Archive for the ‘patient perspective’ Category

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E-Cigarettes: Positive Smoking Substitute or a New Problem Replacing the Old?

May 4, 2012

Photo by Michael Dorausch, via Flickr

By Michael Fergenson, senior editorial coordinator

The dangers of smoking cigarettes are well documented, from the terrifying commercials about what smoking does to our bodies to the warnings right on the pack. Yet the Centers for Disease Control and Prevention estimates that 45.3 million people in the United States smoke.

Now, a new trend in tobacco products has become the center of much debate. I’m referring to the electronic cigarettes, or e-cigarettes, that are gaining popularity as a smoking alternative and, for many, as a tool to quit.

I personally know two people who are using this device in an attempt to stop smoking. An article published in the New York Times last November reports that the number of Americans trying e-cigarettes “quadrupled from 2009 to 2010.” The article also cites the results of a survey published in Tobacco Control last year, which found that 1.2% of adults, or close to 3 million people, had reported using these products in the previous month. But are e-cigarettes really a positive smoking substitute and aid to quitting?

How they work. Most e-cigarettes are shaped like a real cigarette, but some have a unique look. They work by heating up a liquid—purchased separately from the device—until it turns into an inhalable vapor. These liquids are available in a variety of flavors, scents, and levels of nicotine content. Some have no nicotine in them at all. Even though e-cigarettes don’t emit real smoke, they can’t be used everywhere—local governments can ban their use, as can private owners of buildings or transportation services. Because these products are fairly new, there’s no way to conclusively know whether or not they are healthier than cigarettes.

Proponents say that the vapor produced is as harmless as fog-machine smoke. The liquid usually contains five to 10 ingredients, all of which are licensed for human consumption and considered safe. This is compared to the more than 5,300 ingredients that have been identified in cigarette smoke, most of which are harmful. Most people use e-cigarettes as an aid to help quit cigarettes, but some just use them as an alternative nicotine delivery system.

What the critics say. One of the arguments against e-cigarettes is that it may lead to children smoking. Since the liquid packs come in many different flavors, this may appeal to a younger demographic. It would also be easier for teenagers to hide the fact that they are using e-cigarettes, since they don’t produce the tell-tale odor of tobacco smoke. There’s also a new “smart” cigarette pack, designed for use with e-cigarettes, that sets up a social network between smokers. Also seeming to target the younger demographic, this device connects wirelessly to social networking sites, and even flashes a blue light and vibrates when it detects another smart pack nearby. Read the rest of this entry ?

Posted in patient perspective, public health nursing | Tagged , , , , , , | 11 Comments »

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The ‘Inexhaustible Well’: Notes from a Trauma Nurse on Mortality

April 19, 2012

UW Digital Collections/via Flickr

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” will be published in the May issue of AJN.

Years ago, long before I was a nurse, I read The Sheltering Sky, by Paul Bowles. He speaks of the tendency of people to take life for granted, and says that in the unpredictability of death there lies a presumption that everything is limitless:

“Because we don’t know when we will die, we get to think of life as an inexhaustible well. Yet everything happens only a certain number of times, and a very small number really. How many more times will you remember a certain afternoon of your childhood, an afternoon that is so deeply a part of your being that you can’t even conceive of your life without it? Perhaps four, five times more, perhaps not even that. How many more times will you watch the full moon rise? Perhaps 20. And yet it all seems limitless.” 

Lately, especially at work, that quote has edged forward and lingered with me. The ICU I work in is primarily devoted to trauma, but there’s been a recent shift in patient demographics. Last week I took care of only one trauma patient—an athlete who’d had a bike accident—and then three patients with cancer in varying stages.

The patient I’m most haunted by is a 65-year-old woman who had arrived in the ER with pain and weakness and would be leaving the hospital with a stunning diagnosis of stage IV cancer, and with numbered days. When I last spoke to her she’d just met her new oncologist and was waiting to be transferred out of the ICU.

“I’m going home,” she said. “I’m going to be with my family and sit on my porch. I’m having a glass of wine.” Read the rest of this entry ?

Posted in patient perspective, writing and nursing | Tagged , , , , , , , | 7 Comments »

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April Apps and Other Good Things

April 4, 2012

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

April is one of those months most people like, I think—the weather becomes consistently warmer and flowers appear. And this month, we at AJN are especially delighted because we launch our very own iPad app! As a temporary introductory offer, you can download the app for free (click here, or search under American Journal of Nursing in the iTunes app store) and get the full April issue. (Eventual pricing is still being determined.)

