / in my hand for hours while they split your bones,” says the narrator of Janet Parkinson’s poem “Talisman,” which appears this month in Art of Nursing. The poem speaks to the tremendous strain of waiting for the outcome of a loved one’s emergency surgery. It’s about the  need for connection over great distances, for a “stone constant” in the face of grave uncertainty. The poet’s voice is unsentimental and steady, and the poem, just seven lines, itself feels almost talismanic. (Art of Nursing is always free online—just click through to the PDF file.)

In Roger Davies’s poem “Preparing to Pretend to Knit at the Chemotherapy Clinic,” featured in October’s Art of Nursing, a husband also waits, feeling helpless. “I’ll choose the long, elegant needles,” he says, imagining homespun wools dyed in autumn colors. Recalling his mother’s “nonchalant / competence” at the craft, he longs for the solace found in knowing what to do—even if it’s only how to hold the needles. In the poem’s last lines, the narrator says, “I could look out the window / to this fading autumn day.” But it’s clear that he’s not quite ready to see that view yet.

Rebecca Thomas’s painting “The Waiting Room: Norma,” featured in November, depicts the artist’s grandmother, who […]

2016-11-21T13:11:08-05:00December 19th, 2011|Nursing, patient engagement|1 Comment
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Reading Between the Whiteboard Lines in the ICU

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.

My hospital uses dry-erase whiteboards as a tool to communicate with patients and family members. Mounted to the walls in the patients’ rooms, the boards are prominent and concise.  Aside from a lot of basic information, notes get added to the board when diagnostic tests are completed, when complementary therapies have been implemented, and when housekeeping staff visit. The “meat” of the board, however, is the section that addresses plans and goals for the day. The plans and goals are updated and modified continuously by nursing staff. They’re specific to each patient, yet, despite their personalization, the goals for ICU patients tend to fall into distinct categories.

The first category includes goals which are often set by the patients themselves. They tend to require a certain amount of collaboration and active participation. These types of goals, which include things like “maximize incentive spirometer use,” “ambulate,” and “advance diet,” imply a relatively healthy state and tend to predict transfer orders.

The next type of goal is aimed at restoring health and stability. These goals don’t necessarily require patient participation and often focus on pathophysiologic processes. On the whiteboards of these rooms, the listed goals are likely to include things like “wean ventilator,” “control agitation,” “control fever,” or “increase level […]

2016-11-21T13:11:09-05:00December 15th, 2011|nursing perspective, Patients|3 Comments
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Health Care Work and Hypochondria: When Knowledge Equals Fear

By Amy M. Collins, associate editor

This Thursday I will graduate. Not from college—sadly, that was many years ago. Rather, I will finish a health anxiety class, taken in desperation when untimely hypochondria struck. I admit it. I’ve always been a bit of a worrier when it comes to health and illness. Working as a health care writer/editor doesn’t always help. I just have too much information at my fingertips, and a brain that jumps to the extreme (a pain in the side can mean cancer, and so on).

Before getting a degree in writing and journalism, I studied human biology with the intention of going into some type of health care work. But reading about diseases made me start to self-diagnose with fervor, so I decided to switch majors. And this was before the advent of the Internet, where one can constantly consult “Dr. Google.”

Years ago, while working at a medical publishing company in Spain, things got worse. I was put on the cardiovascular beat, which only increased my health fears. Diagnosed with mitral valve prolapse as a child, and on medication for arrhythmia at the time, reading about this particular disease made my heart literally flutter. My boss, recognizing my discomfort, took me off the topic and asked me to instead write […]

2016-11-21T13:11:10-05:00December 14th, 2011|Nursing|4 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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