Archive for the ‘Nursing research’ Category

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Blogging: As Many Voices as There Are Nurses

August 20, 2014

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile.  I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat.

Nurse-midwifery. A post on At Your Cervix: Tales of a New CNM, First Year gives a short nuts-and-bolts glimpse of the author’s daily work life as a certified nurse-midwife. Those considering this specialty may benefit from one person’s experience of the pros and cons of one workplace:

I thought (as I was taught) that I would have more autonomy in practice . . . the two physicians are truly the “bosses.” Everything needs to be run by them . . . I definitely have more autonomy in the office setting. There was a big difference in reading/learning about prenatal care and GYN care, versus doing it. I didn’t learn (or have clinical experience in) nearly enough GYN clients! I think the number of GYN clients for clinicals was only about 35.

For the ‘research-minded nurse.’ At the INQRI blog—that is, the blog of the Interdisciplinary Nursing Quality Research Initiative, which has a stated goal “to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care”—you will find even-handed and brief summaries of recent nursing research on topics such as the potential for hourly nursing rounds to improve patient care.

Renewal. If you’re taking a vacation and going somewhere more peaceful this summer, sometime AJN blogger Amanda Anderson has a contemplative post, “The Place Where Noise Becomes Sound,” at her blog This Nurse Wonders. It starts like this:

Summer has finally found me. Somewhere in the long train ride west, between naps and riders and minutes of staring at passing trees, I listened.

Read the rest of this entry ?

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AJN’s August Issue: Preventing Pressure Ulcers, Strengths-Based Nursing, Medical Marijuana, More

August 1, 2014

AJN0814.Cover.OnlineAJN’s August issue is now available on our Web site. Here’s a selection of what not to miss.

Toward a new model of nursing. Despite the focus on patient-centered care, medicine continues to rely on a model that emphasizes a patient’s deficits rather than strengths. “Strengths-Based Nursing” describes a holistic approach to care in which eight core nursing values guide action, promoting empowerment, self-efficacy, and hope. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Decreasing pressure ulcer incidence. Hospital-acquired pressure ulcers take a high toll on patients, clinicians, and health care facilities. “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment” describes how one of the world’s largest and busiest cardiac hospitals implemented several quality improvement strategies that eventually reduced the percentage of patients with pressure ulcers from 6% to zero. This CE feature offers 2.8 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with the authors (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Read our Cultivating Quality column this month for another article on using evidence-based nursing practice to reduce the incidence of hospital-acquired pressure ulcers and promote wound healing. Read the rest of this entry ?

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Getting Patients Involved in Care Redesign: What the Research Says

July 16, 2014

By Sylvia Foley, AJN senior editor

“I think the whole thing is we’re trying to im­prove care. It’s all about [patients] anyways. So if we’re gonna make changes that impact them I think we have to get them involved.” —study participant

Although there is considerable support for increasing patient involvement in health care, it’s not clear how best to achieve this. And few researchers have specifically investigated the views of patients and providers on patient engagement. In this month’s CE–Original Research feature, “The Perceptions of Health Care Team Members About Engaging Patients in Care Redesign,” Melanie Lavoie-Tremblay and colleagues describe findings from their recent study. Here’s a brief overview.

Objective: This study sought to explore the perceptions of health care workers about engaging patients as partners on care redesign teams under a program called Transforming Care at the Bedside (TCAB), and to examine the facilitating factors, barriers, and effects of such engagement.
Design: This descriptive, qualitative study collected data through focus groups and individual interviews. Participants included health care providers and managers from five units at three hospitals in a university-affiliated health care center in Canada.
Methods: A total of nine focus groups and 13 individual interviews were conducted in April 2012, 18 months after the TCAB program began in September 2010. Content analysis was used to analyze the quali­tative data.
Findings: Health care providers and managers benefited from engaging patients in the decision-making process because the patients brought a new point of view. Involving the patients exposed team members to valuable information that they hadn’t previously thought about during decision making.
Conclusion: Health care teams stand to benefit from engaging patients in the change process. Patients contribute a different point of view, and this helps to ensure that the changes proposed and implemented address their needs.

Noting the importance of mindset, the authors concluded that “perhaps the most important facilitating factor in including pa­tients on care redesign teams is for all those involved to believe that their participation is crucial to im­proving the design and delivery of services.”

For more details, read the article, which is free online. What’s your take on patient engagement?

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AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

June 27, 2014

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one of her adolescent patients, and the patient’s mother (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article). Read the rest of this entry ?

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Providing Culturally Sensitive Care: It Takes More Than Knowledge

June 25, 2014

By Karen Roush, AJN clinical managing editor. Photos by the author.

DSC_0136One Saturday a few weeks ago I grabbed my camera and headed out to spend the afternoon taking photographs around the city. I ended up wandering around the streets of Chinatown, photographing the street life—the rows of fresh fish on piles of ice, the colorful patterns of vegetables in crates outside shops, old women in variations of plaid and flowered housedresses lined up on a bench, children scattering clusters of pigeons.

