Archive for the ‘International nursing’ Category

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Remembering Nurses Who Served the Wounded and Dying and Those Who Died Themselves

May 22, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Normandy American Cemetery, France. Photo by Karen Roush

Normandy American Cemetery, France. Photo by Karen Roush

So many of us look forward to Memorial Day weekend as a welcome long weekend and official start of summer. But there are many for whom Memorial Day (the last Monday in May) is a reminder of loved ones who died in military service—and that includes a significant number of military nurses who cared for the wounded in various wars.

We’d like to take this occasion to remind us all of the real meaning of this day and to honor the sacrifices of our colleagues. While it’s hard to find specific numbers of nurses who died in wars, one can extrapolate from what’s known about women who died, since most women who served in combat areas from the start of the 20th century through the Vietnam War were nurses.* Read the rest of this entry ?

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Florence Nightingale: The Crucial Skill We Forget to Mention

May 13, 2015

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is that Florence Nightingale was a writer.

In fact, Florence was a prolific writer. She published hundreds of articles and books, along with letters and editorials, pamphlets and briefs. If she lived today, I’m sure we’d be reading her regularly on the op-ed pages of the New York Times.

Suppose Florence hadn’t been a writer? Think about it . . . what would we know of her theories without Notes on Nursing? What would have been lost if she hadn’t written about her work in epidemiology, her research on hospital design, her efforts to improve sanitation and lower rates of infection? It’s incalculable.

But all this wasn’t lost—because, along with all her other wisdom, she was wise enough to understand the importance of communicating through writing what nurses do.

Today nurses continue to do work that has a major impact on health care and patient outcomes. But how much of that is getting lost because nurses don’t think of themselves as writers, because they don’t see writing as a part of what nurses do?

I worked with a group of nurses at a medical center here in New York to help them write and publish articles about the quality improvement projects they had completed. I was amazed by the work they’d done—work that had changed patient outcomes, lowered readmission rates, and improved their own working conditions. Patients discharged from the transplant unit were now going home with more confidence and less fear. Patients with congestive heart failure were able to better self-manage their care, and thus stay home with their families instead of being readmitted to the hospital again and again. Fewer mothers were having C-sections because the OB staff were working as a more cohesive interprofessional team.

The issues they were addressing aren’t unusual. Transplant staff everywhere are struggling with how to prepare their patients for discharge when the hospital stay has grown so much shorter and their needs continue to be so great. I’m sure each of you have stories of poor teamwork that has negatively affected patient care. And there isn’t a hospital in the country that isn’t trying to get their readmission rates down—with efforts to do so placed on the already overburdened shoulders of its nurses. Read the rest of this entry ?

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Nurses at Center Stage: AJN’s Top 10 Blog Posts of 2014

December 12, 2014

By Jacob Molyneux, AJN senior editor/blog editor

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

Filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

It’s unsurprising that some of our top blog posts this past year were about Ebola virus disease. But it’s worth noting that our clinical editor Betsy Todd, who is also an epidemiologist, cut through the misinformation and noise about Ebola very early on—at a time when many thoughtful people still seemed ill informed about the illness and its likely spread in the U.S.

Ebola is scary in itself, but fear was also spread by media coverage, some politicians, and, for a while, a tone-deaf CDC too reliant on absolutes in its attempts to reassure the public.

While the most dire predictions have not come true here in the U.S., it’s also true that a lot of work has gone into keeping Ebola from getting a foothold. A lot of people in health care have put themselves at risk to make this happen, doing so at first in an atmosphere of radical uncertainty about possible modes of transmission (uncertainty stoked in part by successive explanations offered as to how the nurses treating Thomas Eric Duncan at a Dallas hospital might have become infected).

And while, relative to the situation in Africa, a lot of knowledge and resources were readily available to support nurses and physicians who treated Ebola patients, the crisis has focused much-needed attention on the quality of the personal protective equipment (PPE) hospitals have been providing to health care workers.

Meanwhile, the suffering continues in Sierra Leone and other countries. Time magazine this week made the Ebola fighters here and overseas its collective Person of the Year for 2014. (See our recent post by Debbie Wilson, a Massachusetts nurse who worked in an Ebola treatment center in Liberia this fall. She will be visiting our offices next week for lunch with the staff.) Read the rest of this entry ?

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AJN in December: Surveillance Tech, Obesity Epidemic, Questioning Catheter Size, More

December 1, 2014

AJN1214.Cover.OnlineAJN’s December issue is now available on our Web site. Here’s a selection of what not to miss.

