Archive for the ‘continuing education’ Category

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A QI Project to Increase Nurses’ Use of ‘Smart’ Pump Libraries

February 1, 2012

By Sylvia Foley, AJN senior editor

In January 2009 an independent community hospital in Massachusetts switched from using older, outmoded IV pumps to using “smart” pumps—pumps that have built-in computers with libraries of information on selected drugs and fluids, including predetermined concentrations and volumes with relevant administration limits. Library subsets (called profiles) contain information specific to certain patient populations or care areas. When properly implemented, these devices can be invaluable tools in reducing the risk of medication errors and improving patient safety.

Photo courtesy of Alaris

But when the hospital conducted a review, it found that smart pump libraries had been used in only 37% of all smart pump infusions done between January and June. One reason was that no “owner” had been assigned to oversee the implementation process. So the hospital’s nursing quality team (NQT) and pharmacy quality team began collaborating to find ways to increase nurses’ use of the pump libraries.

From July through October 2009 the NQT implemented several interventions. Author Andrew D. Harding describes the project as it evolved and reports on the results in this January CE feature, “Increasing the Use of ‘Smart’ Pump Libraries by Nurses: A Continuous Quality Improvement Project.” Read the rest of this entry ?

Posted in continuing education, nurses, nursing perspective, patient safety | Tagged , | 1 Comment »

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From the Blogs: Negotiating Medicare, Nurses Doing Research, Reader Comments

November 29, 2011


Medicare is confusing for providers who aren’t yet familiar with it. Here’s a Nursetopia post that draws attention to its complexity and notes the useful video above (it’s one of a series of videos on different aspects of Medicare). Those of you who know all about it already: Drop by her thoughtful (and consistently updated!) blog and let her know your own tips on handling the ins and outs of Medicare and Medicaid.

EBP matters. Terri Schmitt at Nurse Story has a frank and engaging post on evidence-based practice (EBP): “Translation of EBP: Why Creating Nurse Scientists is the Way to Improve Patient Outcomes.” Here’s what she promises to cover in it:

  • Research is sometimes far removed from bedside nurses
  • Research is COOL!
  • Research is about PATIENTS and not fame/fortune of researcher
  • Research is critical to practice and there are big gaps that nurses need to fill
  • Bedside nurses may be the most crucial link in research ideas, translation, and practice.

(Shameless plug for related AJN content: See our recent, amazingly useful step-by-step CE series on how nurses can get involved in evidence-based practice.)

Plus a brief note on reader comments: we’ve been getting a lot of great comments lately on this blog, and we’re grateful for that. So thank you. A fair number of the comments were on posts from previous months, such as this post comparing U.S. and Australian health care systems. Is somebody by chance teaching a nursing course that requires students to leave thoughtful, respectful, engaged comments in the blogosphere? If so, bless you!—JM, senior editor/blog editor

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Posted in continuing education, nursing research | Tagged , , , , | Leave a Comment »

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Addressing Traumatic Injury in Older Adults

November 18, 2011

By Sylvia Foley, AJN senior editor

Frank Jones, age 83, arrives at a local trauma center after falling down a flight of stairs in his home. Initially diagnosed with two fractured ribs, a fractured ulna, and a fractured tibia, he’s admitted to the ICU.  At first, things seem to go well—his electrolytes and bloodwork appear to be within normal limits, and his vital signs are stable. But the next day he becomes increasingly unstable. What’s going on?

Stairs by spivvo, via Flickr

Trauma is currently the seventh leading cause of death in older adults—and older adults are more likely to suffer complications and die than are younger ones. But as author Christine Cutugno points out in this month’s CE, “The ‘Graying’ of Trauma Care: Addressing Traumatic Injury in Older Adults,” advanced age isn’t a predictor of trauma outcome. Many trauma-related complications are preventable.

What guides current care? While standards of care for geriatric patients and for trauma patients exist, as yet none have been specifically developed for and tested in geriatric trauma patients. Until that happens, Cutugno writes, “nurses will need to be guided by measures known to prevent iatrogenic complications in other patient populations.”

To that end, Cutugno first reviews common mechanisms of traumatic injury in older adults and discusses the effects of aging and comorbidities. She points out that older adults usually have poorer physiologic reserves and are less able to maintain homeostasis. Their compensatory responses may be inadequate. The drugs taken to manage many comorbidities can mask warning signs. In short, it can be challenging for nurses to recognize when a geriatric trauma patient is in trouble. Read the rest of this entry ?

