Archive for the ‘Nursing perspective’ Category

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May AJN: A-Fib and Epilepsy Updates, an Ethics Collection, Diversity, Resolving Conflict, More

April 24, 2015

AJN0515.Cover.2ndAJN’s May issue is now available on our Web site. And in honor of the upcoming Nurses Week, we are offering free access to the entire issue for the month of May. In addition, because the American Nurses Association has designated this the “Year of Ethics” and the theme of this year’s Nurses Week is “Ethical Practice, Quality Care,” we have also made available a collection of some of our top ethics articles from 1925 to the present. Here’s a selection of what else not to miss in our May issue.

Atrial fibrillation adversely affects the quality of life of millions of people, resulting in significant morbidity and mortality and health care costs. Our CE feature, Atrial Fibrillation: Updated Management Guidelines and Nursing Implications,” reviews the recently updated guideline for the management of atrial fibrillation and stresses how nursing intervention in patient education and transition of care can improve outcomes. This feature offers 3 CE credits to those who take the test that follows the article.

Epilepsy is a serious neurologic disease that affects around 2.2 million people in the U.S. Epilepsy Update, Part 1: Refining Our Understanding of a Complex Disease, the first in a two-part CE series, discusses new research on the causes of epilepsy, new definitions that are changing the ways we evaluate the disease, and the psychosocial challenges faced by people who have it. It offers 2.5 CE credits to those who take the test that follows the article; there’s also 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).

Improving Outcomes from In-Hospital Cardiac Arrest,” part of our ongoing Critical Analysis, Critical Care series from nurses at the University of Washington, focuses on 2013 evidence-based recommendations from the American Heart Association, which identify five critical areas to focus on to improve cardiac arrest response and patient outcomes. Read the rest of this entry ?

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A Nurse Ethicist’s Analysis of a Recent Nursing Home Sexual Consent Case

April 21, 2015

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scales of justice/by waferboard, via Flickr

scales of justice/by waferboard, via Flickr

An 78-year-old retired state legislator and farmer in Iowa is currently on trial for having sex with his wife, who has severe Alzheimer’s disease, in her shared room in a nursing home. He has been charged with rape.

The case highlights two ethical questions or conflicts:

  • When is protection needed and when is it intrusive and harmful?
  • What are the mental abilities required to consent to sex?

Consenting to sex is not the same as informed consent for treatment. In treatment, a clinician obtains consent to act on (treat) the patient in a way that will benefit the patient. By contrast, proper consent for sex is mutual and both parties benefit.

To extend the comparison: a patient’s decision to consent to treatment is generally made by balancing the benefits, harms, and risks to the individual patient. The decision to engage in sex often involves consideration of another’s satisfaction—it is not unknown for one spouse to agree to sex to please the other, even though he or she would not otherwise want sexual contact.

Another complicating factor in the question of sexual consent is that gender matters. While the social ideal is to consider sex consensual, societal understanding often tilts toward considering the male as the aggressor and the female as the gatekeeper. In addition, we often assume that power, especially physical power, is not equal in sexual relations.

Decision-making capacity. A patient must have decision-making capacity to give valid consent for treatment. Such capacity is not considered a blanket characteristic, but is assessed in relation to the risks, benefits, and complexity of the specific treatment decision.

The assessment of capacity in relation to the specific decision can also be applied to consent for sex. Unfortunately, a proper level of mental ability needed to confer capacity for sex is not clearly established and can vary in relation to circumstances. The woman in this case had severe mental impairment, but that does not necessarily mean that she lacked the capacity to consent to sex with her husband. Differences of opinion regarding the level needed for her valid consent are illustrated in the following summary of an exchange from the trial included in a recent New York Times article:

Mr. Yunek [the defense attorney] asked Dr. Brady [the center’s physician] if “Donna is happy to see Henry — hugs, smiles, they hold hands, they talk — would that indicate that she is in fact capable at that point of understanding the affection with Henry?” Dr. Brady said no, calling that a “primal response” not indicative of the ability to make informed decisions.

The defense attorney is implying that her actions indicate desire and willingness and that this is a sufficient level of mental ability for valid consent; the physician, on the other hand, suggests that such “primal responses” are not sufficient to indicate a level of mental ability. This is not a disagreement about what her ability is, but about what is the proper degree and type of ability needed to consent. It’s not so much a disagreement about facts as about values.