It’s another way AJN is providing you with accurate, evidence-based information in formats that allow you to access it when and where and how you want it. Don’t forget to subscribe to our always free audio podcasts, too—there are monthly highlights and interviews with authors.

And April is a stellar issue. This month we focus on examining how we treat people with disabilities. The cover, the editorial, and two features all deal with how we need to do better in this area. In the original research article, Suzanne Smeltzer and colleagues report on their survey of people with disabilities, querying them on interactions with nurses during hospitalizations. Their findings are sobering and should serve as a wake-up call when providing care to people with disabilities when they are hospitalized.

There’s also a poignant piece, “Hard Lessons from a Long Hospital Stay,” describing the experience of one of the authors of the research article, Michael Ogg, who despite being severely disabled from multiple sclerosis, lives independently. Yet during his four hospitalizations, he was mostly bedridden, unshaven, and often left unfed because the system is not geared towards people with disabilities nor are nurses familiar with providing care for them.

I hope these articles will increase awareness and spur some changes in how hospital-based nurses view and interact with people with disabilities (and also among faculty who are developing curricula). There’s also an interview with the authors of these pieces—just click on the podcast icon when reading the article on our Web page (or tap the icon when on the iPad).

‘Course, there’s also another CE article in the issue, articles dealing with latent tuberculosis in health care workers, managing cancer fatigue, a QI report on early post-op ambulation, news, Drug Watch, the Reflections essay, Art of Nursing, and more. You can go right to the issue on our Web site, or download the app and check it out on your iPad (the graphics are awesome!), or  of course read it in print—your choice on how you want to keep up to date.

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Posted in nursing perspective, nursing research, patient perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | Leave a Comment »

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“Let Patients Help”: Nurses and e-Patients

March 30, 2012

 

Joy Jacobson is a health care journalist and the poet-in-residence at the Center for Health, Media, and Policy at Hunter College, where she teaches writing to nursing students.

In the March issue of AJN, a letter writer responds critically to my news report, “Leveling the Research Field Through Social Media,” published last October. My report summarizes some recent trends in medical research, including patients using Facebook and other social networking sites to push for the funding of research into treatments that the science may not support. I go on to discuss PatientsLikeMe, which describes itself as “a health data-sharing platform” designed to “transform the way patients manage their own conditions.”

The letter writer objects to the idea of patients sharing their own data online. Can vulnerable, mentally ill patients, she asks, consent to participate in online research? Is enough being done to safeguard them? “I suggest we disseminate information to nurses that helps them steer patients away from Web sites such as PatientsLikeMe,” she concludes, “until programs and processes are in place to better protect the public we’ve pledged to serve.”

Several PatientsLikeMe researchers responded to this nurse’s points; a synopsis of their responses was included along with the reader’s letter in the March issue. “What we are doing is new and as such should be scrutinized frequently and rigorously by peers to ensure we are meeting the ethical standards one would expect for our patients,” they write. “We believe our established processes and procedures are consistent with these expectations.”

While I think the letter writer’s urge to protect patients is laudable, I find unrealistic her suggestion that nurses “steer patients away” from social media, especially in this age of e-patients and participatory health care. As I understand it, e-patients are not reckless. Rather, they’re “enabled, equipped, engaged, and empowered.” But even those who aren’t knowledgeable might want to participate more fully with clinicians and researchers alike in seeking the best care available. Read the rest of this entry ?

Posted in nurses, patient perspective, social media | Tagged , , , , , , | 3 Comments »

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Losses: In Search of an Honest Prognosis

March 19, 2012

by h.koppdelaney/via Flickr Creative Commons

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Several years ago I took care of a lady who’d suffered a small cerebral hemorrhage after falling and hitting her head. She was in the ICU for several days. Her husband stayed at her side constantly, and he became a part of a never-ending loop in which she would wake up startled to be in a hospital, and then notice her husband and ask him where she was and what had happened.  He’d hold her hand and gently relay the events of her injury, after which she’d react with mild surprise, every single time. Then she’d close her eyes and doze until she woke up to reinitiate the same conversation.

Her husband, after days of patiently playing his role in this repetitive scene, was clearly wearing down. He waited anxiously for the neurosurgeon, expecting explanations and hoping for reassurance.

When the neurosurgeon rounded later that day I heard him speak at great length about the details of her injury and the treatment plan. He ultimately advised that, although he thought she’d recover well, only time would tell.

Her husband wanted more than that, though. He pressed for specifics, firing one question after another in his quest for clarity and absolutes, until the neurosurgeon paused and wiped his brow with a sigh. Read the rest of this entry ?

