Archive for the ‘nursing perspective’ Category

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Angelina, Florence, End-of-Life Care, Nursing History, Postpartum Depression: A Web Roundup

May 14, 2013

By Jacob Molyneux, AJN senior editor/blog editor

In the news today we have an op-ed piece in the New York Times by Angelina Jolie about her rationale for getting a double mastectomy. There are sure to be many reactions to this disclosure, with many offering praise for her frankness about her decision. There may also be some who disagree with her decision to take this preventive step because she has the BRCA1 gene, which sharply increases her risk of getting breast cancer. Jolie’s perspective seems to be one of empowerment for women rather than a sense of helplessness or sorrow. Though Jolie’s circumstances are hardly universal in terms of the cushion provided by her great wealth, it’s hard not to admire the strength it takes to see things in such a positive light: “Life comes with many challenges,” she writes. “The ones that should not scare us are the ones we can take on and take control of.”

MarchCoverIt’s come to our attention that, in honor of Nurses Week, the American Antiquarian Society blog, PastIsPresent.org, put together an interesting collection of items related to nursing from its mid-19th century archives, leading their post with a mention of AJN‘s March cover, which featured a vintage illustration, “A Map of the Open Country of  Woman’s Heart.”

A recent post we ran about the fading away of certain nursing blogs gets a mention from PixelRN, who has written a post called “Why I Stopped Blogging.” Short answer, for her: she stopped working in nursing, and “life got difficult.” Understood. As always, we hope new voices will pick up where the early nurse blogging pioneers have left off.

At the INQRI blog, there’s a post about recent nurse-related research, including the finding that nurse home visits decrease postpartum depression. Yes, in a way this is obvious, in that we are well aware that a little attention from nurses could, in many instances, go a long way toward preventing more serious problems down the line. But it’s good to let it be known far and wide in this age of sequestration cuts and lean staffing.

And in the May issue of AJN, Joy Jacobson gives an in-depth look at the important and timely subject of end-of-life care, paying special attention to recent research, whether or not we are improving the quality of the dying experience or still focusing too much on aggressive treatment, and the important role played by nurses at this crucial time when families and patients need a truly understanding presence at the bedside: “Palliative and End-of-Life Care: Where Are We Now?”

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Surely, ‘Tis Not an Easy Cap to Satisfy…

May 8, 2013
Photo from otisarchives4, via Flickr.

otisarchives4/Flickr.

By Karen Roush, AJN clinical managing editor

Though the nursing cap went by the wayside years ago, this beautifully written essay by a nurse about her cap, published in AJN in April, 1929, struck me as a metaphor for many things—nursing itself chief among them. And though the wearing of a cap may have changed, what this author expressed in 1929 about nursing hasn’t: “sympathy without sentimentality; broad understanding without cynicism; charity without weakness.” The opening paragraphs are below, but the entire essay, “My Cap,” will be free until next week on the AJN Web site.

CapExcerpt

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In Celebration of Nurses: Voices from AJN Archives

May 6, 2013

Today starts Nurses Week. AJN is participating in Lippincott’s Nurses Week initiative, and the entire May issue will be set for open access this week. Additionally, we are reprinting here a wonderful editorial from one of AJN’s former editors, Mary Mallison (click the text below for a larger version, or go to this link for the PDF version, free until June 6). Check in each day as we post voices from nurses from the AJN archives. Enjoy and take pride in our profession, in all that nurses have accomplished, and what nurses are doing today.—Shawn Kennedy, AJN editor-in-chief

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Healthcare Editors Society Gives AJN Awards for Cartoon Cover, Three Blog Posts

May 1, 2013

ashpe award 2013-1To briefly toot our own horn: The American Society of Healthcare Publication Editors (ASHPE) recognizes editorial excellence and achievement in the field of health care publishing. AJN has received 2013 silver awards for the October 2012 cover (see image below) and for three blog posts:

“Grief: The Proposed DSM-5 Gets It Wrong,” by Karen Roush, AJN clinical managing editor