Eventually I happened upon a vigorous and highly skilled game of handball in a park. The competitors were predominately young Asian men, though there were a few Hispanic men playing too. Standing next to me, a young man was telling his friend about a clever way a mutual friend had devised to get out of paying a parking ticket. If you live in New York, or almost any big city, you will earn yourself a parking ticket or two at some point. Intrigued by this man’s idea, I asked him if it actually worked and he assured me it did. Then he rolled his eyes and said, “Oh no, I shouldn’t have said anything. Once the white people know, that’s the end of it!” Read the rest of this entry ?

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Pioneering Spirits, Kept Promises: Critical Care Nurses in Denver

May 20, 2014

By Shawn Kennedy, AJN editor-in-chief

In Denver for the annual National Teaching Institute of the American Association of Critical-Care Nurses (AACN), I’m once again overwhelmed by the size and breadth of the meeting. It’s not just the attendance, though it drew over 7,000 nurses. Perhaps it’s the Colorado Convention Center, which seems to go on forever. (Fittingly, there’s a mammoth blue bear two stories high peering in one of the glass walls.)

Big Blue Bear, Colorado Convention Center, Denver

Big Blue Bear, Colorado Convention Center, Denver

While trying to find my way to a session, I met a nurse who was there with her mother. Mom’s a Boston ER nurse and her daughter is a critical care nurse in New Hampshire. Every year they do a mother-daughter trip to either this meeting or the Emergency Nurses Association meeting. Kudos to them!

Sociologist, inspirational speaker, and comedian Bertice Berry mc’d the opening session, quickly warming up the audience. A highlight was the presentation of AACN’s Pioneering Spirit awards to Loretta Ford (founder, along with physician Henry Silver, of the first NP program in 1965), Carrie Lenburg (pioneer in nontraditional and distance learning), and Lucian Leape (a physician who spearheaded the movement to reduce medical errors).

Some quotes from these feisty folks who had major impacts on nursing and health care:

“Earl Warren said that any time he tried to do something worthwhile, he took hell. I was happy to take hell for all of you.”
Loretta Ford on the opposition to the NP role she encountered

“If you want to transform health care, you need to think about a triangle, with the sides representing caring, knowledge, and risk taking. You need all three to move forward.”
Carrie Lenburg on changing the health care system

“I took a lot of flak from my medical colleagues when I suggested the way to reduce errors was to change the system rather than punish our colleagues. I got no flak from nurses—they got it.”
Lucian Leape after his 1994 article on reducing medical errors

Another highlight was the moving presentation of keynote speaker Alex Sheen, founder of the “Because I Said I Would” movement. Read the rest of this entry ?

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Noise in the ICU: Terminology, Health Effects, Reduction Strategies, and What We Don’t Know

May 16, 2014

By Jacob Molyneux, AJN senior editor

Noise isolation headphones to use in loud environments

via Wikimedia Commons

I woke up this morning, as I do every morning now, to the sound of pile driving at a large construction site a block and half away on the Gowanus Canal. It shakes the earth and reminds me of the forges of evil Sauron in one of the Lord of the Rings movies. I once had a dog lose a good bit of hair when there was a pile driver for several months in the lot behind another apartment in Brooklyn.

The negative physical and emotional effects of excessive noise get an occasional mention lately in health reporting, but in New York City or along the remotest forest lane, the forces of quiet can seem to be in rapid retreat before an army of leaf blowers, all-terrain vehicles, diabolically amped-up motorcycles, huge TV sets, garbage trucks, helicopters, and the like.

Lest I sound like a total crank (I do have useful noise-cancelling headphones plus an Android app that offers such choices as white noise, brown noise, burbling creek, steady rain, crickets, and soothing wave sounds), there’s a reason for the preamble. Florence Nightingale herself called unnecessary noise “the most cruel absence of care which can be inflicted either on sick or well,” as is pointed out by the University of Washington researchers who wrote the latest installment of our column Critical Analysis, Critical Care.

“Noise in the ICU” looks at current research about the health effects of noise in the ICU, provides useful definitions of the terminology used when talking about sound levels, and considers strategies for reducing noise, as well as what still needs more study. The article will be free for a month (until June 15), so give it a look and see if it gets you thinking. After all, to quote the article again, “Studies have found that sound levels in the ICU continue to exceed WHO recommendations.”

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Nurses Week: Time to Celebrate (Not Denigrate) Nursing’s Worth

May 5, 2014

shawnkennedyBy Maureen Shawn Kennedy, AJN editor-in-chief

So, on the cusp of Nurses Week, the week when Americans are encouraged to think about the value that nurses bring to health care, readers of the New York Times were treated to an op-ed written by physician Sandeep Jauhar. According to the byline, Jauhar is a cardiologist and the author of an upcoming memoir about his disillusionment as a physician. The title of the piece was “Nurses Are Not Doctors.” While the author makes sure to reassure us that he thinks nurse practitioners (NPs) have a valuable role to play in health care, he makes the usual charge that NPs are not qualified to practice primary care without physician supervision.

