Archive for the ‘Nursing perspective’ Category

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A Lasting Gift for a Nurse’s Holiday Shifts and Lost Family Time

December 19, 2014
Illustration by Lisa Dietrich for AJN.

Illustration by Lisa Dietrich for AJN.

As we know, gifts come in many forms, and often are as valuable to the giver as to the receiver. The best ones come at times when we least expect them. Readers will find that the start of AJN‘s December Reflections essay, “A Change of Heart,” describes a frustration that may be familiar to many nurses. In this case, it’s Christmas Day, and a nurse is kept by the urgent demands of her job from spending time with family. She writes:

I’ve been a nurse for more than half of my life . . . I love my career and consider myself blessed to have found my calling. But we all experience times when our long hours and the rigorous demands of this job make us feel that we sacrifice too much of our personal and family time to care for strangers.

The author had planned to be home for Christmas dinner. But, she tells us, “we had four back-to-back emergency CABGs starting at 8 am and stretching long past my scheduled 3 pm end of shift.” The essay develops from there as the hours pass. And then we meet a patient with everything at stake. The author is not the only one in danger of missing Christmas with family, and not just this year but for all the years to come.

We are reminded again and again that nursing has its truly redeeming moments of connection, those reminders that the work you do can be the difference between life and death for a patient. So it happens in this short, engaging essay. We encourage you to click the article title above and give it a read. It’s free, and it might put the various challenges of the holidays into perspective.—Jacob Molyneux, senior editor/blog editor 

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Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

December 17, 2014

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

Photo copyright Thinkstock.

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results. Read the rest of this entry ?

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Nurses at Center Stage: AJN’s Top 10 Blog Posts of 2014

December 12, 2014

By Jacob Molyneux, AJN senior editor/blog editor

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

Filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

It’s unsurprising that some of our top blog posts this past year were about Ebola virus disease. But it’s worth noting that our clinical editor Betsy Todd, who is also an epidemiologist, cut through the misinformation and noise about Ebola very early on—at a time when many thoughtful people still seemed ill informed about the illness and its likely spread in the U.S.

Ebola is scary in itself, but fear was also spread by media coverage, some politicians, and, for a while, a tone-deaf CDC too reliant on absolutes in its attempts to reassure the public.

While the most dire predictions have not come true here in the U.S., it’s also true that a lot of work has gone into keeping Ebola from getting a foothold. A lot of people in health care have put themselves at risk to make this happen, doing so at first in an atmosphere of radical uncertainty about possible modes of transmission (uncertainty stoked in part by successive explanations offered as to how the nurses treating Thomas Eric Duncan at a Dallas hospital might have become infected).

And while, relative to the situation in Africa, a lot of knowledge and resources were readily available to support nurses and physicians who treated Ebola patients, the crisis has focused much-needed attention on the quality of the personal protective equipment (PPE) hospitals have been providing to health care workers.

Meanwhile, the suffering continues in Sierra Leone and other countries. Time magazine this week made the Ebola fighters here and overseas its collective Person of the Year for 2014. (See our recent post by Debbie Wilson, a Massachusetts nurse who worked in an Ebola treatment center in Liberia this fall. She will be visiting our offices next week for lunch with the staff.) Read the rest of this entry ?

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New CE for Nurses: Understanding the Origins of the Obesity Epidemic

December 10, 2014
By Gaulsstin/via Wikimedia Commons

By Gaulsstin/via Wikimedia Commons

One of our two December feature CE articles, “The Obesity Epidemic, Part 1: Understanding the Origins,” is about a pervasive and complex issue that nurses see the health consequences of in every practice setting:

. . . more than 35% of adults and 16% of children ages two to 18 are obese. Obesity disproportionately affects racial and ethnic minorities as well as people at lower income and educational levels, though it is prevalent among men and women in every segment of society. Obese children and adults are at risk for type 2 diabetes, cardiovascular disease, musculoskeletal dysfunction, and certain types of cancer. The Centers for Medicare and Medicaid Services estimates the annual national health care expenditure on obesity to be about $147 billion, with per capita spending on obese people averaging $1,429 more than spending on individuals of normal weight.

Knowledge about this epidemic continues to evolve. This article is part 1 of a two-part series and provides readers a concise overview of current theories about the pathophysiologic, psychological, and social factors that influence weight control. As the overview points out, “[t]o contribute to obesity’s treatment and prevention, nurses must be conversant in a wide range of theoretical and clinical perspectives on the problem.” Read the rest of this entry ?

