Archive for the ‘International nursing’ Category

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The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

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How a Busy Hospital Reduced Its Rate of Hospital-Acquired Pressure Ulcers to Zero

August 8, 2014

By Sylvia Foley, AJN senior editor

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

A skin lesion monitoring form accompanies a patient. Photo courtesy of NHCH.

In 2009, when one of the world’s largest cardiac care hospitals experienced a spike in the number of surgeries performed and a corresponding rise in hospital-acquired pressure ulcers, many people were concerned. The hospital—Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India—soon initiated a program to address the problem, and nursing superintendent Rohini Paul was tasked with designing and implementing effective preventive strategies. In this month’s CE feature, “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment,” Paul and colleagues describe what happened next. Here’s a brief overview.

Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers.
By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program’s success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U.S. acute care environments.

The authors emphasize the importance of “absolute transparency and personal accountability” in ensuring the program’s sustained success. As one senior nurse said, “It was the personal responsibility that started making a difference. Now everybody’s aware, everybody’s cooperative and on their toes, and we have no skin ulcers.”

For more details, read the article, which is free online. And please share your experiences and insights with us below.

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Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014
Truvada

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

Read the rest of this entry ?

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Flight Nursing Notes – The Feel of a Homecoming

July 14, 2014

Observations of an experienced ICU nurse and long-time AJN blogger who recently made the transition to flight nursing.

clouds-photo-from-airplaneMarcy Phipps, BSN, RN, CCRN, ATCN, TNCC, is an occasional contributor to this blog. Some details have been changed to protect patient privacy.

“We’ve been married for 58 years,” my patient’s wife says. “Fifty-eight years…”

She turns her attention from me and gazes out the window of the plane.

We are on a medevac flight, 35,000 feet over the Pacific en route to an urban, American hospital near “home.” Her husband is being transferred to receive aggressive care for a grave illness.

We collected him hours earlier from a hospital on a foreign island. Local paramedics picked my partner and me up from the barren, windy tarmac. As we sped to the hospital in the back of an ambulance with a cracked windshield, the driver turned to warn us that we were going to “the worst hospital in the city.”

“It’s open-air,” he told us, as he dodged mopeds and swerved through narrow, crowded streets.

This didn’t surprise me. I’d been forewarned that hospital conditions on many of these remote islands could be shocking when compared to American standards. It was something I’d been curious to see firsthand.

Yet when we picked our patient up, we found him in a small and clean room in an intensive care unit. Despite the paramedic’s prediction and the visibly run-down hospital, he appeared well cared for and attended to. His wife told me later that she believed her constant presence at his bedside had guaranteed his good care.

And now it’s two in the morning and I sit in a private jet with the flight medic, tending our patient, who is remarkably stable and tolerating the flight with ease. We are also tending to his wife, albeit in less obvious ways. He’s secured to a stretcher; she sits in a bucket seat at his feet, nervously watching his chest rise and fall with the ventilator-delivered breaths. Each time I assess him or check his vital signs she looks at me anxiously. Read the rest of this entry ?

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Nurses Join Fight Against Counterfeit Medicines

May 30, 2014
Hidden-in-Fake-Meds-2-1024x1809

Click infographic to enlarge

“Fight the Fakes” is a scary article in the June issue of AJN about counterfeit medicines and the role the International Council of Nurses (ICN) has taken in the Fight the Fakes campaign to inform the public about just how common the problem is and how dangerous it can be. Here’s the opening paragraph:

In February 2012, a cocktail of salt, starch, acetone, and a variety of other chemicals was delivered to 19 U.S. cancer clinics, instead of a vital chemotherapy medication they were expecting. Earlier this year, the Daily Mirror reported on black market abortion tablets that are being sold online to young teenage girls too scared to tell their parents they’re pregnant. The pills can kill if the wrong dose is taken.

The article is by David Benton, chief executive officer of the ICN, and Lindsey Williamson, the organization’s publications director and communications officer. Below is a brief blog post they sent us to give readers an idea of what’s at stake—but we hope you’ll also go ahead and read their article, which raises issues that should concern us all as patients or health care professionals.—JM, senior editor

Fake medicines are a global problem: they are reported in virtually every region of the world. Fake medicines may include products with the wrong ingredients, without active ingredients, with insufficient quantities of active ingredients, or with fake packaging. How common are fake medicines? The problem of counterfeit drugs is known to exist in both developed and developing countries. However, the true extent of the problem is not really known, since no global study has been carried out. Counterfeiting of medicines can apply to both branded and generic drugs, prescription and over-the-counter medicines, as well as to traditional remedies. Read the rest of this entry ?

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MERS: A Lucid Overview of What Nurses Need to Know

May 22, 2014

By Jacob Molyneux, AJN senior editor

Coronaviruses derive their name from the fact that under electron microscopic examination, each virion is surrounded by a "corona," or halo. This is due to the presence of viral spike peplomers emanating from each proteinaceous envelope. CDC image by: Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin

Coronaviruses derive their name from the fact that under electron microscopic examination, each virion is surrounded by a ‘corona,’ or halo. CDC image by Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin

In recent weeks, there have been a number of news stories following the first U.S. cases of Middle East respiratory syndrome (MERS-CoV) and the first transmission of the virus that occurred on U.S. soil. This novel coronavirus (the common cold is a coronavirus; so is SARS) can cause respiratory failure and death. So far, the number of identified cases are relatively few, though the numbers are growing. Disease surveillance has been aggressive since the first case was identified in Saudi Arabia.

