Archive for the ‘practice tips’ Category

Older Entries »
h1

What’s Enough? Why It’s Essential for Nurses to Assess Adolescent Sleep

June 7, 2013

By Sylvia Foley, AJN senior editor

Illustration © Anne Horst / http://www.i2iart.com

In her poem “Sleep in the Mohave Desert,” Sylvia Plath wrote about not sleeping, feeling comfortless, tormented by the “heat-cracked crickets . . . [that] fiddle the short night away” in “the blue hour before sunup.” Though Plath was writing as an adult, sleeplessness and other sleep difficulties have troubled humans of all ages for centuries. Until recently, we could only guess at the health consequences. Now there is mounting evidence that inadequate or insufficient sleep has many adverse effects. Adolescents appear to be particularly vulnerable—and it’s not simply because they’re rebelling against bedtime. In this month’s CE, “Assessing Sleep in Adolescents Through a Better Understanding of Sleep Physiology,” authors Nancy George and Jean Davis offer an in-depth look.

Overview: Adolescents need about nine hours of sleep per night, yet most teens get far less. Inadequate sleep has consequences not only for academic performance but also for mental and physical health; it has been linked to lowered resilience and an increased risk of cardiovascular and metabolic diseases. It’s imperative that assessment of sleep become a routine part of adolescent health care. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in this population. Sleep assessment involves evaluating the three main aspects of sleep: amount, quality, and architecture. The authors provide an overview of sleep physiology, describe sleep changes that occur during adolescence, and discuss the influence of these changes on adolescent health. They also provide simple questions that nurses can use to assess sleep and risk factors for disrupted sleep, and discuss patient education and other interventions.

The authors close with detailed suggestions for nurse–patient education, which include teaching adolescents how to

  • unwind from the day’s activities.
  • establish bedtime rituals.
  • create an environment conducive to sleep.
  • avoid activities that might impede sleep.

To learn more, read the article, which is free online. And please share your thoughts and experiences with us in the comments.

Bookmark and Share

Posted in children's health, continuing education, nurses, practice tips, school nurses | Tagged , , | 1 Comment »

h1

AJN’s June Issue: Fracking, Assessing Sleep in Teens, Preventing CAUTI, More

May 24, 2013

AJN0613.Cover.3rd.inddAJN’s June issue is now available on our Web site. Here’s a selection of what not to miss.

Fracking hazards. Though we’re moving into summer, our cover does not depict a jar of fresh, local honey. It is a photograph of Washington County, Pennsylvania, resident Jenny Smitzer, holding a jar of contaminated tap water that turned that color af­ter natural gas drilling began in 2005 above her farm. Eleven U.S. states currently engage in natural gas hydrofracking (“fracking”), and eight more are either considering or preparing for this method of gas drilling.

For an in-depth look at the potential health hazards caused by fracking, such as air pollution, working hazards, and water pollution, see our Environments and Health article, “Fracking, the Environment, and Health.” If you’re reading AJN on your iPad, you can listen to a podcast interview with the authors by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

Most teens get far less than the nine hours of sleep a night they require, which could affect their mental and physical health. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in teens. “Assessing Sleep in Adolescents Through a Better Understanding of Sleep Physiology” provides an overview of sleep physiology, describes sleep changes that occur during adolescence, and discusses the influence of these changes on adolescent health. This article can earn you 2.1 continuing education (CE) credits. A podcast interview with the author is also available on our Web site.

Seven steps to evidence-based practice (EBP) were described in AJN’s popular 12-part series, Evidence-Based Practice, Step by Step. In “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections,” a novice EBP mentor applied these steps in a quality improvement project aimed at reducing the incidence of catheter-associated urinary tract infection among adult patients. This article can earn you 2.4 CE credits.

Still haven’t taken the plunge into the world of social media? This month’s iNurse article, “Microblogging: Tumblr and Pinterest,” gives nurses some ideas about how they can express themselves and share information on two popular social media platforms.

There is plenty more in this issue, including strategies nurses can use to address patients with low health literacy and evidence-based interventions that may reduce risky sexual behavior in adolescents. Stop by and have a look, and tell us what you think on Facebook, or here on our blog.