One approach to establishing whether sexual contact between these two older adults was appropriate is to examine each relevant factor. These include the following: Read the rest of this entry ?

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AJN’s Spring Break with the Student Nurses in Phoenix: Sunnier Job Outlook for New Graduates?

April 17, 2015

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

PhoenixSkylineAfter a long winter in the Northeast, it was wonderful to visit Phoenix last week for the 63rd annual convention of the National Student Nurses’ Association (NSNA).

Like other meetings, this one was packed from morning to late evening with educational sessions, exhibits, resume-writing consultation, and for some, deliberating over 60 resolutions at the House of Delegates. Keynotes addressed:

  • health care reform (Gerri Lamb).
  • progress on implementing recommendations from the Future of Nursing report (Susan Hassmiller).
  • clinical ethics and moral distress (Veronica Feeg and Cynda Rushton).
  • and, the closing speech, a charge to continue nursing’s legacy into the future (yours truly).

Concurrent sessions, most of them well attended by Starbucks-fueled students, covered nursing specialties, exam help, licensure and legal/ethical issues, and clinical topics. (Betsy Todd, AJN‘s clinical editor, who is also an epidemiologist, led a session called “Is It Safe: Protecting Ourselves and Our Patients from Infectious Diseases.”)

Changing job climate? Several students I spoke with who were graduating at the end of the semester didn’t seem to have the anxiety of previous years’ students over securing a job. Maybe this is because things are looking up in the job market for new graduate nurses, at least according to recent figures in NSNA’s annual survey of graduates.

Reporting in the January issue of Dean’s Notes, researcher Veronica Feeg, associate dean of Molloy School of Nursing, and NSNA executive director Diana J. Mancino note that, in a September 2014 survey of NSNA members who were 2014 graduates, 78% reported they had secured an RN position by six months following graduation. This is an increase over the prior two years, when results were 76% for 2013 graduates and 66% for 2012 graduates. Read the rest of this entry ?

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Recent End-of-Life Care Links of Note, by Nurses and Others

April 13, 2015
nature's own tightrope/marie and alistair knock/flickr creative commons

nature’s own tightrope/marie and alistair knock/flickr creative commons

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

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent NPR story, a Honolulu hospital offers patients and their family members instructive videos on the sometimes gruesome realities of some end-of-life treatment options. Starting with the no-sugar-coating-it statement, “You’re being shown this video because you have an illness that cannot be cured,” these videos explain intubation, CPR, and the different care options available.

I really liked this piece because the physician admitted that he was ill prepared to talk to a patient running out of options who he had never met before. Then he remembered the counsel of other professionals to give patient-specific care (“What are your goals for your care?”).

And some recent coverage in AJN or on this blog
Joy Jacobson’s short end-of-life and palliative care overview from 2013. Read the rest of this entry ?

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Bedpans and Learning: Nursing Basics Still Matter

April 8, 2015

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

Photo by Morrissey, via Flickr.

Photo by Morrissey, via Flickr.

There I was, orienting to a busy medical ICU, perplexed over a bedpan. You’d think, since I was just graduating from nursing school, that bedpans would be my area of expertise. Critical thinking and vent strategies came easy; how could I possible admit I had no idea how to give a bedpan to a patient?

Frightening, to graduate from nursing school and a competitive externship program without this competency. Somehow, though, every unit I’d experienced offered patient care assistants, or patients who didn’t need this age-old tool. I’d certainly helped patients to the bathroom and cleaned incontinent ones. Despite the barrage of clinical learning, the basics of offering the pink plastic tool hadn’t sunk in.

Paralyzed, I stood with it in my hand, looking at my intubated, awake patient. I’d had the wherewithal to ask the family to step out, but couldn’t figure out which end went first. The horror of my preceptor finding it backwards would end me. Did the pointed end go towards the patient’s back? The larger end toward the feet for better coverage? Why couldn’t I remember?

Somehow, I managed to decide, and with heart racing, I urged the patient: “Turn to the side!” We both grimaced: I grasped the bedpan with one hand and his right hip with the other, while he reached towards the opposite side rail. His body, heavy with fluid, resisted my timid and inexperienced grasp, and he rolled back onto his back, without bedpan.

