Archive for the ‘Nursing perspective’ Category


Thanksgiving in the ICU: Woven into the Tapestry of Traditions

November 25, 2015

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.) 


I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great joy. I work with people I care about and like so much that I look forward to spending a holiday with them. And at the end of the day I’ll be going home, where my family will be waiting for me, and I’ll hug my kids and count my blessings all over again.

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Imagery: A Safe, Simple Practice Available to All Nurses

November 23, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by Ramon Peco/via Flickr

by Ramon Peco/via Flickr

“In our quest to keep up with the latest medical advances, we often forget that the healing art of imagery is available to each of us,” writes nurse practitioner Laurie Kubes in this month’s AJN. In “Imagery for Self-Healing and Integrative Nursing Practice,” Kubes explores some of the evidence supporting this technique and illustrates how it can enhance both patient care and our own self-care.

Imagery builds upon the quiet reassurance and support that we routinely provide to patients in our efforts to make them comfortable and relaxed. The more deliberate practice of imagery engages the power of imagination for deeper relaxation and a potentially more healing experience. And all we need in order to do this, as Kubes notes, is an open mind, a basic knowledge of the practice, and time to dedicate to it.
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Top Health Story Picks of AJN Contributing Editors for 2015

November 19, 2015

By Diane Szulecki, AJN associate editor

Kelley Johnson by Disney | ABC Television Group via Flickr

Nurse and Miss America contestant Kelley Johnson by Disney | ABC Television Group via Flickr

With the end of the year steadily approaching, AJN asked its contributing editors, editorial board members, and staff to share what they consider to be the most significant health care and nursing-related headlines of 2015 so far. Now it’s readers’ turn. See the top picks below and feel free to leave a comment to share your thoughts and additions to the list.

Clinical/Care Issues

  • The growing patient experience movement and the limitations of patient satisfaction measurements
  • The rise in chronic diseases due to lack of prevention efforts and unhealthy lifestyles
  • Substance abuse, including alcohol, prescription drugs, heroin
  • Vaccinations and issues regarding public trust of vaccines

Professional Issues

  • Nurses’ responses to critical comments made on The View and related ongoing discussion about the nursing profession’s image
  • Challenges and trends in nursing education: the shift toward advanced practice as a career path for many nurses and rapid growth in the number of DNP programs and applicants
  • Workplace stresses: staffing issues, moral distress, strain caused by an aging population with multiple comorbidities, plus an increase in the number of insured due to the Affordable Care Act

U.S Health Care and Health System Issues

  • Gun violence as a critical public health issue
  • Lack of adequate mental health care
  • Health care used as a political wedge by feuding political parties
  • Issues surrounding access to health care, including health equity and culturally sensitive care

Global Health Issues Read the rest of this entry ?


Recognizing and Managing Late or Long-Term Complications in Adult Allo-HSCT Survivors

November 17, 2015

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

Everybody, myself included, thought he was going to die. Another nurse on another floor had administered his stem cell transplant a few weeks prior, but as his primary nurse I was now in charge of managing its aftereffects.

Ben (not his real name, and some details have been changed) was one of the many young patients I’d cared for who suffered from a violent course of complications following allogeneic hematopoietic stem cell transplant (allo-HSCT). Intractable diarrhea and skin sloughing led to graft-versus-host-disease’s usual sequelae: wounds, drug-resistant infections, looming sepsis. The walls of his bladder, scarred and irritated by the myriad of toxic drugs he’d been given, bled. One day, while I slept at home between night shifts, he lost so much blood that they rushed him to the OR. The treatment—never before performed—stopped the bleeding. But it left him in excruciating, around-the-clock pain.

Between regular doses of Dilaudid and PCA pump pushes, he cried out to me, “I can’t do this. I don’t want this anymore.” I couldn’t blame him—his cancer fight raged on endlessly. Watching his boyishly handsome face grimace with so much pain, I remembered other young allo-HSCT patients’ faces, some of them peaceful only in the postmortem.

As it turned out, Ben survived his ICU stay. I heard about his discharge to the bone marrow transplant unit after I returned from a vacation. I lost touch with him, in the way that most ICU nurses lose touch with their patients (as though the unit is earth and the floors are outer planets, foreign and unknown, impossible to visit). I hope he’s home now, though, and a part of me believes he is—living, joining the growing population of allo-HSCT survivors.

As I read Kara Mosesso’s November CE article in AJN,Adverse Late and Long-Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors (the first of several articles from Memorial Sloan Kettering Cancer Center about cancer survivorship care), I thought of Ben and was glad to be reminded that people like him do survive. While the current population of allo-HSCT survivors is fairly small, it’s growing, and by 2020 may reach around half a million worldwide.

It seems that all nurses—whether caring for allo-HSCT patients in the acute phase, like me, or in the chronic phase in an outpatient setting, must become familiar with the multifaceted long-term care of this population of patients. The table below, from the article, lists various late and long-term allo-HSCT treatment effects and their risk factors. Visit the article link above for more context, sources, and more.

Late and Long-Term Allo-HSCT Effects

(click to enlarge)

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Check my Conduct: Committing to a Better Way to Act with Colleagues

November 10, 2015

Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.

Kindness quotation. Photo by Steve Robbins/Flickr

by Steve Robbins/Flickr Creative Commons

I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.

Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”

I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”

Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting tips I learned. But there’s still a problem. I’m concerned about Ms. S. and I’m uncomfortable that I’ve missed something. I think this is a safety issue.”

I recognized Emily’s use of the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS “CUS” words: Concern, Uncomfortable, and Safety, a tool designed to clearly communicate that a patient is at risk for harm when a first attempt to get a safety threat across to a member of the health care team doesn’t work. The initial irritation I’d felt turned to embarrassment, and I answered Emily’s explanation with, “Okay, let’s go see Ms. S.”

I followed Emily to her patient’s room where, together, we figured out the problem. Ms. S. was unharmed. Outside of the patient’s room, Emily thanked me and asked what she could do for me in exchange for the time I’d spent helping her. When nothing came to mind, she reiterated, “Please let me know if something comes up, because I’d happy to help you.”

My embarrassment grew in the presence of Emily’s team approach. With the potential safety threat averted, we carried on with our respective patient care responsibilities.

Reflect and Amend
For the rest of the shift, I couldn’t stop thinking about my outburst, which stood in glaring contrast to Emily’s professionalism. When I realized that a patient could have been harmed while I was resisting my peer’s call for help, I was horrified. I wanted to apologize to Emily. Read the rest of this entry ?


Ebola, One Year Later: What We Learned for the Next Big Epidemic

November 6, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

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Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

November 2, 2015
Illustration by Denny Bond. All rights reserved.

Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the course of the essay the author finds that she must revise her opinion of cell phones. Time and the pressures of geographical distance are sometimes felt more urgently in the ICU.

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