Archive for the ‘International nursing’ Category


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

July 21, 2014

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 ?


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 ?


Nurses Join Fight Against Counterfeit Medicines

May 30, 2014

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 ?


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 ?


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 ?


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 ?


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 ?


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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At Least Once in Every Nursing Career: Final ICN Congress Recap

June 4, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

from Great Ocean Road in Australia

from Great Ocean Road in Australia

Here’s a final recap of my trip last week to the 25th quadrennial congress of the International Council of Nurses (ICN). (My previous posts on this year’s ICN events are here and here; there’s also a podcast of my interview with outgoing ICN president Rosemary Bryant.)

My final few days were busy with sessions as well as a meeting with some members of AJN’s International Advisory Board. Here are some highlights:

  • Nurses and the Nazis. A session on ethics led by Australian nurse Linda Shields examined nursing in Nazi Germany and discussed how nurses might have rationalized participation in Nazi euthanasia and killing programs. She noted that aside from the usual “just following orders” mantra, obedience was tied to housing and livelihood, as well as to the belief that “the health of the volk (community) was more important than the health of the individual.” (The topic brings to mind our 2009 article, “The Third Reich, Nursing, and AJN [abstract only], which made the case that “in the interest of promoting international cooperation and an image of nursing unity, AJN shirked its duty to hold German nurses accountable” for complicity in the Holocaust.)
  • Nursing visibility. Presentations by Canadian nurse union leaders reminded me of home: they talked about campaigns to make what nurses do more visible, noting that if RNs were invisible and their work not valued, they would be at high risk for job cuts. Debbie Forward, president of the Newfoundland–Labrador Nurses Union, talked about “role clutter” and the loss of an RN identity when one couldn’t distinguish RNs from other health care providers, and she described a union campaign—the Clarity Project—to protect and promote the RN role. Sandi Mowatt from the Manitoba Nurses Association, which represents all levels of nurses, talked about initiatives to protect and support all nurses. Ten years ago, she said, only 26% of their members would recommend nursing as a career because of dissatisfaction with workplace policies and wages; today, 72% of nurses in the union would recommend nursing as a good career. Read the rest of this entry ?

Dispatch #2 from Melbourne: Dues, Election Results, Nursing at the WHO

May 21, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

There’s lots happening at the International Council of Nurses (ICN) meeting and I’ve logged more walking miles here in Melbourne in the last two days than I do in a week at home.

Judith Shamian

Judith Shamian

On Monday, the Council of National Representatives (CNR), the ICN’s governing body, announced election results. Judith Shamian, a well-known Canadian nursing leader, was elected the 27th president of the ICN. (For more information about Judith and other election results, read this press release.)

The CNR also agreed to address issues related to membership models and will move forward with a plan designed to support inclusiveness and membership growth in national associations. The plan also includes a tiered voting model that takes membership and percentage of membership into account. (The final vote will take place at the 2015 Congress).


Rosemary Bryant

New dues scheme: will RCN return? The CNR approved a new scheme for dues that should address the issue that led the Royal College of Nursing (RCN) to withhold dues, resulting in its suspension from the ICN and its recent vote to withdraw from the ICN. According to ICN president Rosemary Bryant, Norway and Japan, who were also unhappy with their dues payments, were pleased with the new model. She is hopeful that the RCN will be as well. (A podcast interview with Bryant can be listened to at our podcast conversations page here.)

I spoke with David Benton, chief executive officer of the ICN, about the RCN’s two-year suspension. According to Benton, the ICN had no choice. “The RCN made a unilateral decision in 2010 with no attempt to negotiate another resolution,” he said. He added that as a long-time member and a fellow of the RCN, he’s personally saddened by its decision to withdraw from the ICN. He noted that only a small portion of RCN’s dues goes to ICN membership and that other countries with far less resources continue to support the ICN’s work. He, too, is hopeful that the changes recently approved by the CNR will prompt the RCN to reconsider its position.

Meanwhile, two new associations were admitted to the ICN: the Chinese Nurses Association and the Palestinian Nursing and Midwifery Association (read more here).

Invisible nurses at the WHO. Another issue, not new but perhaps one that is coming to a head, is the “eradication of nursing expertise at the WHO.” Nursing positions, especially leadership posts, have been disappearing from the WHO headquarters and regional offices and are now at an all-time low of 0.6% (down from 2.6% in 2000).  (See AJN‘s July 2011 editorial and July 2012 report on this.) According to a document issued Monday, the CNR “calls upon the WHO Director General to urgently reinstate the vacant positions of WHO Chief Nursing Scientist  at WHO headquarters and urges regional directors to retain and strengthen senior nursing advisor positions in their regions.”

I also attended several interesting sessions: Read the rest of this entry ?


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