Archive for the ‘Nursing perspective’ Category

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Addressing Alarm Fatigue in Nursing

March 2, 2015
by flattop341/via flickr

by flattop341/via flickr

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

“Will you please silence that alarm?!” The nurse is on the phone, and can’t reach the screaming cardiac monitor. It’s a normal request, considering that we’re working together in an ICU and the alarm has been ringing for awhile.

But her request for silencing the alarm isn’t issued to me; she’s talking to the unit clerk. Stuck in my patient’s room, I watch as this untrained staff member taps the flashing rectangle on the unit’s central monitor. Without having first been appropriately evaluated, the ringing disappears, along with the words “Multifocal PVCs.”

Later, the same unit clerk absentmindedly turns off a sounding alarm, without encouragement from a nurse. I’m floating today, and although I’ve just met her, I can’t help but ask, “Do you know what that alarm was saying? Was it accurate?”

She is clearly startled by my admonishment, but I persist. “A lot of the alarms around here do seem to be false, but what if this one wasn’t? Do you have the training to know the difference, and to report it?”

If looks could kill, the one that meets my gaze is certainly homicidal, but it’s paired with a grumbled promise to never touch the screen again. So maybe my point has stuck. Read the rest of this entry ?

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AJN in March: Post-ICU Syndrome, Workplace Conflict Resolution, Prostate Cancer Options, More

February 27, 2015

AJN0315.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss.

New program for postintensive care syndrome (PICS). With increased ICU survival rates, we are seeing more complex cognitive, physical, and psychological sequelae. The authors of “Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors” share how they created and implemented an evidence-based collaborative care program for ICU survivors to reduce morbidities that can affect their quality of life. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Helping men with localized prostate cancer make informed decisions. The information men receive at diagnosis of prostate cancer can be overwhelming. “Early Localized Prostate Cancer” reviews the multiple treatment options available for men with newly diagnosed, low-risk, localized prostate cancer and explains how nurses can help these men make informed decisions. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). Read the rest of this entry ?

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Tips for Getting a Nursing Job Interview in the Age of Electronic Applications

February 26, 2015

Illustration by the author

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration is by the author.

Twenty-plus years ago I was job hunting in Portland, without a local connection in health care. Prepared with an Oregon nursing license, I applied for the only two open pediatric ICU positions in the city, found in newspaper want ads. The positions were in the same unit. Having several years of PICU experience, I was hopeful that I’d get an interview.

Two weeks went by without a phone call for an interview. Worse, I noticed that only one of the postings remained. With nothing to lose, I called the hospital’s human resources department.

“Hi, I applied for the positions of pediatric intensive care nurse at your hospital,” I said. “I see that one has been filled. I have seven years of experience, including transport of critically ill children, and PALS certification. I’m curious if there’s a reason I haven’t been offered an interview? I know if the manager meets me, she’ll love me.”

“I’ll look up your application, and get back to you,” was the response. Half an hour later, the PICU nurse manager called to set up an interview. “I’m sorry,” she explained. “Your application didn’t make it to my desk. Apparently it was misplaced by HR.”

I was hired at the interview, and held the position happily until transitioning to adult oncology 12 years ago.

My homespun approach may not work in today’s job market. First of all, nursing jobs are applied for online. The electronic application creates a formidable hurdle, as I learned recently while pursuing a new nursing position. If you’re really good on the phone, a follow-up call to HR might get you the phone number of the hiring manager’s office assistant, but don’t expect a return call for the voice mail you left her. It’s more likely that the HR representative will politely respond, in so many words, “Don’t call us, we’ll call you.”

Although I sought a specific position, I needed a back-up plan in case I didn’t get it, so I applied for a few others. Many experienced nurses move from job to job by calling colleagues or past managers, but most of mine had retired or moved. I was just another nurse applying electronically for a job.

If you’re a nurse looking for work, here are some ideas for getting past gatekeeping electronic applications and, hopefully, scoring an interview. Read the rest of this entry ?

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The Delicate Dance for Stability

February 23, 2015

By Patricia O’Brien

Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons

Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons

In college I got a part-time job as a companion to an elderly widow named Fran, driving her around town and assisting with errands: post office, hairdresser, the market, her psychiatrist. The routine was set, and all was well for many months.

But one day, something unusual happened. Fran opened her door with a grand flourish, eyes shining. The television, radio, and blender were blasting. “Shall we go,” I asked, hurrying to turn off the noisy electronics.

“Fran,” I observed, “the blender’s empty.”

“Let’s not bother with tiresome details. I’m out of my head today,” she said, with purposeful excitement. At the pharmacy, this time, I took notice of the medication I picked up for her: lithium.

“What’s lithium for?” I asked, sliding into the car.

“A bipolar disorder. Not to worry. I’ve navigated these choppy seas half my life.”

