Archive for the ‘patient perspective’ Category

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Widespread Support for Nurse’s Refusal to Force-Feed: Grounded in Ethical Principles

November 24, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

Nasal tubes, gravity feeding bags, liquid nutrient Ensure used in Guantanamo force-feeding/Wikimedia Commons

Last week, reports hit the news media of a nurse in the U.S. Navy facing possible discharge for refusing to participate in force-feeding a hunger-striking prisoner at Guantanamo Bay. An early discharge, two years shy of the 20-year mark, could cost him his pension and other benefits.

The nurse had initially volunteered for duty at the Guantanamo facility, but then, as we noted in a blog post examining the ethics of his decision back in July, decided he could not continue to participate in force-feeding detainees in violation of professional ethics.

In a letter to Chuck Hagel, U.S. secretary of defense, the American Nurses Association has supported the decision of the naval nurse. ANA president Pam Cipriano reaffirms that a nurse’s primary commitment is to the patient and “in addition, this commitment is present regardless of the setting in which nursing care is provided. The military setting does not change the nurse’s ethical commitments or standards.” Read the rest of this entry ?

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Ebola: A Role for Nurses in Sharing the Facts

October 29, 2014

By Shawn Kennedy, AJN editor-in-chief

Screen Shot 2014-10-29 at 12.27.27 PMThe current Ebola crisis has everyone concerned over transmission, and rightly so. The public has been in a quandary as to who and what to believe. I can’t say I blame them. We should have been better prepared and anticipated that, given the situation in West Africa, we would eventually see a patient with Ebola present to a U.S. hospital ED (or clinic or urgent care center). What’s surprising is that it didn’t happen sooner.

I’d thought fears about widespread transmission of Ebola had abated after no more new cases arose from that of Thomas Eric Duncan in Dallas: his family, who were in the apartment with him during the time he was sick, did not contract Ebola and have since been released from quarantine; the two nurses who became ill treating Duncan have now been declared Ebola free and none of their contacts have become ill; no other nurses who provided care for him have fallen ill.

But with the onset of confirmed Ebola in a New York physician who had recently returned from caring for Ebola victims in West Africa, fears of widespread contagion resurfaced. Craig Spencer had been self-monitoring his symptoms while he went about his life; when he began to feel ill and developed a low-grade fever, he initiated a controlled transport in isolation to Bellevue Hospital.

And when nurse Kaci Hickox returned from volunteering in West Africa, she was caught in New Jersey’s new Ebola precautions and placed in mandatory quarantine in a tent outside a hospital in Newark. She protested, secured attorneys to advocate on her behalf (basing her protest on CDC recommendations that routine quarantine of nonsymptomatic health care workers is not justified), and was released to travel home to Maine, where she is now disputing Maine’s mandatory in-home quarantine and active monitoring requirement in favor of self-monitoring. Read the rest of this entry ?

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Resisting the Rising Tide of Parkinson’s

October 13, 2014
By Barbara Hranilovich. All rights reserved.

By Barbara Hranilovich. All rights reserved.

The Reflections essay in the October issue of AJN is called “After-Dinner Talks.” These are talks with a purpose, a form of physical therapy with high stakes. Writes the author, Minter Krotzer, of her husband’s long struggle with Parkinson’s disease: “Hal always says Parkinson’s is not his identity, and it isn’t, as long as he doesn’t let it claim him, or as long as it doesn’t claim us.”

Here’s an excerpt from the beginning:

‘I’d like you two to have a conversation every night after dinner,’ Hal’s speech therapist said to us.

. . . . Over the years, Hal’s Parkinson’s disease has made him difficult to understand. His vocal cords have restricted movement and it is hard for him to make it to the end of a sentence. He often swallows his last words or they just barely come out. Sometimes he sounds like he is underwater—the words indistinguishable from one another, blurry and pitchless.

But read the short essay, which is free. In just one page it manages to say a lot about chronic illness and the constant, conscious effort it can require of both patients and family members; about a clinician’s good advice; about marriage and communication; and about the power of language to keep us human.—Jacob Molyneux, senior editor.

Illustration by Barbara Hranilovich; all rights reserved.