Posted in continuing education, home care nursing, nursing perspective, palliative care, practice tips | Tagged , , | 2 Comments »

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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 »

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Caring for Suicidal Children in the ED

September 1, 2011

By Sylvia Foley, AJN senior editor

Emergency lights #5, by DrStarbuck via Flickr

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and the hospital staff safe as the day progressed. Read the rest of this entry ?

Posted in audio interviews, children's health, continuing education, nurses, patient safety, practice tips, school nurses | Tagged , , , , , , | Leave a Comment »

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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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Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

June 7, 2011

By Sylvia Foley, AJN senior editor

In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.

Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?

Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 2 Comments »

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What Is the Role of the Staff Nurse on a Medical Emergency Team?

May 25, 2011

By Sylvia Foley, AJN senior editor

There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)

But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.

The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:

  • Nearly three-quarters of the respondents had participated in a MET call.
  • The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
  • But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?

Posted in continuing education, nurses, nursing perspective, nursing research, patient safety | Tagged , , , , , | 1 Comment »

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‘A True Art’: Strategies for Feeding Patients with Dementia

April 1, 2011

By Sylvia Foley, AJN senior editor

The fork and the spoon, by Jordan Fischer via Flickr

Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:

People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.

In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. Read the rest of this entry ?

Posted in continuing education, nurses, nursing research, palliative care, practice tips | Tagged , , , | 1 Comment »

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Vampire Nurses, PhDs, Your Best Moment as a Nurse: Today’s Notes from the Nursosphere

March 30, 2011

Here are some recent posts of interest we noticed on the nursing blogs. Many of these blogs can actually be found on our blogroll, so we hope you’re exploring what’s there from time to time, even if we know the list isn’t exhaustive and is probably missing some other excellent (and at least somewhat frequently updated) blogs.

It’s good to know that Will, the nurse/comic artist who shares his drawings at Drawing on Experience, has started posting again more regularly. One of his most recent efforts depicts a night shift nurse as a kind of vampire. It’s funny and, in a way, insightful. We give just a thumbnail version of it below on the right, in the interests of preserving the artist’s copyright; to see it enlarged, click the image and visit the version posted on his site, where you can also find a bunch more drawings, many about his life as a relatively new nurse. 

The INQRI Blog (that INQRI stands for Interdisciplinary Nursing Quality Research Initiative, a real mouthful) has a new post about an increase in enrollment in nursing doctorate programs. Here’s an excerpt:

According to new data released recently by the American Association of Colleges of Nursing (AACN), enrollment in doctoral nursing programs increased significantly in 2010. The AACN believes that this shows a strong interest in both research-focused and practice-focused doctorates.

The post also connects this enrollment trend with some recommendations from the IOM Future of Nursing Report, which we’ve written about more than once on this blog in recent months. But no more policy today! Whatever your degree, if you’re a nurse, you probably wonder from time to time why you do such a challenging job. An evocative post at Those Emergency Blues recounts an after-dinner conversation between two friends about just this. One of them asks the other, “What’s your best moment in nursing?” The author struggles to find an answer. Here’s part of what she says:

I stopped and thought. I could see my reflection in the dining room mirror, dimly, and even I could see bone-tired in my face. But I thought about codes and trauma. I thought about why I was once made Employee of the Month. I thought of smaller moments of giving care— warm blankets, a back rub, a cup of ice chips, repositioning. I thought about missed findings. I thought about the time a patient an ambulance gurney went VSA while I was triaging her, and walked out of hospital ten days later. I thought about innumerable STEMIs caught and thrombolysed (and later sent for rescue cathetherization) within minutes of arrival. I thought about the times when I pushed for some extra intervention which made a real difference in the patient’s life.

It’s engaging, but it’s probably not the most important part of her answer, which you’ll have to read the entire post to learn. Anyway, maybe we’ll steal the question and ask it here, since we’d really like to know what our readers think (as the chill air hangs on at the end of March and energy levels waver). So what’s your best moment as a nurse?—JM, senior editor/blog editor

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Posted in art and nursing, continuing education, nursing students, professional identity, writing and nursing | Tagged , , , , , , , | 2 Comments »

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