Archive for the ‘International nursing’ Category

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Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

February 1, 2016

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

MarcyPhipps_Flight_NursingI’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market crowded with live chickens and full of fruits and vegetables I’d never seen.

But the ‘rightness’ I felt was owed entirely to the experience I had at the foreign hospital. Read the rest of this entry ?

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AJN in January: Year in Review, Fibromyalgia, Massage Redux, Fall Prevention, More

January 6, 2016

AJN0116 Cover Online

On this month’s cover, refugees clash with police as they attempt to cross the border into Macedonia from Greece. The photo, taken last August, depicts a chaotic scene that has become increasingly familiar as large numbers of migrants flee to Europe from the Middle East and Africa. At press time, the International Organization for Migration estimated that more than 832,000 refugees had crossed Europe’s borders by sea since January 2015. Many migrants, including those from Syria, are risking their lives to escape violence, destitution, and displacement caused by civil war.

Health concerns have arisen as Europe struggles to absorb the huge surge of arrivals. According to the World Health Organization (WHO), overcrowding in receiving facilities has led to unsanitary living conditions and instances of food- and waterborne diseases. But the journey itself also takes a toll: the WHO reports that injuries, burns, and psychological trauma are among the most frequent health problems refugees face. Those with chronic conditions like cardiovascular disease, diabetes, and hypertension find their diseases worsened by the interruption of treatment, and women suffer from pregnancy-related complications and sexual health issues.

As policy makers grapple with responding to the influx, the crisis is likely to remain a key global political and health issue in 2016. To read about this and other top health-related news stories of the past year related to nursing and health care policy in the United States, see “AJN’s Year in Review: 2015.”

Some other articles of note in the January issue:

CE Feature: Fibromyalgia Syndrome: Current Considerations in Symptom Management.” Fibromyalgia syndrome, one of the most common rheumatic disorders, is estimated to affect up to 15 million people in the United States. Management of its symptoms appears to be best addressed using a multimodal approach, with treatment strategies tailored to the individual. This article describes the existing treatment guidelines, discusses pharmacologic and nonpharmacologic approaches, and outlines nursing approaches aimed at enhancing patient self-management. Read the rest of this entry ?

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Inside an Ebola Treatment Unit: A Nurse Shares Her Experiences in Liberia

December 11, 2015

By Sylvia Foley, AJN senior editor

“It is extraordinarily difficult to establish an IV line in a dehydrated patient by generator-powered light while double gloved, with one’s goggles fogging.”—Deborah Wilson

Author Deborah Wilson at the Foya ETU cemetery. Photograph by Marcos Leitão.In one of this month’s CE features, “Inside an Ebola Treatment Unit: A Nurse’s Report,” author Deborah Wilson offers readers a rare look from the frontlines of the 2014 Ebola epidemic. Her stories about her patients and colleagues are as compelling as they are informative. Here’s a short overview of the article:

In December 2013, the first cases of the most recent outbreak of Ebola virus disease (EVD; formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.

In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Foya, Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it’s like to work during an Ebola outbreak and to put a human face on this devastating epidemic.

Read the rest of this entry ?

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AJN in December: Inside an Ebola Unit, Acupressure, Early Mobility, EHRs, More

November 30, 2015

AJN1215.Cover.OnlineOn this month’s cover, nurse Elie Kasindi Kabululu cares for a patient at Centre Médical Evangélique in Nyankunde, Beni, Democratic Republic of Congo. Originally, this location served a population of 150,000 and also housed a nursing school; but in 2002, during war in the region, the facility was attacked. About 1,000 people were killed—including patients and staff—and the center was looted and destroyed.

Providing medical assistance in the world’s war-torn and neediest areas is commonplace for health care providers like Kabululu, just as it is for humanitarian organizations such as Médecins Sans Frontières (MSF), which works in 70 countries worldwide—nearly half of these in Africa. Shortly after the recent outbreak of Ebola in West Africa, MSF sent close to 300 international workers to help combat this public health emergency. To read one nurse’s experience traveling to Liberia for MSF to work in a treatment center, see “Inside an Ebola Treatment Unit: A Nurse’s Report.”