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How Do You Want to Be Cared For?

October 8, 2014
The patient in the next bed by mynameisharsha  / Harsha K R, via Flickr

The patient in the next bed by mynameisharsha / Harsha K R, via Flickr

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

How do you want to be cared for?

Have you written your own personal nursing care plan? I’m not asking about your health care proxy or living will; most nurses have seen enough disastrous end-of-life scenarios to understand the need for formal advance directives. But if you become comatose or unable to communicate, what small pleasures would ease your suffering? What sights and sounds would promote healing for you, or ease your dying?

I’m often dismayed by the thoughtlessness of some staff regarding what their patients see and hear. Nurses will tune an unconscious patient’s television to the staff’s favorite soap opera, or blast the music of their own choice from the patient’s radio. I’ve witnessed staff talking on cell phones, and even arguing loudly with other staff, as though the person in the bed weren’t even there. When did we lose our attentiveness to patients as unique individuals? Read the rest of this entry ?

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AJN in October: Getting Inpatients Walking, Calciphylaxis, Nurses and Hurricane Sandy, More

September 30, 2014

AJN1014.Cover.OnlineAJN’s October issue is now available on our Web site. Here’s a selection of what not to miss.

Calciphylaxis is most often seen in patients with end-stage renal disease. “Calciphylaxis: An Unusual Case with an Unusual Outcome” describes the rare case of a patient diagnosed with calciphylaxis with normal renal function, and how the nursing staff helped develop and implement an intensive treatment plan that led to the patient’s full recovery. This CE feature offers 2.5 CE credits to those who take the test that follows the article. To further explore the topic, listen to a podcast interview with the author (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).

The adverse effects of bed rest. Prolonged periods of immobility can have adverse effects for patients, such as functional decline and increased risk of falls. “A Mobility Program for an Inpatient Acute Care Medical Unit” describes how an evidence-based quality improvement project devised for and put to use on a general medical unit helped mitigate the adverse effects of bed rest. This CE feature offers 2 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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A Patient’s Inner Soundtrack from Better Times

September 8, 2014
Illustration by Gingermoth. All rights reserved.

Illustration by Gingermoth. All rights reserved.

She was at high risk for developing bedsores and it was important that she be turned every two hours, but when approached by staff, she would scratch, punch, and spit. Her speech consisted of expletives, which she screamed in a shrill, piercing voice.

Music can soothe, comfort, engage, bring a recognizable world into an alien one. And, crucially, it can allow a nurse or other caregiver a chance to provide badly needed care to someone with dementia or mental illness who is agitated, confused, hostile, or terrified.

In this case, the place is Detroit and the music is Motown. The short passage above is from the Reflections essay in the September issue of AJN. “Playing Her Song: The Power of Music” is not the first submission we’ve had about the ways music can reach patients when words and other measures fail.

Putting on some music would seem a simple kind of strategy, but it may be worth a try in some situations that seem otherwise hopeless. Please give the short essay a read. Reflections are free.—Jacob Molyneux, senior editor/blog editor

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How Much Was Your Last Blood Test?

August 18, 2014

By Shawn Kennedy, AJN editor-in-chief

500px-Vraagteken.svgWe all know that prices for medical procedures often vary without rhyme or reason. But an article on Vox.com brought home just how ridiculous this price variation really is. The article describes the findings of a new study published in BMJOpen, the open access arm of the British Medical Journal.

The study evaluated costs charged for 10 common blood tests at more than 100 general acute-care California hospitals. Most were not-for-profit, urban, non-teaching hospitals with under 300 beds and an average of 25% Medicaid patients and 41% Medicare patients. The results were astounding:

“We found significant variation in charges for 10 common outpatient blood tests performed at California hospitals. For example, hospitals charged a median of US$214 for a basic metabolic panel, but the charges ranged from US$35 to US$7303. A lipid panel generated a median charge of US$220 at California hospitals, but the maximum charge of US$10, 169 was over a thousand times the minimum charge of US$10.”

It seems incredible: $10 vs. $10,000 for a lipid panel. As the authors conclude: Read the rest of this entry ?

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