We did errands. All the while, she acted like she was on the campaign trail for mayor, laughing, waving to friends, and smoking up a storm. At the market she hugged the meat manager, who was arranging Italian sausages. He looked confused, but smiled and told her there was a special on calf’s liver.

“I’ll take it all,” she declared, making a grand gesture with her newly acquired Cecil B. DeMille tendencies. Read the rest of this entry ?

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Strong Nurse and Patient Voices On the Blogs This Week

February 20, 2015

By Jacob Molyneux, senior editor/blog editor

Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

Here’s a short Friday list of recent smart, honest, informative blog posts by nurses, as well as a couple of interesting patient perspectives on prominent types of chronic illness and the ways they are talked about by the rest of us.

At Head Nurse, in “Yes…No. I’m Having Some Thoughts About BSNs,” an ADN-prepared nurse makes some familiar and some more surprising observations about the effects of the new policy of hiring mostly BSN-prepared nurses at her facility as it tries for Magnet status. For example, one of the effects she notes is “a massive drop-off in terms of the diversity of our nursing staff.” The move toward BSNs is obviously the trend in nursing, and is supported by research, but this doesn’t mean that there aren’t still two sides to the issue, or real unintended consequences to address as this change is gradually implemented.

At Hospice Diary, the blog of hospice nurse Amy Getter, there’s a post called “Hearts, Flowers, and Bucket Lists.” Reflecting on the imminent death of a patient, the author puts the popular notion of bucket lists into perspective:

“I think about some of the things I would still like to do in my life, and realize . . . . most of those wish-list items would be swept away in a moment, if I only had a little time this week. I would hug my kids harder and love more, and want to squeeze every last drop of time to put into my relationships that I will have to leave behind. “

Staying with the end-of-life theme for a moment longer, you’ll find at Pallimed, a very good hospice and palliative medicine blog, a new post with a to-do list that some of us or our loved ones really can’t put off until next month or next year: “10 Practical Things to Do When Diagnosed With a Serious Illness.”

Two consistently good nurse bloggers, both of whom have written for this blog or for the journal itself from time to time, happen to have reviews of books about aspects of nursing on their blogs this week. Read the rest of this entry ?

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Fish Safety Concerns: Navigating the Waters

February 19, 2015

Considering the conflicting advice on eating fish that has appeared in the media over the past few years, the public is undoubtedly confused. Nurses and other health care professionals will likely find themselves having to address this issue, especially with pregnant and nursing patients and parents of young children, all of whom are likely to be concerned.

–(from “To Eat Fish or Not to Eat Fish” in the February issue of AJN)

Photo by Emilio Ereza/ag e fotostock

Photo by Emilio Ereza/ag e fotostock

I’ve been hearing about the unexplained illness of a good friend’s close colleague for a number of months. Dozens of costly and invasive tests have been performed to explain her malaise, headache, chronic stomach and digestion problems, fatigue, dizziness, and so on. Recently, a potential culprit was identified: mercury poisoning. I don’t know all the facts, but her mercury poisoning may well have something to do with the fact that she eats sushi at least once a week, and perhaps a lot of other mercury-containing fish as well.

What does this have to do with nursing? Maybe a lot, in terms of providing sound nutritional advice to patients who might be at particular risk for mercury poisoning, or in terms of adding mercury poisoning to the list of possible causes of certain nonspecific complaints.

There’s no doubt that eating fish can be good for us for a number of reasons. We know, for example, that some fish can be an excellent source of omega-3 fatty acids. But there’s a lot of contradictory information out there about which fish are most harmful, which actually have the most omega-3 fatty acids, how often we should eat which fish, and so on—in short, the waters are hard to navigate. Read the rest of this entry ?

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Paired Glucose Testing With Telehealth Support to Empower Type 2 Diabetes Patients

February 13, 2015

Jacob Molyneux, senior editor

bloodglucosetestingType 2 diabetes is challenging for those trying to meet blood glucose target ranges, often requiring one or more daily medications, increases in exercise, changes in eating habits, and self-monitoring of glucose level. Those who are willing and able to learn about factors affecting their glucose level and to make small daily efforts in one or more areas have the potential to radically improve their sense of control over their diabetes.

This month’s Diabetes Under Control column, “Better Type 2 Diabetes Self-Management Using Paired Testing and Remote Monitoring” (free until April 1), presents a successful story of patient engagement in diabetes self-management. It describes the case of a participant in a clinical trial who, with clinician support, incorporated paired glucose testing (self-testing before and after meals) and telehealth (remote patient monitoring, or RPM).

The article is easy to follow and gives a series of biweekly updates on the patient’s progress. Before the study starts, she’s not very engaged in self-management. For example, she’s only testing her own glucose level three to four times a month. To get a sense of how much more empowered she’s come to feel by week 12 of the protocol, consider this brief excerpt: Read the rest of this entry ?

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