To watch or not to watch? Long-term care facilities are challenged with providing care for a growing number of patients with dementia or intellectual disabilities. This month’s original research feature, “The Use of Surveillance Technology in Residential Facilities for People with Dementia or Intellectual Disabilities: A Study Among Nurses and Support Staff,” describes an ethnographic field study on the ethics, benefits, and drawbacks of using this technology in residential care facilities.

The obesity epidemic. Obesity rates are rising at an alarming rate in the United States. “The Obesity Epidemic, Part 1: Understanding the Origins,” the first article in a two-part series, outlines pathophysiologic, psychological, and social factors that influence weight control.

Smaller catheter size for transfusions?Changing Blood Transfusion Policy and Practice,” an article in our Question of Practice column, describes how a small team of oncology nurses designed and implemented an evidence-based project to challenge the practice that a 20-gauge-or-larger catheter is required for the safe transfusion of blood in adults. Read the rest of this entry ?

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Counting Your Blessings

November 26, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

A perhaps idealized past: 'Home for Thanksgiving,' Currier and Ives lithograph/Wikimedia Commons

A perhaps idealized past: ‘Home for Thanksgiving,’ Currier and Ives lithograph/Wikimedia Commons

At the Thanksgiving holiday in the U.S., it’s customary to take some time to reflect on our good fortune—to give thanks for what we have. For many of us, it means being thankful for family and good health. But what about all the other people who may make a difference in how we live our lives, who make the world in which we live better or in some indirect way have had an impact on what we do, how we do it, how we feel about life or our work?

Here are some folks I’d like to thank:

  • The incredibly talented team here at AJN who are committed to fulfilling AJN’s mission to provide accurate, evidence-based content with high journalistic standards, and the publishing team that provides the resources it takes to deliver on our mission.
  • AJN’s editorial boards, contributing editors, and peer reviewers, who contribute their expertise and wisdom to keep AJN on track.
  • Organizations like the Robert Wood Johnson Foundation, AARP, Johnson & Johnson, the Jonas Foundation, the John Hartford Foundation, the Macy Foundation, and others who believe in the value of nursing and provide support to further the profession.
  • Carolyn Jones, the photographer and filmmaker, for her wonderful book and film project, The American Nurse, which portrays the incredible work of nurses across settings and makes it visible to the public.
  • Brave people like nurses Kaci Hickox and Debbi Wilson and physician Craig Spencer and their colleagues at Doctors without Borders/MSF and at other relief agencies who volunteer (often with considerable risk to themselves) to provide care and compassion to those who need it (read about Wilson’s experience in a Liberian Ebola-treatment center in her recent blog post).
  • Nurses who make the hard decisions and are examples to us all, like the U.S. Navy nurse who has refused to force-feed detainees at Guantanamo Bay because it violates professional ethics.
  • Nursing faculty, who pursue teaching careers because they are committed to educating the next generation of nurses.
  • Nurses who stand up for colleagues, new and old, and work to promote teamwork and unity in the workplace.
  • And the nurses who, every day, show up and do whatever it takes to meet the needs of the patients in their care.

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Ebola Changes You: Reflections of a Nurse Upon Return from Liberia

November 12, 2014

By Deborah Wilson, RN. The author is currently an IV infusion therapist with the Berkshire Visiting Nurses Association in Pittsfield, Massachusetts, and is completing her BSN at UMass Amherst. In October, she returned from Liberia, where she worked with Doctors Without Borders at a 120-bed Ebola treatment center. Names of patients mentioned in the article have been changed to protect patient privacy.

At the cemetery, newly dug graves

At the cemetery, newly dug graves

I have recently returned from Liberia, where I worked as a nurse for six weeks along with a dedicated team of physicians, nurses, and other professionals, treating 60 to 80 Ebola patients a day. My 21-day transition time is recently over and, although I am back at work and school, my heart is with the West African nurses who I worked with for those weeks in September and October.

I worked in a town called Foya, managing a 120-bed Ebola treatment center (ETC). During the first two weeks, I wondered if I would last. In the grueling heat, dressed up in all that personal protective equipment (PPE), constantly sprayed with chlorine, each day I was haunted by the question of whether I’d somehow gotten infected.

It all took its toll. Twice a shift the nursing team would put on PPE and enter the confirmed Ebola isolation area. People lay on mattresses on the floor, vomit and diarrhea everywhere. In our bulky gear, double-gloved, goggles fogging and sweat running out of every pore, we would insert IVs, push meds, try to help someone eat a little something, tell the hygienists that a body needed to be removed to the morgue.