My preceptor, just passing by, or discreetly watching from her secret post behind the curtain, arrived just as I was about to start my second try. From the opposite side of the bed, she pulled his body towards her and I placed the bedpan where I thought it should go, praying to the ghost of Florence Nightingale that I’d positioned it right.

If it hadn’t already been so, this experience made it clear to my preceptor that, while I was confident in my nursing knowledge, my skills weren’t up to snuff. Instead of choosing a final clinical placement in a med-surg unit or intensive care, I had opted to spend my senior year working in public health. When I decided that I wanted bedside experience before specializing, I figured I’d just pick up what I missed on orientation.

For some reason, understanding when to intubate a patient came easily, but giving a bed bath? Terrifying. In our unit, we had no patient care assistants, and my preceptor’s goal was to teach me how to perform all patient care without any help. “I don’t want you to do everything by yourself all the time; I just want you to know how to do everything by yourself.” Read the rest of this entry ?

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Breathing Training May Ease Depression in Dialysis Patients: Study Findings

April 7, 2015

By Sylvia Foley, AJN senior editor

It’s estimated that depression afflicts between 25% and 50% of people who have chronic kidney disease. And depression has been associated with numerous adverse outcomes in this population, including poor sleep, reduced quality of life, and higher rates of hospitalization and death. Researchers Siou-Hung Tsai and colleagues wanted to know whether teaching patients a basic relaxation technique—deep, slow breathing—could alleviate depressive symptoms.

To learn more, they developed a four-week intervention and conducted a trial. The intervention included instruction by a dialysis nurse trained in deep breathing techniques, additional audio device–guided instruction, and guided exercises. The authors report on their findings in this month’s CE–Original Research feature, “The Efficacy of a Nurse-Led Breathing Training Program in Reducing Depressive Symptoms in Patients on Hemodialysis.” Here’s a brief summary.

Objectives: The purpose of this randomized controlled trial was to examine the efficacy of a nurse-led, in-center breathing training program in reducing depressive symptoms and improving sleep quality and health-related quality of life in patients on maintenance hemodialysis.
Methods: Fifty-seven patients on hemodialysis were randomly assigned either to an eight-session breathing training group or to a control group. The Beck Depression Inventory II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Outcome Studies 36-Item Short Form Health Survey (SF-36) were used to assess self-reported depressive symptoms, sleep quality, and health-related quality of life, respectively.
Results: The intervention group exhibited significantly greater decreases in BDI-II scores than did the control group. No significant differences in PSQI change scores were observed between the groups. SF-36 change scores for both the domain of role limitation due to emotional problems and the mental component summary were significantly higher in the intervention group than in the control group.
Conclusion: This intervention significantly alleviated depressive symptoms, reduced perceived role limitation due to emotional problems, and improved the overall mental health component of quality of life in patients on maintenance hemodialysis.

Pointing to the intervention’s simple design and ease of implementation, the authors note that it offers nurses “a novel way to relieve depression in and offer psychological support to a vulnerable population.” For more details, read the article, which is free online.

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Have You Fallen Prey to a Predatory Publisher?

April 6, 2015

Predatory publishers promise prompt, easy publication. The hidden charges come later, as well as the realization that the journal has no real standing or quality control. Not only is this bad for potential authors, it’s bad for knowledge, flooding the market with inferior information made to superficially resemble the information you need.

Imagine this scenario: You receive an email from a seemingly respectable journal inviting you to submit a paper for publication. You’ve wanted to publish on this topic for some time, and this journal promises you a quick review and publication within a few months. As a new author, you are thrilled . . . that is, until you get charged an outrageous processing fee upon turning the article in. You’ve just fallen victim to a predatory publisher.

Unfortunately, this scenario is becoming all too common. These journals are often difficult to spot, with their professional-looking Web sites and names that sound legitimate, if a little vague. In fact, just recently at AJN, we stumbled across a Web site featuring a journal that looked a lot like ours and had a very similar name. (Jeffrey Beall, a librarian at the University of Colorado, has been tracking predatory publishers since 2009 and maintains a list of them on his Web site, Scholarly Open Access.)

shawnkennedyIn our April issue, editor-in-chief Shawn Kennedy tackles this topic in her editorial, “Predatory Publishing Is No Joke.” As Kennedy explains, predatory publishers “take advantage of the relatively new open access model in publishing,” in which authors “pay the publisher a fee in order to make their article freely available or ‘open’ to all.” Read the rest of this entry ?

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