Archive for the ‘International nursing’ Category

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Ebola: Infection Control Resources Make All the Difference

September 16, 2014

This post is follow-up to our widely shared post (“Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective”) by AJN clinical editor Betsy Todd. The author, Amanda Anderson, is a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. Her last post for this blog is here.

Ebola virus viron

By CDC microbiologist Cynthia Goldsmith, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. CDC image library.

I don’t know a single nurse who likes caring for multiple isolation patients. The process of donning a new gown, pair of gloves, and mask each time you enter an isolated patient’s room is arduous and time-consuming. Personal protective equipment (PPE) clogs the garbage cans and can be hot and confining.

PPE has been in the news quite a bit lately because of Ebola. An interview with Liberian nurses by Hunter College’s Diana Mason on her WBAI radio show Healthstyles revealed that the Liberian Ministry of Health estimates 75% of virus victims are women—mostly nurses and caregivers. Nurses in West Africa might really love some of those pesky yellow isolation gowns.

Ebola can be a messy virus. Infected people have copious diarrhea and vomiting, often containing blood. The basics of care for Ebola patients should not be new to us; HIV and hepatitis can be spread in many of the same ways. We’ve got little to fear if we follow CDC guidelines for PPE and infection control. But in parts of Africa, where supplies we take for granted are scant, nurses and caregivers can’t even hold the hand of a dying patient or family member, much less clean them, without fearing for their lives.

As Mason’s interview reveals, many nurses are assigned 25 or more patients each shift in hospitals that lack electricity, running water, and gloves. (In an article for Buzzfeed, Jina Moore describes a nurse working in an Ebola ward who wears the isolation kit sent to her by the Liberian Ministry of Health. The kit includes a shower cap, gloves, and rubber bands for her wrists. Her ankles and neck are exposed, peeking out from her own short scrubs.) Read the rest of this entry ?

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How Do You Define Nursing?

August 27, 2014

Virginia Henderson

Virginia Henderson

By Maureen Shawn Kennedy, AJN editor-in-chief

Fifty years ago this month, in the August issue of AJN, Virginia A. Henderson, one of nursing’s giants, explained how she came to her definition of nursing: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.” (We’ve made the article, “The Nature of Nursing,” free until September 30. Click through to the PDF under “Article Tools.”)

Many (older) nurses may remember Henderson as one of the authors of Harmer and Henderson’s The Principles and Practices of Nursing, a mainstay textbook for nursing schools, or for her internationally published book, Basic Principles of Nursing Care, which was translated widely. She also taught nursing at Teacher’s College, Columbia University, and then later at Yale University, where she developed a comprehensive index of nursing research. But her accomplishments went far beyond that. Her writings helped change how nursing was being regarded—from an occupation that existed only to provide physicians with helpmates to a scholarly, independent profession.

I had the good fortune to meet Henderson in the early 1990s, when she came to AJN’s offices to meet with Fred Pattison, AJN’s librarian at the time, who was also the editor of the International Nursing Index. She was warm, engaging, down-to-earth, and had a wonderful sense of humor—not what I expected from a legend! Her personality shines through in this video, shot in 1978 for a series on nursing leaders produced by Sigma Theta Tau International.

Her biography from her 1996 induction into the American Nurses Association’s Hall of Fame notes: “A modern legend in nursing, Virginia A. Henderson has earned the title ‘foremost nurse of the 20th century.’ Her contributions are compared to those of Florence Nightingale because of their far-reaching effects on the national and international nursing communities.”

(Subscribers to AJN have full access to AJN’s complete archives, chronicling 114 years of nursing—very worthwhile browsing!)

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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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