Posted in patient perspective, writing and nursing | Tagged , , , , , , | 1 Comment »

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The Elusive Strict Diet

March 14, 2012

Photo by techwithtodd, via Flickr

By Amy M. Collins, associate editor

Several days ago, we linked on our Facebook page to an abstract of a JAMA article that found that women hospitalized for myocardial infarction were more likely than men to present without chest pain. A few days later, my 59-year-old mother was told by her general practitioner that her ECG had shown an electric “blip” that could be due to scarring from an unnoticed heart attack. My mother—always too lax about these things (unlike her hypochondriac daughter)—calmly told me she always has random chest pains and it could have happened at any time.

A visit to the cardiologist a few days later eased our fears. She hadn’t had a heart attack, but was diagnosed with right bundle branch block and has to undergo further testing. With high C-reactive protein levels, elevated cholesterol, and a history of heart disease in the family, one can’t be too careful. A stress test and cardiac ultrasound have been ordered.

In discussing her cholesterol level, which had increased since my mother’s last wellness exam, the cardiologist suggested she start taking statins. Not keen on medication, and worried by recent reports of adverse effects from these drugs, she said she’d rather only start with that if there were no other options. His suggestion was to maybe try some over-the-counter products to lower the cholesterol, mentioning that there were products that acted liked sponges to absorb cholesterol, but not offering anything specific.

My mother’s general practitioner followed up by letter, giving her a three-month window to try to bring  the cholesterol levels down by following a “strict diet,” with no further information on what that entails or what she could do to accomplish this. Exercise was not mentioned at all.

Today my mother asked me what she should eat to make her cholesterol go down. (She thinks that, as an editor at AJN, I naturally have all the answers!) Already thin and following a low-fat diet, she says she doesn’t know where to start. She also admitted to consulting WebMD to find out what she could do.

Resorting to searching online for answers, to me, raises a huge red flag that communication between provider and patient had broken down somewhere, or wasn’t sufficient. Surely this can’t be the best answer. A phone call and discussion or at least an information pamphlet seems warranted.

I guess we can’t expect physicians to be nutritionists and personal trainers, but it seems strange and all too familiar that the first line of defense always appears to be medication, without a mention of specific lifestyle changes that are within our control (treating the disease instead of possibly preventing it). Read the rest of this entry ?

Posted in patient perspective | Tagged , , , , , | 4 Comments »

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‘Like an Origami Swan’ – Remembering Tea with Miss Elsie

March 8, 2012

“Hello,” I said. “I’m the nurse. I’m here to see Miss Elsie.”

“I know,” he answered, grabbing my wrist and pulling me inside.

The heat of the cramped house slammed into my face. The windows were closed and the shades pulled down. Without a word, my little escort guided me down a narrow hallway into a room not much bigger than a closet, then deftly released my wrist and slipped out of sight.

So starts “Tea With Miss Elsie,” by Claire Schuster, MSN, RN, APRN-BC, CWS, associate professor emerita in the nursing program at Berea College, Berea, Kentucky. The Reflections essay in the March issue of AJN is a subtle, quiet portrait of a moment and the gesture at its heart, and it’s well worth a read. (For the most appealing version, click through to the PDF version link in the upper right of the landing page.)—JM, senior editor  

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Posted in nursing perspective, patient perspective, writing and nursing | Tagged , , | Leave a Comment »

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Are You Ever Justified in Deceiving a Patient?

March 1, 2012

A patient’s irrational refusal to take medication can be frustrating for the nurse. Crushing the pill into applesauce or ice cream saves time and effort, and spares the patient the aggravation of quarreling. But while hiding medication is sometimes ethically justified, often it is not.

That’s the start of the “Putting the Meds in the Applesauce,” an article (free for March) by nurse ethicist Douglas Olsen in the current issue of AJN. Olsen notes that studies suggest hiding medications in food may be a relatively common practice, considers the ethical principles at play in such a decision, and offers advice for those who may be considering it. (Added: The column chiefly concerns the nursing care of cognitively impaired patients—not those who simply don’t want medications or those with with psychiatric illnesses who may be endangering themselves or others by refusing medication.)

Says Olsen, “[t]wo factors must be considered in determining whether hiding medication is justified or not: the nurse–patient relationship and the patient’s rights.” He adds that such a decision “requires the nurse and surrogate decision maker to imagine how the patient might have reasoned: would the earlier, cognitively intact patient have agreed that, given the present impairment, the providers shouldn’t be morally bound to accept the patient’s decision to decline medication?”

Another question he suggests asking oneself is this: “could the deception survive public scrutiny, including that of professional peers?”

What’s your take? What’s your experience?—JM, senior editor

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Posted in ethical issues, patient perspective | Tagged , , , , , , | 3 Comments »

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The Cruel Irony of Alzheimer’s Disease

February 6, 2012

Photo by 50 Watts, via Flickr.