Bookmark and Share

Posted in audio interviews, practice tips | Tagged , , , , , , , , , | Leave a Comment »

h1

AJN’s February Issue: COPD, Fungal Meningitis Outbreak, SIDs, Nursing Leadership

February 1, 2013

AJN0213 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Last month, we published findings from a quantitative study exploring antiparkinson medication–withholding times during hospitalization and symptom management. This month you can catch part two of this series, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with Parkinson’s disease. Participants’ comments in this study made it clear that the actions of nurses could affect the perioperative experience for better or worse. The article is open access and can earn you 2.1 continuing education (CE) credits.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the U.S. Our CE feature “COPD Exacerbations” outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations. The article is open access and can earn you 2.6 CE credits.

This month we introduce our new series, Perspectives on Leadership, which is coordinated by the American Organization of Nurse Executives. This first article, “Partnering for Change,” describes how one hospital’s nurse leaders and staff worked together to change the way nurses conduct shift report.

Matthews_BillboardEach year in the U.S., more than 4,500 infants die suddenly and unexpectedly. February’s In Our Community article, “Babies Are Still Dying of SIDS,” describes how a nurse’s advocacy and activism resulted in safe-sleep legislation. A podcast with the authors of the article is also available.

Want to learn how hospitals, clinics, and the public health system responded to the recent fungal meningitis outbreak? Read this month’s Emerging Infections article for more.

There is plenty more in this issue, including a report on the recovery of health care facilities following Hurricane Sandy, so stop by and have a look. Feel free to tell us what you think on Facebook, or here on our blog.

Bookmark and Share

Posted in audio interviews, patient safety, practice tips | Tagged , , , , , , | Leave a Comment »

h1

AJN’s January Issue: Men in Nursing, Perioperative Medication Withholding in Patients with PD, Book of the Year Awards, More

December 28, 2012

AJN0113.Cover.Online

AJN’s January issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Even though more men are starting to become nurses, they still make up less than 7% of all RNs.  In “Men in Nursing,” the authors discuss the challenges of recruiting and retaining men in the nursing profession. This article is open access and can earn you 2.1 CE credits.

 In this month’s original research article, the authors report on findings from a quantitative study exploring antiparkinson medication withholding times during hospitalization and symptom management. Part one of a two-part series, this article is open access and can earn you 2.5 CE credits. Look for part two in our next issue, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with PD.

After sustaining a needlestick injury during a research study, nurse Lynn Petrik created a new safety device for a commonly used glucose sensor. “From Putty to Prototype” takes readers through the steps of her invention, from the prototype to the provisional patent.

 Looking for a good read? The votes are in, and the winners of AJN’s annual Book of the Year Awards are listed in this issue. A supplemental online only companion to the article gives the judges reviews for each book.  

 And finally, read “The Clinical Nurse Leader and the Case Manager: Are Both Roles Needed?” for an exploration of these two roles, how they complement each other, and why each is necessary.

 There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog. And have a happy and healthy New Year!


Bookmark and Share

Posted in continuing education, nursing research, patient safety, practice tips | Tagged , , | Leave a Comment »

h1

Depression in Older Adults: A Nurse’s Guide

November 6, 2012

By Sylvia Foley, AJN senior editor

‘Mourning Old Man’ by Vincent Van Gogh

“It is a misconception that depression is a normal, inevitable part of aging; it is not,” writes author Cynthia Cahoon in this month’s CE, “Depression in Older Adults.” Depression affects an estimated 15% to 19% of Americans ages 65 and older living in a variety of settings, yet it often goes unrecognized and untreated. Granted, recognition can be challenging, in part because many symptoms of depression are also common to other illnesses seen in older adults. As Cahoon points out, though, there is also “abundant evidence that depression in older adults is treatable, perhaps in as high as 65% to 75% of cases.”