“The Cruel Irony of Alzheimer’s Disease,” by Amy Collins, AJN editor

“Forward or Back? Some Personal Notes on Why the Affordable Care Act Matters,” by Jacob Molyneux, AJN senior editor/blog editor

AJN1012.Cover.Online

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The Nuts and Bolts of Fluid Therapy in Critically Ill Patients

May 1, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the day when I was a bedside nurse, hemodynamic monitoring was just coming into play, and then only in coronary care. In the ER, we relied on a combination of vital signs (pulse and BP), urine output, and central venous pressure (CVP) to guide fluid administration. Later, patients in need of close monitoring received arterial lines to monitor pulmonary arterial pressures; monitors and stopcocks were everywhere (and soon after, infections, but that’s another story . . . ).

But things are changing again, and the trend is toward less-invasive monitoring. In our May issue, we’re pleased to bring you a comprehensive CE article (worth 2.6 contact hours), “Using Functional Hemodynamic Indicators to Guide Fluid Therapy.” The author is Elizabeth Bridges, PhD, RN, CCNS, an associate professor in biobehavioral nursing and health systems at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center in Seattle. Many critical care nurses will know her from her “standing room only” research sessions at the American Association of Critical Care Nurses National Teaching Institute (this year it will be in Boston, May 20–23), in my view one of the best annual national nursing meetings.

Here’s the article abstract:

Hemodynamic monitoring has traditionally relied on such static pressure measurements as pulmonary artery occlusion pressure and central venous pressure to guide fluid therapy. Over the past 15 years, however, there’s been a shift toward less invasive or noninvasive monitoring methods, which use “functional” hemodynamic indicators that reflect ventilator-induced changes in preload and thereby more accurately predict fluid responsiveness. The author reviews the physiologic principles underlying functional hemodynamic indicators, describes how the indicators are calculated, and discusses when and how to use them to guide fluid resuscitation in critically ill patients.


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Misplacing Our Focus on Quality Improvement

April 24, 2013

Gold_StarBy Maureen Shawn Kennedy, AJN editor-in-chief

I welcome manuscripts written by nurses in clinical practice, especially comprehensive updates on managing a clinical syndrome or a common problem that readers would find informative and interesting. I call these the “meat and potato” papers—the ones that provide substantial content, the need-to-know information that will help nurses provide quality, evidence-based care. The best ones discuss the physiology and pathology underlying clinical symptoms, practice implications for ongoing monitoring and management, and patient and family teaching and concerns.

The other papers I value are those that describe quality improvement initiatives or processes that improve outcomes and, by following the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, are sufficiently detailed so that others can replicate them. (For information on what we seek to publish, see a recent blog post.)

Lately, though, I’m seeing more and more submissions that are not so much focused on how to use best practices to improve care, but rather on ways to improve scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The authors typically describe the impetus for the improvement as low scores, get administrative support to set benchmarks for improving scores, and define success as improved scores. Often the changes are clinically insignificant but scores increase, so everyone is happy.

While the HCAHPS is a national measure that has been adopted as a measure of quality, it’s important to keep in mind that it measures the patient’s experience and satisfaction with only a few selected aspects of care, such as, according to the official HCAHPS Web site, “communication with nurses, communication with doctors, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.” And because these measures  are tied to reimbursement, they receive a lot of attention.

There are many more aspects of care—treatment based on evidence, thwarting complications, early mobility to prevent pressure ulcers, adequate patient and caregiver teaching to prevent readmissions, to name a few—that are not measured in such a direct way and that may not be visible to patients and families, but may be more critical to a successful hospital experience.

We need to take a balanced approach to assessing quality and to be sure we’re placing emphasis on the right things. And while patients and their families are—or should be—at the center of what we do, our improvement initiatives shouldn’t be focused on getting a “gold star” for customer service.

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Posted in nursing perspective, patient safety, Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged , , , , , | 1 Comment »

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Good Medicine

April 22, 2013

musichospitalroomBy Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped cold by the slow drawing of a wide-toothed comb through someone’s hair, seen someone instantly relax when provided pictures of a beloved pet, and have witnessed music provide relief more than once.

Small measures, perhaps, but sometimes little things matter a lot, and good medicine doesn’t always come from a vial.