By Amy M. Collins, associate editor

As I watch my grandmother navigate the murky waters of her Alzheimer’s disease, it continues to surprise me that parts of her brain work at warp speed, while other parts seem to be completely defunct. For example, although she can’t remember what she’s done from one minute to the next, she can make up a lie to compensate for the memory loss in less than 30 seconds.

“Where did you get that new necklace, Grandma?” I recently asked at a family party. “Oh I bought it at the place where I work, you know, I type at a school,” she said, with certainty. Or when asked where she got a new sweater, she told my mother she went to the store. “How did you get there?” my mother asked. “I drove,” she said. “But you don’t have a car.” “Oh, well then I must have walked.”

She no longer remembers my name unless prodded, but she does remember that she has a cat in her room at the independent living center, and worries about it constantly. “I have to get back to take care of my cat,” she says when she visits us, becoming increasingly stressed the longer she’s away. Yet it’s hard for her to remember to care for herself, and she often forgets to shower or eat.

She still has a sense of humor, making fun of the “old” people at her facility and bragging about how great her own paintings are. She once complained about a photo of her that hangs in her independent living center’s entrance, together with photos of all the other residents. “Maybe it’s just the lighting, because nobody’s photo looks good,” my aunt said. “Yes, but the other residents really look like that,” my grandmother quipped.

But sometimes even her ability to laugh at things is heartbreaking. She recently called because she was worried about my grandfather—she couldn’t find him in the home. “Dad’s been dead for eight years,” my mother told her, worried at what my grandmother’s reaction might be in revisiting this particular pain. “Oh, well, then that explains it,” she said. “I was wondering how we both fit in a single bed!”

Another unexpected acuity is her ability to outwit her nurses. When it’s time for them to dispense her pills, she sometimes convinces them she’s already taken them. She’s also managed to sidestep nurses’ intervention in her diet. After my grandmother had gained weight over the past few months, the nurse we hired to keep an eye on her told the waiter at her facility not to give her any more ice cream after dinner or bacon for breakfast. While “in her right mind,” she would never have eaten these foods, even once denying my dying grandfather eggs because of “high cholesterol.” But the day after the nurse intervened with the waiter, we found out my grandmother had switched tables, got a new waiter, and got the bacon. Read the rest of this entry ?

Posted in patient perspective | Tagged , , | 6 Comments »

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Tilting the Earth

January 30, 2012

Elizabeth R. Plumer, PhD, JD, is a biochemist and intellectual property attorney. She lives in Saco, ME.

When an MRI revealed that my four-year-old daughter’s brain cancer had returned, I took the only action possible: I bought a dog. I scoured the Sunday papers and found just the puppy I was looking for, a Rottweiler. No deep psychological analysis was necessary to decipher my choice. I wanted a dog to protect my daughter from external threats, even if it could not protect her from the one threat that mattered most.

We named our puppy, Maggie, after Rod Stewart’s Maggie May, because from the moment she entered our lives, she stole our hearts. Maggie whimpered through that first night until I fell asleep on the couch with her gently snoring on my chest.

It was like having a newborn in the house again, and just as I had filled photo albums of my daughters, I took pictures of Maggie and my girls together. In one, taken the first summer we had her, Maggie lies in the shade beneath the swing set as if on sentry duty for my four-year-old and her seven-year-old sister. My girls hold steady on their swings and smile into the camera. The younger one wears one of my husband’s T-shirts over her bathing suit and sports a pixie haircut, the short hair a legacy of her recent surgery and radiation treatments. In my mind, the still photograph morphs into action as my daughters jump off their swings and pounce on Maggie, who luxuriates in the attention and rolls over to request a belly rub.

My younger daughter was 18 months old when she was first diagnosed with brain cancer. Her tumor was an astrocytoma, named for the star-shaped cells from which it had originated. Her tumor was benign, a meaningless term since benign brain tumors can be just as deadly as malignant ones, if left untreated. The location of my daughter’s tumor made it impossible to completely excise without risking paralysis. Radiation treatments were not recommended for children under six because of their harmful effects on a child’s developing brain. The surgeon removed as much of the tumor as possible. The rest was left behind until a second operation became inevitable.

When my daughter turned four, an MRI showed that the tumor had increased in size, she underwent a second operation to reduce the mass as much as possible. This was followed by daily radiation therapy for eight weeks. The doctors gave my daughter a one in three chance of surviving five years. Read the rest of this entry ?

Posted in children's health, patient perspective | Tagged , , , , | 4 Comments »

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