The article provides an overview of depression in older adults and outlines its pathophysiology and disease types. Known risk factors for this population include the following:

  • chronic medical conditions
  • polypharmacy
  • multiple losses
  • functional decline (physical, cognitive, or both)
  • personal or family history of depression
  • social isolation
  • substance abuse or dependence

According to Cahoon, a majority of adults with depression will present for treatment of physical conditions, rather than for a mood disorder. So it’s important to assess each patient’s mood, regardless of presenting symptoms. Several brief, validated screening tools exist, and busy nurses have several options. One tool, the Whooley Depression Screen, takes less than five minutes to administer and asks just two questions:

1. During the past month, have you often been bothered by feeling down, depressed, or hope­less?

2. During the past month, have you often been bothered by little interest or pleasure in doing things?

Cahoon goes on to describe several treatment modalities, which include psychosocial interventions, psychotherapy, and psychopharmacology. She also covers nursing implications in detail. To learn more, read the article, which is free online. And if you’ve cared for older adults with depression, we’d love to hear about your experiences.

Bookmark and Share

Posted in continuing education, nurses, practice tips | Tagged , , | Leave a Comment »

h1

‘No One Ever Put the Puzzle Pieces Together’: A Nurse’s Guide to Celiac Disease

October 5, 2012

By Sylvia Foley, AJN senior editor

Wheat spikes by Dag Endresen, via Flickr

If you’ve thought that celiac disease is just another disease-of-the-moment that few people actually have, this month’s CE by McCabe and colleagues, “Celiac Disease: A Medical Puzzle,” might make you reconsider. The disease is an autoimmune genetic illness that typically targets the small intestine, and it’s caused by an intolerance to ingested gluten, a complex protein found in wheat and certain other grains. Until recently, celiac disease was considered rare; but widespread serologic testing has indicated otherwise. Experts estimate that up to 1% of the U.S. population—more than 3.1 million people—are affected.

Yet celiac disease remains widely underrecognized. For one thing, clinicians are still being taught that it’s a childhood illness, although onset can occur at any age; for another, disease presentation is highly variable (there are more than 200 associated signs and symptoms). All of the article’s six authors have themselves “either personally endured or witnessed the misery of misdiagnosis.” To help raise awareness, they offer several illustrative stories, including this one:

I am a registered nurse. I was treated for irritable bowel syndrome for more than 10 years. Although I was very careful with my diet, I never seemed to get better and felt sick most of the time. One day, I was admitting an elderly woman to home care and was reviewing her many diagnoses. She told me about her celiac disease and the symptoms she’d experienced. As she went down the long list, I put down my pen and looked at her. “I have the same symptoms,” I said.

The article provides a brief overview of celiac disease, outlines its pathophysiology and the four disease types, and discusses signs and symptoms. As the authors point out, “Diagnosis is all the more challenging because a significant proportion of patients may present with nongastrointestinal symptoms or have no symptoms at all.” Among the numerous non-GI signs and symptoms associated with celiac disease are the following:

  • anemia
  • arthralgia
  • ataxia
  • behavioral disturbances
  • dental enamel hypoplasia
  • dermatitis herpetiformis
  • migraines
  • night blindness
  • peripheral neuropathy

McCabe and colleagues also address disease management and patient education. The only known treatment for celiac disease is strict adherence to a gluten-free diet, which can be challenging, since gluten is widely used as an additive. Nursing implications include teaching patients how to read food, vitamin, and supplement labels and helping them find psychological support. To learn more, read the article—it’s free online. And if you’ve cared for patients with celiac disease, we’d love to hear about your experiences.

Bookmark and Share

Posted in continuing education, nurses, nursing perspective, practice tips | Tagged , , , | Leave a Comment »

h1

AJN’s September Issue: Bariatric Surgery, Biomarkers, Mobile Technology for Nurses, More

August 31, 2012

AJN’s September issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

It’s no surprise that obesity and overweight are on the rise in this country, and nurses will likely find themselves caring for patients who have undergone bariatric surgery at some point in their career. “Outcomes and Complications after Bariatric Surgery” reviews the five most common procedures, outcomes and complications of surgery, and pre- and postoperative patient care. This CE article is open access and can earn you 2.5 CE credits.

