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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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Saving ‘Mimi’: How Nurses Can Combat Human Trafficking in the USA

February 1, 2011

By Sylvia Foley, AJN senior editor

Never to lie . . . by flickrohit, via Flickr

Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.

In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?

Posted in advocacy/political action, audio interviews, children's health, continuing education, human rights, nurse practitioners, nurses, nursing students, patient safety, practice tips | Tagged , , , | 1 Comment »

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Placenta Facebook Photos: Nurse and Mommy Tribes See Student Expulsion Differently

January 12, 2011

By Shawn Kennedy, AJN editor in chief

Many of you may be familiar with the recent “nursing-in-the-news” topic involving nursing students and a placenta. (For those who’ve been out of touch, here it is in a nutshell: three students were involved in photographing themselves with a placenta from a recently delivered mother and posting it on, where else, Facebook. The students were expelled. One student sued; the judge ordered all the students reinstated. See this article by the Kansas City Star that sums it up.)

The incident has provoked debate on various Web sites, including our own Facebook page, where the discussion mainly concerns whether the students were treated fairly or too harshly:

“It’s a placenta. I agree that it can seem a bit juvenile to photograph yourself with it, but an offense worthy of expulsion?”

“Juvenile? Perhaps. Punishable by expulsion? Absolutely not, imo. What exactly was wrong with taking a picture of a placenta? It’s not like you can identify who the placenta came from.”

“I think she should be punished but not expelled. in all reality a placenta is medical waste after delivery but it showed no respect for her patient, which needs to be addressed.”

And a really interesting question:

“Would she have been handed the same punishment had it been a picture of a full bed pan?”

Other sites also argue the “no harm, no foul” rationale—since there was no way to link the organ to a patient and so no breach of privacy, what was the harm? Comments on one of several posts about this issue at Those Emergency Blues came out in favor of the students. Nurse and blogger Phil Baumann’s post, “The Placenta Incident and The Shawshank Redemption,” did as well.

The school did seem to react harshly, especially when there seems to be some question as to whether the clinical faculty member might have been aware of the students’ activities.

However, there was a decidedly different tone on a blog called The Stir at CafeMom, a Web site focusing on pregnancy and motherhood, that should give us pause. Author Jean Sager writes the following in a post called “New Pregnancy Fear: Who’s Got Your Placenta Now?”: Read the rest of this entry ?

Posted in ethical issues, legal issues, media depictions of nursing, nurses, nursing perspective, nursing students, patient perspective, professional identity, Shawn Kennedy, AJN editor-in-chief, social media | Tagged , , , , , , , , , | 18 Comments »

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‘The Birthplace’: Showcasing a Collaborative Practice Model

December 21, 2010

By Sylvia Foley, AJN senior editor

Megan Tudryn, RN and expectant mother, undergoes a contraction. Photo by Alice E. Proujansky; all rights reserved.

Photojournalist Alice E. Proujansky reports in AJN this month on The Birthplace, a collaborative care practice model at Baystate Franklin Medical Center in Greenfield, Massachusetts, where a team of five nurse midwives, three obstetricians, and 35 nurses attend some 400 to 500 births annually. Except for preterm and other higher-risk deliveries, the nurse midwives manage all deliveries and monitor fetal and maternal health. Patients complete detailed birth plans that afford them various care options. Physicians are called in only when necessary; as one nurse midwife told the author, “There’s an awful lot that we can do on our own.”

How well does the model work? The Birthplace has lower-than-usual rates of medical interventions such as episiotomy, epidoral anesthesia, and cesarean section. The patients have greater autonomy and decision-making capabilities. And the practitioners “relish the collaborative approach,” says Proujansky, who interviewed several clinicians and patients for the article; her photographs appear alongside the text and on the December cover. Proujansky’s last piece for AJN, a photo essay on a Dominican maternity ward, appeared in our December 2008 issue; read it here.


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Posted in children's health, nurse practitioners, nurses, nursing innovations, patient perspective | Tagged , , , , | Leave a Comment »

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When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

December 14, 2010

By Sylvia Foley, AJN senior editor

Coffee Time (detail) / by S.M. Drawing used with permission of family.

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two of these drawings illustrate the article (a detail from one is shown above). The authors also profile one facility’s approach to pain assessment of its patients. And they discuss collaborative team solutions with AJN interim editor-in-chief Shawn Kennedy in this podcast interview.

Have you  faced the challenge of assessing pain in patients like S.M.?

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Posted in art and nursing, audio interviews, continuing education, nurses, nursing perspective, pain control, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 3 Comments »

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