Archive for the ‘nurses’ Category

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A QI Project to Increase Nurses’ Use of ‘Smart’ Pump Libraries

February 1, 2012

By Sylvia Foley, AJN senior editor

In January 2009 an independent community hospital in Massachusetts switched from using older, outmoded IV pumps to using “smart” pumps—pumps that have built-in computers with libraries of information on selected drugs and fluids, including predetermined concentrations and volumes with relevant administration limits. Library subsets (called profiles) contain information specific to certain patient populations or care areas. When properly implemented, these devices can be invaluable tools in reducing the risk of medication errors and improving patient safety.

Photo courtesy of Alaris

But when the hospital conducted a review, it found that smart pump libraries had been used in only 37% of all smart pump infusions done between January and June. One reason was that no “owner” had been assigned to oversee the implementation process. So the hospital’s nursing quality team (NQT) and pharmacy quality team began collaborating to find ways to increase nurses’ use of the pump libraries.

From July through October 2009 the NQT implemented several interventions. Author Andrew D. Harding describes the project as it evolved and reports on the results in this January CE feature, “Increasing the Use of ‘Smart’ Pump Libraries by Nurses: A Continuous Quality Improvement Project.” Read the rest of this entry ?

Posted in continuing education, nurses, nursing perspective, patient safety | Tagged , | 1 Comment »

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Legacy of the Living Legends: Slackers Need Not Apply

October 27, 2011

By Shawn Kennedy, editor-in-chief

Earlier this month, I attended the American Academy of Nursing 38th Annual Meeting and Conference. With e-mails flooding my inbox and a full meeting agenda over the next few days, I was thinking of skipping the 2011 Living Legends event that took place on the first evening. Thankfully, an old friend, nurse historian Sandy Lewinson, talked me into going—it was one of the more memorable nursing events I’ve attended.

The academy honors “Living Legends” in recognition of the multiple contributions these nurses have made to the profession and the impact these contributions have made on health care in the United States and abroad. This year’s honorees are shown in the photo, from left: May L. Wykle, Meridean L. Maas, Ada Sue Hinshaw, Suzanne Lee Feetham, and Patricia E. Benner.

Credited with such achievements as creating a nursing taxonomy on nursing error, building the science of pediatric nursing in the context of the family, conducting ground-breaking nursing research, developing and implementing professional nurse governance in employing organizations, promoting policy change, and addressing the nursing shortage, these nurses join 77 other nursing notables who’ve been so honored since the first class was named in 1994. Read the rest of this entry ?

Posted in nurses, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 2 Comments »

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Toward a Less Painful Death: ICD Deactivation at End of Life

October 14, 2011

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

Lightning by snowpeak, via Flickr

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So it’s essential for providers and patients to talk about the possibility of deactivation, well in advance of such crises.

Russo, the coordinator of the pacemaker clinic at the Department of Veterans Affairs Medical Center in New York City, wanted to better understand why providers and patients weren’t discussing this possibility and to find ways to promote more timely discussions. Read the rest of this entry ?

Posted in audio interviews, continuing education, ethical issues, nurses, nursing research, pain control, palliative care, patient perspective | Tagged , , , , , | Leave a Comment »

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Caring for Suicidal Children in the ED

September 1, 2011

By Sylvia Foley, AJN senior editor

Emergency lights #5, by DrStarbuck via Flickr

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and the hospital staff safe as the day progressed. Read the rest of this entry ?

Posted in audio interviews, children's health, continuing education, nurses, patient safety, practice tips, school nurses | Tagged , , , , , , | Leave a Comment »

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Tragedy into Policy: A Hepatitis C Outbreak and a Study of Nevada RNs Lead to New Protections for Whistleblowers

June 7, 2011

By Sylvia Foley, AJN senior editor

In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.

Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?

Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 2 Comments »

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What Is the Role of the Staff Nurse on a Medical Emergency Team?

May 25, 2011

By Sylvia Foley, AJN senior editor

There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)

But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.

The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:

  • Nearly three-quarters of the respondents had participated in a MET call.
  • The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
  • But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?

Posted in continuing education, nurses, nursing perspective, nursing research, patient safety | Tagged , , , , , | 1 Comment »

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Farewell to Nurses Week 2011

May 18, 2011

By Shawn Kennedy, AJN editor-in-chief

So Nurses Week 2011 has come and gone. I was in Malta at the start of it—at the 2011 International Council of Nurses (ICN) meeting in Valletta—and in New York City at the end of it.  From two disparate locations, there was a singular thread: nurses seeking information to improve the lives of their patients and themselves.

In Malta, there were over 2,000 nurses from all over the world. Some participated as their nation’s representatives in the Council of National Representatives (see an earlier post describing ICN activities); some came for the educational sessions, or to share experiences or initiatives that have made a difference in the lives of nurses or patients. (I wrote about two of these moving stories.) The conference also served as a reminder of how much I regret not being fluent in another language—four years of high school French and a French-speaking grandfather helped a little, but there’s nothing like meeting colleagues who speak two or three languages (their own native language, English, and usually a bit of another one) to make you realize how necessary it is to be multilingual in today’s world.