Some other articles of note in the December issue:

Original Research: Implementation of an Early Mobility Program in an ICU.” This article, from our Cultivating Quality column, recounts how the effects of an early mobilization program delivered to critically ill patients at a community hospital by an independent ICU mobility team contributed to fewer delirium days and improvements in patient outcomes, sedation levels, and functional status.

CE Feature: Incorporating Acupressure into Nursing Practice.” The effects of acupressure can’t always be explained in terms of Western anatomical and physiologic concepts, but this noninvasive practice involves minimal risk, can be easily integrated into nursing practice, and has been shown to be effective in treating nausea as well as low back, neck, labor, and menstrual pain. The author discusses potential clinical indications for the use of acupressure, describes the technique, explains how to evaluate patient outcomes, and suggests how future research into this integrative intervention might be improved.

From our iNurse column: Nurses and the Migration to Electronic Health Records.” In many settings, the clock has been ticking for providers to switch to electronic health records (EHRs). Most U.S. hospitals are now using some form of EHR system, as are a smaller majority of physicians’ offices. This article presents the challenges and benefits of using electronic health records and provides tips for adapting to EHR systems.

There’s much more in our December issue, so click here to browse the table of contents and explore the issue on our Web site.

 

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Ebola, One Year Later: What We Learned for the Next Big Epidemic

November 6, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

Read the rest of this entry ?

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Violence Against Women: Old Stories Repeat, But Some Progress

October 19, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Emergency lights #5, by DrStarbuck via Flickr

Emergency lights #5, by DrStarbuck via Flickr

It seemed ironic that, during this month of domestic violence awareness, a Florida judge showed little awareness of the fear that intimate partner violence can instill. Judge Jerri Collins came under attack from victim advocacy groups after she jailed a young mother who was a victim of domestic violence for failing to show up in court to press charges against her husband. According to various news reports, the distraught woman was afraid to face her husband in court for his sentencing to 16 days for choking and threatening her with a knife. Advocates say the judge’s action sends a message that may result in many women not bringing charges against abusers.

According to the CDC report Intimate Partner Violence Surveillance: Uniform Definitions And Recommended Data Elements (version 2.0; 2015), “over 1 in 5 women (22.3%) and nearly 1 in 7 men (14.0%) have experienced severe physical violence by an intimate partner at some point in their lifetime.” The real numbers are almost certainly higher, as many victims are afraid to report their partners for fear of retaliation once the abuser is released from jail. There are too many cases where that has happened, many ending in a woman’s death. Judge Collins’ actions seem heartless; she appears to be woefully misinformed about the dynamics and psychological effects of abuse.

At the recent Association for Women in Communications meeting in Kansas City, Nanette Braun of UN Women talked about several programs to raise awareness about women’s rights and reducing violence against women. The UNiTE to End Violence Against Women campaign has proclaimed the 25th of every month “Orange Day,” a call to action day to end violence against women and girls; Braun reported that over 60 countries have signed on to promote the campaign.

Another initiative that seems to have taken off, with the help of actress Emma Watson, is the HeForShe campaign, which aims to engage young men to end discrimination and violence against women and promote gender equality.

And here are some resources in AJN that you might find helpful: Read the rest of this entry ?

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On Nursing Identity: What We Can Learn from African Nurses’ Oral Histories

August 17, 2015

 By Sylvia Foley, AJN senior editor

Port of Mauritius by Iqbal Osman, via Flickr

Port of Mauritius by Iqbal Osman, via Flickr

“I have chosen this profession and nobody can take it away from me.”—Sophie Makwangwala, study participant

In the summer of 2009, at the International Council of Nurses (ICN) Quadren­nial Congress in Durban, South Africa, a small group met to discuss collaborating on joint history projects. At that meeting, several African leaders of pro­fessional nursing associations reported that their expertise had long gone unrecognized. Seeking to have the stories of African nursing history told, they pro­posed interviews with other retired nurse leaders. Barbara Mann Wall, an American nurse researcher who was in the room that day, found herself intrigued.

The study. In keeping with Braun’s tenet that “indigenous research should be led, de­signed, controlled, and reported by indigenous peo­ple,” Wall first trained three of the African nurse leaders in the oral history method, aided by a grant from the University of Pennsylvania School of Nursing. Then the team embarked on the study reported on in this month’s original research CE, “ ‘I Am A Nurse’: Oral Histories of African Nurses.” Here’s an overview: Read the rest of this entry ?

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