So how did I go from wondering how I would make it through my six-week assignment to now actually considering going back? It was thinking about the nurses and teams who are still there going in every day, never having a 21-day transition period like mine to look forward to, all with colleagues and family who died during this devastating outbreak.

With staff at the 120-bed Ebola clinic in Foya

With staff at the 120-bed Ebola clinic in Foya

Our lives were in each other’s hands—we helped each other dress in PPE and double-checked each other before going in. Talking with one patient, I said, “we must look really weird,” and he laughed, which made us all laugh.

But there was not much laughter in the area for confirmed cases. We never knew who would live or die; sometimes the healthiest would suddenly be dead. We delivered babies who were so small and premature—I think about the young 19-year-old mother dying only an hour after her little boy had been placed in a white body bag and given a name so he could be identified in the morgue. I find myself wondering what her and her son would be doing now if there had been a way to save her.

I wonder about Joy, whose love and dedication to her husband touched all of us deeply. Daily she would come to the fence with his favorite food and George would come out and sit on the other side. When he got too sick to come outside, we dressed her in PPE and took her in, where she prayed with him. We all rejoiced when a pregnancy test revealed that Joy was pregnant, then saw her nearly immobilized with grief the next day when George died. Joy’s cries and sobs as the psychosocial team sat with her is something I still wake up to. I wonder how she is doing and where she is now. Will she have a boy or girl and what will she tell him/her about George?

The Liberian nurses still call me on the phone. They tell me that there is not one case of Ebola now in the ETC! Many have to go back to the health clinics where they worked before. All of them lost colleagues because, when sick people came to their clinics, they had no gloves, masks, or chlorine to protect them. Will they have basic protective equipment now?

They also haven’t been paid for September or October. The Liberian Ministry of Health keeps saying that they will get paid, but I fear that this outbreak has wreaked such havoc on the economy that they have risked their lives, working in conditions we will never have to endure, perhaps only to also risk earning no income as well for their efforts.

My three-week transition involved learning the news of the two nurses in Texas who were infected caring for Thomas Eric Duncan, of physician Craig Spencer testing positive in New York City and Kaci Hickox being locked up in an unheated New Jersey tent with no shower. At times I thought I would go mad—watching as a collective insanity gripped our nation about a virus unlikely to ever take hold in the U.S., I yearned for the day when we could instead turn our attention to what I believe this terrible epidemic in West Africa could really be teaching us: Read the rest of this entry ?

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Addressing Nurses’ Urgent Concerns About Ebola and Protective Equipment

October 15, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor. (See also her earlier post, “Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective.”)

This is not a time to panic. It is a time to get things right.—John Nichols, blogging for the Nation, 10/12/2014

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

For years, nurses have tolerated increasingly cheap, poorly made protective gear—one result of health care’s “race to the bottom” cost-cutting. Now the safety of personal protective equipment (PPE) is being hotly debated as the Ebola epidemic spills over into the U.S.

If all nurses had access to impermeable gowns that extended well below the knee (and could be securely closed in back, had real cuffs, and didn’t tear easily); faceguards that completely shielded; N95 respirator masks that could be properly molded to the face; and disposable leg and shoe covers, we might not be having the same conversation. Yet how much protection can we count on from the garb we now have available, especially considering the minimal donning and doffing training given to most nurses?

While there is more to be learned about possible “outlier” modes of Ebola transmission, it’s pretty clear from past experience (including recent Ebola hospitalizations at Emory University Hospital and the University of Nebraska Medical Center, where no transmission has occurred) that standard, contact, and droplet precautions will virtually always prevent Ebola virus transmission. Because of the theoretical possibility that the virus could be aerosolized during procedures like intubation or suctioning, airborne precautions are usually added. (And from what we’ve seen, they’re being followed routinely, and not used only during aerosolizing procedures.)

Many organizations, including National Nurses United, are calling for hazmat-type gear and PAPR hoods (powered air-purifying respirators, which are HEPA-filtered) for staff who care for Ebola patients. Because most nurses have not used these, this more complex gear presents new challenges, especially because of the potential for self-contamination when worn and removed by untrained staff.

Specific techniques for donning and doffing PPE are not new, but many nurses have never been taught to pay attention to these details. One has only to look at staff in a contact precautions room, only half covered by their untied gowns, to understand why resistant organisms continue to spread within hospitals. Many clinicians may not have believed that their cavalier attitude towards PPE had anything to do with the next patient’s nosocomial MRSA pneumonia. During this Ebola epidemic, though, we are quickly learning that the proper use of PPE is a matter of life and death—ours. Read the rest of this entry ?

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