Jauhar conveniently ignores the many studies that have refuted this argument, while basing his case largely on weak anecdotes and one study from 1999 that showed NPs ordered more diagnostic tests. His conclusion: the NPs in the study ordered too many expensive tests because they lack the experience and knowledge of physicians (he concedes in passing that “there are many reasons the NPs may have ordered more tests”). I can’t help thinking that this piece’s publication was purposely timed to take some of the shine off Nurses Week.

I’m surprised that the Times published such a weak letter. First, along with other nonphysician health care providers who have earned doctoral degrees in their fields, many nurses are indeed doctors. “Doctor” is an academic title and is not exclusive to only those who’ve earned doctorates in medicine. Physicians should get over the fact that they do not own that term, just as they need to realize that medical care is only one aspect of health care. Nurses, too, need to use terms correctly—use physician, not “doctor,” when referring to a medical provider; use health care, not medical care, unless specifically talking about care provided by a physician.

Is one 15-year-old study all Mr. Jauhar can come up with? This author and many of his physician colleagues need to stop mourning an idealized golden age of American health care. Their arguments undercutting nursing in the public’s eyes and sowing doubt about nurses’ capabilities are without merit. To assume that nurses will venture to practice beyond their capabilities and training is akin to assuming that internists are likely to attempt heart surgery.

As I co-wrote in an editorial in 2006, these kinds of claims are “a misguided attempt to hold onto an antiquated and dysfunctional model of medical imperialism . . . [that] isn’t serving anyone but physicians.” Read the rest of this entry ?

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If You Really Want to Get That Letter Published

April 28, 2014

By Karen Roush, PhD, RN, FNP, AJN clinical managing editor

via Wikimedia Commons

via Wikimedia Commons

We love getting letters to the editor . . . really . . . whether it’s to agree or disagree, applaud or admonish. With some articles we actually feel a sense of excited anticipation—this should get some letters!—not because we like to create controversy (though we don’t shy away from it either when there’s something important at stake), but because we want to create dialogue among our readers.

That’s what the Letters to the Editor column is for: to add to the conversation by pointing out nuances, adding support from personal experience, expressing a dissenting view of a topic, or offering corrections or clarifications.

A good letter to the editor contains:

• a point of view
• a sense of the writer and why they were moved to write a letter
• additional information that clarifies, corrects, or enhances the original text (and the evidence backing it up)
OR:
• a reasoned, respectful argument (and the evidence to back it up) against some aspect of the original text
OR:
• a narrative that gives a clearer sense of the human implications of the original text

These are the main criteria we look for in the letters we receive.

We are glad when you enjoy an article or are pleased to see the topic covered in print or can relate to something we published. Drop us a line anytime and let us know. We share those emails with the staff and it helps us know that we are staying on target. But those types of letters are usually not going to get published. They matter to us, but they don’t add a lot to the conversation.

A special alert for students: we get a lot of letters from students that follow along these lines:

I really liked the article/enjoyed reading the article/agree with the author. Here are some other studies/research/evidence that say the same thing about the topic. This is what I do/did/want to do/all nurses should do related to the article.

Such letters are good examples of the kind that don’t get published because they don’t add anything new to the conversation. (Perhaps unsurprisingly, many student letters are about short items in our News section. These articles are often about studies that have been published elsewhere; they summarize findings, provide valuable analysis and context, and sometimes quote study authors or others with a stake in the topic. If you have something to say about the topic of the news item, and it meets the general criteria I listed above, then send it to us. If you have something to say about the individual studies, consider whether your letter should instead go to the journal that published the original study, not to us.) Read the rest of this entry ?

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The Power of Imagination: Helping Kids with Sickle Cell Disease to Cope with Pain

April 2, 2014

By Sylvia Foley, AJN senior editor

Many people with sickle cell disease suffer from both acute and chronic pain, which can be severe. Although the exact mechanism isn’t known, the pain is believed to result when sickled erythrocytes occlude the vascular beds, causing tissue ischemia. Such pain, which often begins in early childhood, arises unpredictably. Although some pain crises may require ED visits, hos­pitalization, opioid treatment, or a combination of these, most are managed at home. Yet little is known about at-home pain management in people with sickle cell disease, especially children.

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Cognitive behavioral therapy (CBT) has shown promise in helping patients with other chronic illnesses to cope with pain. Cassandra Elaine Dobson and Mary Woods Byrne decided to test guided imagery, a form of CBT, among children enrolled at one sickle cell treatment clinic in New York City. They report on their findings in this month’s original research CE, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease.” The abstract below offers a quick overview; if you click the image above, you’ll see an enlarged view of one table showing key results.

Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training.
Methods: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.
Results: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well.
Conclusions: Guided imagery is an effective technique for managing and limiting sickle cell disease–related pain in a pediatric population.

The technique was easily taught in training sessions lasting 15 to 45 minutes, with no child needing more than one session. The authors concluded that “the use of guided imagery in this population assumes that a child’s imagination has the potential to affect health, and our findings support that assumption.” Because this was a small study, they urged further large-scale clinical trials.

To learn more, read the article, which is free online. As always—and especially if you have experience caring for children with sickle cell disease—we welcome your comments.

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