Back in January, before the U.S. had seen its first cases, infection prevention specialist Betsy Todd provided a clear, engaging overview of MERS in our Emerging Infections column. “Middle East Respiratory Syndrome (MERS CoV)” lucidly and succinctly describes early MERS cases, the clinical findings as we currently understand them, the speedy development of worldwide surveillance efforts and the rapid development of an assay, the possible sources and transmission of the virus, and what we know about prevention. The article will be free until June 30. Read the rest of this entry ?

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Workplace Discrimination: A Survey among Newly Arrived Foreign-Educated Nurses

January 27, 2014

By Sylvia Foley, AJN senior editor

Table 2. Outcome Metrics by Recruitment Model

Table 2. Outcome Metrics by Recruitment Model

This country has often relied on foreign-educated nurses (FENs) to ease nursing shortages—and  with more shortages predicted for as early as next year, it’s likely we’ll do so again. A positive workplace environment is a known predictor of staff retention; yet little is known about how FENs experience their jobs. To learn more, Patricia Pittman and colleagues surveyed more than 500 FENs. This month’s original research CE, “Perceptions of Employment-Based Discrimination Among Newly Arrived FENs,” reports on their findings. This abstract offers a brief overview.

Objective: To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007.
Background: With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction.
Methods. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes.
Results: We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. Read the rest of this entry ?

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Worsening Global Health Workforce Shortage: What’s Being Done?

December 9, 2013
JM: photo emailed to you. Photo is of Frances Day-Stirk, president of the International Confederation of Midwives, and David Benton, CEO of the International Council of Nurses. Photo courtesy of Marilyn DeLuca, consultant, Global Health - Health Systems  and adjunct associate professor, College of Nursing, New York University.

Frances Day-Stirk, president, International Confederation of Midwives, and David Benton, CEO of International Council of Nurses. Photo courtesy of Marilyn DeLuca.

By Shawn Kennedy, MA, RN, AJN editor-in-chief

While it might seem—based on what we see in our own country—that there is no shortage of health care workers, there is indeed a global shortage and it’s only going to get worse. We reported on the global health workforce last year; new reports are revealing just how much worse things may get. According to the World Health Organization (WHO), by 2035 there will be a shortage of 12.9 million health care workers; currently, there is a shortage of 7.2 million.*

The shortage is being exacerbated by a confluence of occurrences:

  • the aging population is living longer and with more illness
  • noncommunicable chronic illnesses like cancer, cardiovascular disease, and diabetes are increasing worldwide
  • many undeveloped countries lack educational facilities for training new professionals
  • experienced health care workers migrate to developed countries for better working conditions and pay

Discussions focused on how nations individually and together can develop and strengthen the workforce to meet Millenium Development Goals and attain the goal of universal health coverage. The result was the Recife Declaration, a call to action detailing what needed to be done to address the problem, asking nations and organizations to commit to a goal of universal health coverage for all, and committing resources to develop the workforce to provide it.

Read the rest of this entry ?

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We Call You ‘Wheat Head’ – An Unexpected Crosscultural Encounter

November 8, 2013

I entered the wall-less, thatch-roofed waiting area of the clinic with my right hand in a ball of bandages, taped to my chest. The airy space was almost empty, without nurses or even a receptionist. The only other person in the little space, sitting very elegantly on one of the narrow wooden benches, was a woman in traditional West African dress who was quite pregnant.

NovemberReflectionsThe November Reflections essay in AJN is called “Surprise!” Its opening paragraph is above. This is one of our occasional Reflections essays by a writer who is not a nurse. In this case, the author Thomas Turman’s easy, self-deprecating tone, and the matter-of-fact manner in which his unexpected patient faces a situation that might induce a certain panic in many people from wealthier countries, feels just right. Read the rest of this entry ?

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AJN’s August Issue: Positive Deviance, Vital Sign Alert Systems, Using Focus Groups, Teaching Nursing Abroad, More

July 29, 2013

AJN0813.Cover.OnlineAJN‘s August issue is now available on our Web site. Here’s a selection of what not to miss.

Sometimes rules are meant to be broken in order to serve the greater good. This month’s CE feature “Exploring the Concept and Use of Positive Deviance in Nursingaims to increase our understanding of positive deviance (“an intentional act of breaking the rules in order to serve the greater good”) within the context of nursing practice. You can earn 2.5 CE credits with this article. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

The early warning signs of deterioration that patients often exhibit several hours before cardiopulmonary arrest often go unrecognized by nurses. “Developing a Vital Sign Alert System describes an automated vital sign alert system that was designed to enhance patient monitoring without increasing the nurse’s workload. Earn 2.4 CE credits by reading this article and taking the test that follows it.

“Using Focus Groups to Inform Innovative Approaches to Care,” an article in our Professional Development department, uses case studies to describe how nurses can use patient focus groups for gathering qualitative data that can advance patient advocacy.

And if you are interested in what’s going on in the nursing world in other countries, read this month’s In Our Community article, “Buurtzorg Nederland,” which focuses on a grassroots effort led by nurses in the Netherlands to create an improved model of home care. Called Buurtzorg—Dutch for “neighborhood care”—the model is designed to improve patient outcomes while reducing costs and increasing nurse and patient satisfaction.

Despite many challenges, Bangladesh is a rapidly developing part of the Indian subcontinent that has made significant progress on the United Nations Millennium Development Goals. “Teaching Nurses in Bangladesh,” an article in our Correspondence From Abroad column,  describes the experience of teaching bachelor of science in nursing–prepared nurses in Bangladesh since 2004, and provides some lessons in transcultural education.

There is plenty more in this issue, including an article on how to best measure wounds. Stop by and have a look, and tell us what you think on Facebook or here on our blog.

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