Archive for the ‘patient perspective’ Category

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‘A New Antibiotic’: What Restores a Patient’s Will to Recover?

February 5, 2016
Illustration by Pat Kinsella. All rights reserved.

Illustration by Pat Kinsella. All rights reserved.

A little bit of levity when writing of serious topics can be good medicine. This month’s Reflections essay, “A New Antibiotic,” reminds us of how important it can be for hospitalized patients to be kept in touch with their lives and loves beyond hospital walls. In this story, author Judith Reishtein, a retired critical care nurse and nursing professor, finds herself willing to bend the rules a little for one patient. Here’s how it starts:

Sally had been a patient on the step-down unit all winter. After her open heart surgery, she developed an infection in her chest. The infection required another surgery and four more weeks of ventilator support as her open chest healed. Because she was not moving enough, she developed clots in her legs. Because of the DVTs, she had activity restrictions, which led to another bout of pneumonia. One complication led to another, with more medications that had to be carefully balanced. We tried not to do anything that would create a new problem while curing an existing one.

Now she was finally getting better, but her energy lagged behind. Did she still have the will to heal? I worried about that; I had seen too many patients slide from lassitude into the grave. I wasn’t sure if she could recoup her energy and will to live; but her daughter Trudy knew exactly what would strengthen her spirit…..

We hope you’ll read the rest of this short, free access essay, and see how it turns out. There’s a deeper truth hidden here, whatever your take on this nurse’s compassionate decision to allow a certain type of visitor on the unit.—Jacob Molyneux, senior editor 

 

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Ethical Practice with Patients in Pain

January 20, 2016
Photo @ AJ Photo / Hop Americain / Science Photo Library

Photo @ AJ Photo / Hop Americain / Science Photo Library

Pain is difficult to define and hard to convey. The way both patients and clinicians respond to it can be influenced by a multitude of possible biases. This month’s Ethical Issues column in AJN is by Doug Olsen, PhD, RN, an associate professor at Michigan State University College of Nursing. In “Ethical Practice with Patients in Pain,” Olsen summarizes the challenge nurses and other clinicians face in treating patients’ pain:

Responding to a patient’s pain is a fundamental ethical obligation in nursing. However, nurses caring for patients in pain can run into ethical conflicts from both over- and undertreatment of pain. Undertreatment of pain represents a failure to fulfill the core nursing obligation to alleviate suffering—but overtreatment may ultimately harm the patient, contradicting a core nursing value, nonmaleficence. The complex nature of pain complicates efforts to provide treatment that is ‘just right.’ Nurses must understand that complexity if they are to make ethical decisions in the care of patients who experience pain.

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A Nursing Perspective on a Recent NEJM Palliative Care Article

January 8, 2016

Pam MolloyBy Pam Malloy, RN, MN, FPCN, director and co-investigator of the ELNEC Project, American Association of Colleges of Nursing (AACN), Washington, DC.

I just read a New England Journal of Medicine article by Drs. Craig D. Blinderman and the late J. Andrew Billings that came out on Christmas Eve, 2015. “Comfort Care for Patients Dying in the Hospital” was a thoughtful, informative article and I am grateful that it appeared in a journal that wasn’t focused solely on hospice/palliative care.

2016_ELNECLogoWhile the information in the article is essential for all health care professionals, I would like to take this opportunity to remind my nursing colleagues that we have a tremendous opportunity and privilege to plan, provide, and orchestrate the care that was described in this article—and we have been doing so for some time.

Nurses spend more time at the bedside and out in the community assessing and managing patients with serious, complex illness than any other health care professional. Our interdisciplinary colleagues depend on our assessments and we play a major role in developing plans of care with our diverse team. We are there having difficult conversations with patients—many times in the middle of the night when they cannot sleep.  We are entrusted with their care. It is an awesome responsibility and opportunity to care for the most vulnerable in our society, to alleviate suffering, and to provide attention to grieving families. Read the rest of this entry ?

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How a Nurse Quietly Helped One Intern Out of a Tricky Situation

December 9, 2015
Illustration by Annelisa Ochoa. All rights reserved

Illustration by Annelisa Ochoa. All rights reserved

In this month’s Reflections essay, “My Turn,” a recently retired physician tells a story of how a nurse adroitly helped him through a very disorienting moment when he was still an intern. Here’s a bit of the setup:

Medicine was my first rotation as an intern. . . . [T]he medicine rotation had a particularly intimidating reputation and a red-hot I was not. I was terrified.

On morning rounds every day our entourage of physicians, nurses, and students would go room to room discussing each patient. I can still see the open door to Mrs. Finkelstein’s room near the morning sunlight at the end of the hallway. Mrs. Finkelstein was old and was dying. And every morning when we walked in, her husband was sitting there next to the bed, holding her hand. He told us regularly how many years they had been together. We each dreaded being the one on call when she died.

There are many situations in medicine and nursing that require a certain amount of experience—most readers will agree that this is definitely one of them. At a certain point in the story, the author finds himself being asked a question that absolutely needs to be answered, and answered immediately. It’s not just the intern who needs help in this moment. The stakes are high for the patient and her husband. Failure is not an option. Read the rest of this entry ?

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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.) 

cranberries

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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Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

September 21, 2015

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

by luke andrew scowen/flickr creative commons

luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for thought in the midst of our high-tech workplaces and death-denying culture. Read the rest of the article in this month’s AJN.


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