This Memorial Day, we here at AJN would like to pay tribute to those nurses who gave their lives in defense of their country. And to all the nurses who care for the casualties of war with dedication, skill, and compassion, often at great risk to their own safety – we honor and thank them.
By Maureen ‘Shawn’ Kennedy, MA, RN, AJN editor-in-chief
“Hi, this is General Patty Horoho,” and so began a phone interview with army nurse Lieutenant General Patricia Horoho, who was sworn in as the 43rd Army Surgeon General in December.
Horoho made history, becoming the first woman and the first nonphysician to assume command of the U.S. Army Medical Command, a $13 billion global health system. She had also been the first nurse to command Walter Reed Army Medical Center, taking over after a report in the Washington Post revealed a host of deficiencies in care, housing, and processes at that facility, leading to the firing of the commanding officer, Maj. General George Weightman.
She was recommended for her new position by the prior Army Surgeon General, Eric Schoomaker, and it then went up the chain to the secretary of the army and the secretary of the defense, who then recommended her appointment to President Barack Obama.
We (there were representatives from four nursing publications on the call) spent over an hour peppering General Horoho with questions about her experience, objectives, strategic plans, and major challenges. Here’s a few of the highlights:
Horoho’s had a long journey to get to her current position. You can read her bio here.
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
By Gail Pfeifer, MA, RN, AJN news director
I’m not a history buff, but my husband is. So I nicely went along on a recent trip with him to Virginia, visiting historic sites like Montpelier, Jamestown, Yorktown, and Appomattox. It was more fun than I’d anticipated and it really did open a door for me, showing me how much, and how little, has changed, especially in political behavior: When Cornwallis had to surrender to Washington, for example, he feigned illness and sent his second in command, General O’Hara, to do so. Washington, in return, would not accept the sword from O’Hara, directing him to his own second in command. Tit for tat.
Interior doorways, Clover Hill Tavern, Appomattox Court House
One of the things I least expected from the National Park Service was a specific acknowledgment of nurses or nursing (except for maybe Clara Barton, who established the American branch of the International Red Cross). Yet there it was at one of our Civil War site stops: a note that Dorothea Dix had visited to review care of the Union soldiers.
Although she is best known for her work improving care for the mentally ill, Dix became Superintendent of Female Nurses for the Union during the Civil War, serving for the entire duration without pay. At that time, biographers say (variably) that she was 59 or 60 years old, a strong, unmarried woman of her times. Dix was a social reformer and far from politically correct for her day. They called her “Dragon Dix” because of her outspoken opinions and her “autocratic” approach to choosing nurses who could serve under her aegis—no hoop skirts, no jewelry, and preferably plain looking and over 30. Despite her nickname, and perhaps (depending on how you view appropriate behavior in women) her flaws, you can find her described online, along with Barton, as an “Angel of the Battlefield.”
These polar-opposite labels tweaked my interest in nursing history and made me wonder: How far have we come as nurses in the eyes of those we serve, and how do these labels end up persisting over decades? Are we either dragons or angels, or will we finally be acknowledged as professionals with individual, imperfect personalities who work to improve health care? When new nurses look at nursing history 150 years from now, what doors will they see opened, by us, in 2011?
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
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.
By Sue Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation Senior Adviser for Nursing (from an ongoing series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)
As I enter the city of Istanbul today, I am tired. Almost immediately I catch myself and remember that it took me just 3.5 hours to fly from London to Istanbul and it took Ms. Nightingale almost a month to sail here (Istanbul was called Constantinople at the time). She was sick most of the time, but resolute in her mission. I look around at the airport and see that all I come into contact with are standing upright, while those Nightingale came into contact with were mostly horizontal. Read the rest of this entry ?
Nightingale in Scutari ward/Library of Congress, via Wikimedia Commons
Representing mortality. Early in her life, Ms. Nightingale identified the need for hospitals and healthcare systems to collect and use data to improve care. She asked what use are statistics “if we don’t know what to make of them?” She is credited with developing the famous “coxcomb” illustration, which was a multidimensional way of depicting mortality rates. She used statistics at Scutari Hospital (also called Selimiye Barracks) in Turkey to guide her actions and used statistics and data in the London Times to convey the travesty of the Crimean War.
Institutional and cultural barriers. But Nightingale didn’t just rely on data for getting more of what she needed for the soldiers—she also used storytelling . . . a lesson that’s not lost on me in terms of affecting policy today. However, and this is a big however, just as they do today, politics, context, and culture reigned supreme. Read the rest of this entry ?
By Sue Hassmiller, PhD, RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing (this is the latest in a series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)
This post is dedicated to Bob Hassmiller.
It is hard to believe that Florence Nightingale is not buried at Westminster Abbey. The offer was made, but turned down by Florence herself. For all the treasures she bestowed upon this earth while here, she was not one for a lot of pomp and circumstance. She simply wanted to do her work nonstop—to ensure that her voice was heard, and her lessons followed—but she did not want much to do with heroes’ welcomes, medals, or an honorary this or that. So in her will, and in the name of furthering medical science, she asked that her body be donated for medical research. Read the rest of this entry ?
By Sue Hassmiller, PhD, RN, FAAN (this is the 4th in a series of posts by Hassmiller retracing Florence Nightingale’s influential and innovative career)
Seeing the famous St. Thomas’ Hospital today, I thought Florence Nightingale would roll over in her grave with disgust! What were they thinking, I asked the tour guide? Well, she said, it was the ‘60s. No excuse, I barked back! Prince Charles doesn’t like it either, if that makes you feel any better, she responded.
Applying best practices. The most visually prominent buildings in the hospital now consist of a couple of plain, brown, nondescript, blocklike structures—not anything like Nightingale, once the most famous hospital designer in the world, would have had it. Or, rather, did have it. Her friend, Queen Victoria, laid the first stone and Florence Nightingale contributed to the design and relocation of the St. Thomas’ Hospital of the mid-1800s, with the intention of applying best practices she had brought back from the Crimean War as well as her own research and statistics.
Nightingale was much sought after as a master designer of hospitals; architects, physicians, and royalty from around the world asked her advice. And here was supposed to be her masterpiece . . . but her version of St. Thomas’ is just about gone.
Physical, spiritual, mental health needs. Nightingale envisioned the relocated and rebuilt St. Thomas’ as a beautiful series of pavilions where different patients with different ailments lay. Read the rest of this entry ?
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