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Posted in healing/holistic, nursing perspective | Tagged , , , , , , | 4 Comments »

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Friday Nursing Blogs Roundup, More or Less

April 19, 2013

By Jacob Molyneux, AJN senior editor/blog editor

BostonAnother Friday in New York, and it’s time to do a quick tour of the nursing blogosphere after a grueling week in which the city I will always think of as home, Boston, took a major hit on a holiday that always marks the end of a long winter, the first stirrings of spring, the Red Sox playing in the morning, no one at work, glimpses of marathoners passing in the distance up still salt-stained avenues under barely budding trees, usually in bright sun and a gusty breeze with an underside of chill.

I have noted ad nauseam in the past that blogs have life cycles, wax and wane, flourish or fade out. And that’s okay. Though maybe blogs should go to a blog graveyard at some point, or be given a proper burial, or demolished like old buildings in a great controlled cinematic whoosh of collapsing pixels and pixel-dust. Or, in some cases, put in a museum to mark a moment in Web history or preserve particularly lively voices and experiences for posterity.

Enough throat clearing. There isn’t much out there to report this week. We try to collect links to sane, more or less active blogs on our nursing blogs page. A few nurse bloggers are perennially engaging and active, and a couple of these excellent bloggers even write occasional posts for this blog, so for once I won’t draw attention to them. But here’s what else I could find:

We the people. Many nurse blogs and Twitter streams and Facebook pages have been posting links to a petition to the White House to remove barriers preventing advanced practice nurses from practicing to their full scope. The petition has until just April 22 to reach the required 100,000 signatures; the last time I checked, admittedly about a week ago, it was only about a quarter of the way there. If you happen to know Justin Bieber, please ask him to publicize this. In lieu of that, consider sending it to your social media connections, and take a moment to sign yourself.

A brief note on the readability of blogs. By “readability,” I’m not talking about style, as you’d expect, but more about how easy and pleasant the blog is to read in an actual physical sense. The right word might instead be “legibility.” Or, put another way, did you choose a green or black or red background for your text? Though it’s nice to be reminded of the early days of the Web and the idiosyncratic appearance of many blogs, I now find blogs with such colored backgrounds almost impossible to read. Consider making a change to something closer to the traditional black text on a whitish background. And consider avoiding flowery fonts.

More on nurse staffing and why it matters: at the INQRI (Interdisciplinary Nursing Quality Research Initiative) blog, further confirmation that “better nurse staffing, education and work environment contribute to patient outcomes”:

A new study in Medical Care, conducted by Matthew McHugh, an RWJF Nurse Faculty Scholar,
finds that the lower mortality rates at Magnet Hospitals are achieved
in part because of investments in nursing. This study reflects many of
the findings of INQRI studies into the impact of nurse staffing, work environment and education on quality of patient care.

Conference tips. At In the Round, the blog at Nursing Center, a short post lists “tips and time-savers” for those of you who from time to time attend professional conferences. I used to go to a lot of them, and they really do take practice and some strategy.

Already sick of Nurses Week and Nurses Day (and still wondering about whether to use an apostrophe s or just an apostrophe or nothing with them)? At Impacted Nurse, there’s a strangely heartwarming yet appropriately skeptical piece called “Note to Nurse Day: I don’t need to write some silly note.”

And that’s really it for today. Have a great weekend, and let us know if you find a really good nursing blog we don’t know about yet.
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The Hands of Strangers

April 16, 2013

By Karen Roush, AJN clinical managing editor

Boston MarathonA marathon is a triumph of spirit and endurance. It is a solitary endeavor carried along by a hundred thousand strangers. Anyone who has run a marathon knows that the spectators are not merely spectators. They are participants—they give their energy, their encouragement, their voices; they become part of your will, your perseverance; they carry you forward. Some part of every voice, every hand touched, crosses that finish line with you.

A marathon takes place in a particular city but it belongs to the world. For months, even years, someone in Sydney, in Kampala, in Seoul, in Cedar Rapids, in Damascus, in some small unknown village and in every great city, prepared for those same 26.2 miles ending yesterday at Boylston Street in Boston.

