Archive for the ‘continuing education’ Category

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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 ?

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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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Saving ‘Mimi’: How Nurses Can Combat Human Trafficking in the USA

February 1, 2011

By Sylvia Foley, AJN senior editor

Never to lie . . . by flickrohit, via Flickr

Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.

In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?

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Buyer Beware: Most Online Nursing Schools are Reputable, But How Do You Know?

January 3, 2011

By Maureen ‘Shawn’ Kennedy, AJN interim editor-in-chief

Imagine spending a significant amount of money and long hours of study to earn credits toward a nursing degree—and then finding out that the credits are not transferable to the school where you planned to complete the degree. For some nursing students, this is a reality, not just an exercise in imagination.

In the January issue of AJN, we assigned one of our freelance journalists to do a report examining for-profit nursing programs, many of which are online.

Newspaper articles and other news sources and organizations have reported that some students are getting shortchanged, with nursing students sometimes finding themselves ineligible to take licensing exams and facing crippling debt.

I’ve seen ads for various online nursing programs—indeed, AJN and other reputable nursing journals run these promotions in our pages or on our Web sites. Most are credible organizations and many students have indeed graduated from them or with credit obtained through them and gone on to pursue successful careers. But a few such programs apparently fail to deliver on promises—or may not provide full disclosure about what students can expect.

If you’re contemplating going back to school and are considering an online program, be sure to read our report and follow the recommendations from the National Council of State Boards of Nursing detailed in the article. Going back to school might very well be the best decision you make—but make it carefully, and with full knowledge.

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When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

December 14, 2010

By Sylvia Foley, AJN senior editor

Coffee Time (detail) / by S.M. Drawing used with permission of family.

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two of these drawings illustrate the article (a detail from one is shown above). The authors also profile one facility’s approach to pain assessment of its patients. And they discuss collaborative team solutions with AJN interim editor-in-chief Shawn Kennedy in this podcast interview.

Have you  faced the challenge of assessing pain in patients like S.M.?

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Startling Findings about Men’s Awareness of Male Breast Cancer . . .

October 5, 2010

and a look at the benefits of dragon boat racing for breast cancer survivors of either sex.

By Sylvia Foley, AJN senior editor

Although breast cancer is far less common in men than in women, being a man doesn’t make one immune to the disease. Yet misconceptions about male breast cancer abound. In this month’s CE feature, Men’s Awareness and Knowledge of Male Breast Cancer, nurse researcher Eileen Thomas reports on a qualitative study of 28 men at higher risk (all had at least one maternal relative who had been diagnosed with breast cancer). The goals were twofold:  to learn more about men’s understanding and perceptions of this life-threatening illness, and to elicit information that might guide clinical practice and the development of sex-specific educational interventions.

The study findings are rather startling. Nearly 80% of the participants had no idea that men could develop breast cancer. Fully 100% of the participants reported that none of their primary care providers had discussed the disease with them. Asked how they thought male breast cancer was detected, most participants could name only one symptom  (“a lump”); one said, “They find it on the autopsy table.” And 43% reported that being diagnosed with breast cancer might cause them to question their masculinity. One participant stated, “I would feel like my manhood was taken away.” Read the rest of this entry ?

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An Evidence-Based Look at the ‘Unvoiced Symptom’: Fecal Incontinence

September 7, 2010

Public toilet by Looking Glass / Fernando de Sousa, via Flickr

First, a confession: initially the subject of this month’s CE, fecal incontinence, seemed so daunting that we considered lighter titles (“Don’t Pooh-Pooh Fecal Incontinence,” for one). But we decided against going that route, because we didn’t want to minimize the condition’s importance or its life-altering effects. Indeed, fecal incontinence has been called the “unvoiced symptom,” one so embarrassing that sufferers often fail to tell their health care providers about it—and one that many providers never ask about.

Fecal incontinence has been defined as the “involuntary loss of liquid or solid stool that is a social or hygienic problem.” As authors Donna Zimmaro Bliss and Christine Norton report, possible causes include cognitive or physical disability, impaired sensory or motor function, poor coordination of defecation processes, and loose stool consistency; in some cases the cause may be multifactorial or idiopathic. Although studies of nursing home residents have found prevalence rates of more than 40%, the condition is by no means limited to elderly or disabled people.