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Too Tired to Nurse

December 8, 2014

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

by patchy patch, via flickr

Just about every nurse I know has been “asked” (or “guilted” or “mandated”) to work an additional shift on top of a grueling one. The worst such experience I ever had was having to work from midnight to 8 am after working a straight week of 4 pm to midnight shifts. I was exhausted, but someone had called in sick, leaving only two RNs and one aide for the 11-bed ED trauma unit.

I was so tired that at one point I found myself falling asleep while I was standing by a patient’s bed charting vital signs. I couldn’t remember the blood pressure reading I had obtained just moments before. It was good luck that I didn’t make an error—and had the good sense to have a colleague double-check medications I was readying (these were the old days, before unit dosing). Read the rest of this entry ?

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Storytelling as a Vital Source of Knowledge and Connection in Nursing

December 5, 2014

I’m not saying that nurses should abandon the quantitative and evidence-based practices that we know have saved many lives. But we should also seek to balance and contextualize this approach through humbly listening to the stories of those we care for. Some of my greatest learning has come from individual client stories and from the rich meaning of their experiences. Stories from clients about their lives can have both a tangible and an intangible effect on the care we provide. A story may create an atmosphere of openness, closeness, and warmth that is both soothing and healing during the most trying times.

Lascaux cave painting/via Wikipedia

Lascaux cave painting/via Wikipedia

That’s an excerpt from “He Told Me a Dream of Animals Leaving His Heart,” this month’s Viewpoint essay by Mary Smith, a nurse practitioner and PhD student who writes of caring for a traditional healer as a community health nurse working in a First Nation community in an isolated northern area in Canada.

Smith discusses the many roles storytelling can play: it’s a way to inspire nursing students and explore ethical issues, a source of knowledge about patients and communities, a way to bridge cultural differences, and much more. The piece is direct, short, and written with clarity and insight. Give it a read and see if it gets you thinking or speaks to your own experience.—Jacob Molyneux, senior editor

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Patient Safety, Patient Advocacy: In Pediatric Nursing, A Tricky Balance

December 3, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

CT Scan ink and watercolor on paper 2014 by jparadisi

CT Scan ink and watercolor on paper 2014 by jparadisi

I was precepting a new nurse. She’d earned a job in our PICU during her student clinical rotation. New grads weren’t routinely hired, but her competency led to her recruitment. Precepting her was a joy.

This particular shift, we were assigned one of those midafternoon admissions with the potential to keep us overtime: rule out meningitis. The preschool-aged patient had been brought to the ED after having a first-time seizure. When he reached the PICU, however, we were relieved that he presented more like a febrile seizure.

Besides a fever and runny nose, the only other remarkable characteristic about the child was his utterly charming personality. We drew his labs while starting an IV. An antibiotic infusion was started, and acetaminophen administered. Feeling better, and not the least postictal, he played with our stethoscopes.

This was many years ago. There were standards in place that accompanied certain diagnoses. ‘Rule out meningitis’ came with a CAT scan and lumbar puncture.

Both seemed excessive, given the child’s presentation, but there was the order for CAT scan. He sat upright in his crib singing, as my preceptee (we’ll call her Beverly) and I rolled the crib down to the CAT scan.

IV sedation was ordered for the CAT scan, if it proved necessary. I had some in a syringe in my pocket (that’s how we did it in those days) to enable our patient to lie still for the scan.

But he charmed the technician too, who asked me to hold the sedation. Instead, he seated the willing child on the sliding table, and allowed him to glide in and out of the tube several times, as if it were a Disneyland ride. Then he asked the child to lie on the table, and to stay very still with his arms at his sides. The boy did as told, and the CAT scan was completed without trauma or sedation.

Not surprisingly, the results of the scan were normal.

Returning to the PICU, Beverly and I transferred the monitor leads back to the wall unit. She took vitals signs and we reviewed charting the procedure. The parents came to the room.

Soon afterwards, the pediatrician returned and ordered the lumbar puncture. Beverly and I suggested that the procedure was unnecessary, given the child’s lack of symptoms, but protocol prevailed. The parents opted to leave the room.

It was a disaster. The child, who’d adopted us as his newfound friends, willingly curled on his side as Beverly and I hugged him close. But as soon as his skin was swabbed and the tip of the needle pricked his back, he went ballistic. There was no holding him still. He fought as if his life depended it. Read the rest of this entry ?

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