When I think about the marathons I’ve run, it is not crossing the finish line that I remember. What I took away, and what stays with me to this day, is a powerful and joyful sense of our shared humanity. That is what the bomber tried to shatter yesterday.

I have no doubt that in time investigators will find answers to who did this and why. But the greater questions will remain. How do we live with the certainty of our vulnerability? How do we come together freely and joyfully, knowing the threat that walks in our midst? How do we stay open enough to reach our hands out to strangers?

As we grieve the terrible losses suffered in Boston and face an uncertain future, we need to be like those participants lining the route, sharing our energy and voices to carry each other forward. We need to refuse to allow anyone to shatter our shared humanity.

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Finding Future Leaders – and a NICHE in Nursing

April 15, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

It has been a hectic few weeks, as I’ve been traveling to the early spring nursing meetings (with still more to come).

With John Gransbach at NSNA meeting

With John Gransbach at NSNA meeting

First I went to Charlotte, North Carolina, to attend the National Student Nurses Association (NSNA) annual meeting (April 3–7). AJN has had a long association with the NSNA, supporting it in various ways since its 1952 founding, from hosting board meetings at AJN offices to producing the convention newsletter to convention scholarships for key contributors. In recent years, we’ve sponsored travel expenses to the annual meeting for the winner of Project InTouch, the member incentive plan. This year, the winner was John Gransbach, who graduated from the Goldfarb School of Nursing at Barnes-Jewish College in St Louis. He recruited 228 new NSNA members—an achievement certainly worth recognizing.

Future leaders. As I told the audience when I presented the plaque to Mr. Gransbach, this award isn’t just about growing membership in the NSNA—it’s about contributing to the future of the profession. Students who join the NSNA are already demonstrating a commitment to nursing by going beyond what’s required of them. They’ve joined an organization that provides considerable resources to help them begin their careers. Not only does it provide practical help with passing the NCLEX exam, writing a resume, and finding a job, but it informs them about what it means to be a nurse. NSNA members are the future of nursing and likely the future leaders of nursing. We’re pleased to support this award and NSNA.

NICHE. And this past week I was in Philadelphia for a meeting of the Nurses Improving Care for Healthsystem Elders (NICHE) initiative, a program based at New York University College of Nursing that seeks to provide education and resources to improve care for hospitalized older adults. It provides training curricula and tools to the 450 hospitals that are members of the NICHE network. Much of the agenda focuses on initiatives that NICHE members have successfully implemented to improve care.

NichePhotoAJN partnered with NICHE in a joint initiative, “Professional Partners Supporting Diverse Family Caregivers Across Settings,” funded by the Jacob and Valeria Langeloth Foundation in collaboration with the AARP Foundation. (Pictured in the photo are, from left: Liz Capezuti, director, NICHE; Susan Reinhard, senior VP, AARP Public Policy Institute; Rita Choula, program manager, strategic initiatives, AARP; myself.)

Helping family caregivers. We worked with NICHE to develop a series of articles and videos designed to teach nurses concepts and skills to help them better support family caregivers in assuming care for loved ones after hospital discharge. These materials were used in training staff and as a basis for developing family-centered practices, which were then piloted in five NICHE hospitals. Dennise Lavrenz, the NICHE coordinator on the project, presented some initial results that were encouraging. Overall, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores, caregivers showed increased satisfaction with their experience and with staff communication and felt more prepared to care for family members.

At the meeting, presenters from Carolinas Medical Center-Mercy in Charlotte, North Carolina, discussed their success in improving caregivers’ experience through employing a caregiver assessment tool, paying closer attention to caregivers’ information needs, and providing the caregiver with a tote bag of personal items for their use when their family member was admitted to the hospital. What started as a nurse-driven pilot on two units was now being rolled out hospital-wide—certainly a success story for the nurses who spearheaded the project and and the hospital, but most of all, a win for the caregivers.

The NICHE Web site offers a wealth of information; you can also find AJN-produced, foundation-funded resources for caring for older adults at this Web page; or access AJN’s family caregiver videos here.

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