Quality-of-life issues. Bliss and Norton provide an overview of fecal incontinence and describe what the research thus far has revealed about its impact on patients’ quality of life. Read the rest of this entry ?

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Interventions to Promote Physical Activity in Chronically Ill Adults: What Does the Evidence Tell Us?

July 14, 2010

By Sylvia Foley, AJN senior editor

It sounds like a no-brainer: physical activity can have great health benefits for people who are chronically ill. But which interventions promote physical activity in this population most effectively? Many studies evaluating such interventions have been conducted; but “without the benefit of a statistical analysis across studies it can be difficult to detect patterns and interpret results,” say the authors of this month’s CE feature, Todd M. Rupper and Vicki S. Conn.

In 2008 Conn and colleagues did just that, performing a meta-analysis that summarized the findings of 163 reports on 213 independent tests of interventions used to promote physical activity among more than 22,000 adults with various chronic illnesses. Now, in this article, Rupper and Conn discuss the implications of  the findings from that meta-analysis, describe the strategies and practices most commonly used, and identify which ones have proven most effective. Among the take-aways: Read the rest of this entry ?

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Photo-essay Depicts Home Nursing in Gaza Strip; All AJN May Articles Free for Next Two Weeks

April 29, 2010

The above photo is from a photo-essay on home nursing in the Gaza Strip that appears in the May issue of AJN. The text and images depict Palestinian nurses trained by a medical aid organization called Merlin to attend to local communities in need, especially those cut off from urban health care services. Have a look (since it’s a photo-essay, we suggest you click through to the PDF version once you reach the article). 

In honor of Nurses’ Week, which occurs in early May, this and all other articles in AJN will be free from now until May 15. At all other times, the departments and article types listed below are always free (along with other selected articles):

  • Reflections, a monthly personal essay from a reader
  • Viewpoint, a position piece from an expert or concerned citizen
  • news articles like this on turf wars between physicians and nurse anesthetists, this on the continuing trickiness of treating sepsis, and this on a new plan for radiation safety
  • Art of Nursing (it’s a poem this month; click through to the PDF to read it)
  • the editorial
  • letters like this one on end-of-life opioid use
  • CE features such as this comprehensive look at asthma in adolescents and adults

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Turf Wars Aside, How Do NPs and MDs Really Differ?

April 20, 2010

By Christine Moffa, MS, RN, AJN clinical editor

By Richard Danby/via Flickr

There’s been a lot of talk lately about turf wars between NP’s and physicians, especially when it comes to the much discussed U.S. shortage of primary care providers. Before going back to school and getting a master’s in nursing education, I batted around the idea of becoming a nurse practitioner. It seemed like the ideal next step for someone who was happy being a clinician but wanted to take on an advanced role.

However, there was something that didn’t sit right with me about becoming an NP—namely, my fear of public perception. I’m not sure most people know exactly what the role of an NP is and how it differs from that of a physician, particularly in primary care. I’ve seen patients call their primary care NP “doctor [insert first name here],” which to me illustrates the confusion.

When people ask me the difference, I myself have a hard time articulating it. How do I respond when someone says something like this: “if entry to medical school and residency is typically more competitive than for advanced degree nursing programs, and if physicians spend a longer time attending tougher programs, how do you justify their doing the same work as NPs?” (For instance, when I was in school we, along with the NP candidates, were only required to take two semesters of pathophysiology!)

Now, I’ve been to an NP as a patient, and I was happy with the care I received. She certainly spent more time with me than any medical doctor ever did. And people often point out that NPs work in poor and/or rural areas that have a tough time recruiting physicians. But by promoting ourselves as a cheaper, less busy alternative, are we doing ourselves a favor or confirming the suspicions of those who—despite the available research to the contrary—say we’re less qualified than physicians to provide effective primary care? I’m still looking to go back to a post–master’s certificate program to become an NP because I’d like to work in that capacity one day. I’d like to hear from any NPs or DNPs about how they handle these kinds of questions. How are you like physicians, and how do you differ?

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