On one day, I was eating lunch with colleagues from Brazil and Belgium. Read the rest of this entry ?

Posted in advocacy/political action, infection control, international nursing, nurses, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged , , , | 3 Comments »

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Bearing Witness: April’s ‘Art of Nursing’ and Cover Art

April 14, 2011

By Sylvia Foley, AJN senior editor

In “Palm Sunday,” the poem featured in this month’s Art of Nursing, nurse and poet Rachel Betesh evokes the prolonged anguish of those who tend the dying. A man lies “sick and stained” in a bed, leaves his food untouched, and “hardly speaks anymore.” His wife and sons lament “the sin of the too-long moment”; time does not heal, but gapes like an “open wound between sickness and dying.”

A lesser poem might have slipped into sentimentality. But Betesh’s characters are a lively, indomitable bunch. “Pop!” the man’s sons say, visiting; you can feel their vigor. His wife remembers a baked potato he’d once given her, and her response: “You gonna marry me or what?” Indeed, it’s through witnessing, hearing the family’s stories, that the nurses can offer some comfort. They cannot heal the man, but they can “pack the wound, and listen.” (Art of Nursing is always free online—just click through to the PDF file.)

Windows and Doors by Paula Giovanini-Morris

This month’s cover art, a work of embroidery by nurse and fiber artist Paula Giovanini-Morris, explores the concept of memory and illustrates its mechanisms, the neurons and synapses through which the brain registers, encodes, and retrieves events. The piece, titled “Windows and Doors,” was prompted by another kind of witnessing: the artist’s visits to her mother, who was suffering from the early stages of dementia.

AJN senior editorial coordinator Alison Bulman spoke with Giovanini-Morris, who explained, “As I watched [my mother] search for words to express herself and attempt to recall recent events, I was struck by a sadness, realizing that in a short period of time the mother I knew might be replaced by someone who had no idea who I was.” Giovanini-Morris also acknowledged that she faces the possibility that she might eventually suffer from dementia herself. For more on this artist and her work, read this month’s On the Cover.

If you’re interested in submitting your own work to Art of Nursing—we consider visual art, very short “flash” fiction, and poetry—send me an email (sylvia.foley@wolterskluwer.com) for more information.

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Posted in art and nursing, home care nursing, nurses, nursing perspective, palliative care, patient perspective, writing and nursing | Tagged , , , , | 1 Comment »

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‘A True Art’: Strategies for Feeding Patients with Dementia

April 1, 2011

By Sylvia Foley, AJN senior editor

The fork and the spoon, by Jordan Fischer via Flickr

Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:

People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.

In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. Read the rest of this entry ?

Posted in continuing education, nurses, nursing research, palliative care, practice tips | Tagged , , , | 1 Comment »

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The Shape of a Woman: Two Poems in ‘Art of Nursing’

February 4, 2011

By Sylvia Foley, AJN senior editor

Abstract ice patterns by net_efekt, via Flickr

“I think about the woman / wilting // on the pillow of the steering wheel,” begins Stacy R. Nigliazzo’s poem “Sketch,” featured in this month’s Art of Nursing department. As the title suggests, the poem sketches out a scene, the immediate aftermath of a car accident. The driver appears dead; the paramedics “offer her up, prostrate / in white splints,” while the physician records the time. The narrator—who might be an ED nurse (perhaps Nigliazzo, an ED nurse herself)—describes what she sees. And as she does, we feel the terrible burden of her witnessing: the victim’s eyes brim “like black bowls that can’t be filled.” When the victim has been taken away, we’re left with almost nothing, only some coins and “buckled lines / in the shape of a woman.” It’s a short, spare piece that conjures up far more complicated matters, like where the dead reside, and how the living might go on.

The narrator of “Connection,” the poem by Camille Norvaisas that’s featured in January’s Art of Nursing, has undergone a double mastectomy. She is shockingly direct in her stated desire. “I want to feel the same / as my nipples, so cold, / in some jar in a sterile lab,” she tells us. She’s trying to comprehend a literal disconnection: once her breasts were part of her; now, “referred to as tissue,” they lie on a stainless steel table somewhere awaiting dispassionate study. The poem hums with sensation, real and imagined. Somehow it manages to be both fierce and stoic in its lament.

Have a look at these poems, sit with them a while; poems tend to reveal more upon rereading. (Art of Nursing poems are always free online—just click through to the PDF files.) And if you’re interested in submitting your own work to Art of Nursing—we consider visual art, short-short fiction (750 words max), and poetry—feel free to send me an email (sylvia.foley@wolterskluwer.com) for more information.

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Posted in art and nursing, healing/holistic, nurses, nursing perspective, patient perspective, writing and nursing | Tagged , , , | 2 Comments »

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