Nearly 40% of all surgeries in the United States are performed on adults ages 65 and older. A common complication of surgery in this population is postoperative delirium, which is associated with extended lengths of stay, higher patient care costs, increased morbidity, and greater risk of death. “Postoperative Delirium in Elderly Patients” evaluates risk factors for postoperative delirium in elderly patients and examines potential intervention strategies. This CE article is open access and can earn you 2.5 CE credits.

Smartphones, e-readers, and tablets are everywhere, including at the bedside. In “Tablet Technology for Nurses,” Megen Duffy provides a guided tour of the potential uses and pitfalls of mobile technology for nurses—plus a comparison of the iPad and Kindle Fire.

Whether to predict, diagnose, or monitor disease, biomarkers are useful in every step of patient care. “Biomarkers: An Important Clinical Assessment Tool” reviews common biomarkers used in diagnosing and treating several health conditions, and the effects of their use on patient outcomes.

And if you like our cover, which features photographs of nurses from the The American Nurse, a book of 75 black-and-white portraits of nurses and accompanying interviews by Carolyn Jones (to be published next month by Welcome Books),  read On the Cover and listen to a podcast with the photographer.

There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog.

Bookmark and Share

Posted in audio interviews, continuing education, nurses, practice tips | Tagged , , | Leave a Comment »

h1

Caring for Patients Who Have Bariatric Surgery

August 30, 2012

Roux-en-Y gastric bypass. Image courtesy of Ethicon Endo-Surgery, Inc.

By Sylvia Foley, AJN senior editor

People who are obese (BMI of 30 kg/m2 or greater) are prone to a laundry list of ills. They’re not only at greater risk for diseases such as type 2 diabetes, coronary heart disease, stroke, and osteoarthritis—they’re also more apt to experience discrimination and psychological abuse, and to suffer from anxiety and depression. Many have repeatedly tried to lose weight through diet, exercise, psychotherapy, and pharmacotherapy, to no avail. Until recently, there was little else providers could offer them.

But bariatric surgery, known to be an effective treatment for obesity and obesity-related comorbidities, is becoming an increasingly common option. In 1998, only about 13,000 bariatric procedures were performed in the United States; by 2007 that figure had jumped to 200,000, and it continues to rise. With prevalence rates for overweight and obesity also at record highs in this country, more nurses will likely find themselves caring for patients who have undergone such procedures.

In this month’s CE, “Outcomes and Complications after Bariatric Surgery,” authors Lauren Gagnon and Emily Karwacki Sheff explain the two main types of bariatric surgery and outline five of the most common procedures in the United States: 

  • Roux-en-Y gastric bypass (RYGB)
  • adjustable gastric banding (AGB)
  • vertical sleeve gastrectomy (VSG)
  • biliopancreatic diversion with du­odenal switch
  • vertical banded gastroplasty

Gagnon and Sheff then discuss the outcomes and complications of bariatric surgery, noting that although it is “generally safe,” there is always some risk. Read the rest of this entry ?

Posted in continuing education, nurses, practice tips | Tagged , | 1 Comment »

h1

Making a Case for Therapeutic Hypothermia

July 23, 2012

Photo © Rick Davis 2011.

One of the articles published in AJN’s July issue that’s proving popular is “Therapeutic Hypothermia After Cardiac Arrest,” by Jessica L. Erb, an acute care NP at the University of Pittsburgh Medical Center Presbyterian Shadyside Hospital, and colleagues Marilyn Hravnak and Jon C. Rittenberger. The article points out that, despite evidence supporting its effectiveness, therapeutic hypothermia is not widely used.

According to the article’s overview, “Irreversible brain damage and death are common outcomes after cardiac arrest, even when resuscitation is initially successful. Chances for both survival and a good neurologic outcome are improved when mild hypothermia is induced shortly after reperfusion. Unfortunately, this treatment is often omitted from advanced cardiac life support protocols.”

The article discusses the efficacy of therapeutic hypothermia, indications and contraindications for its use, various induction methods, associated complications and adverse effects, and nursing care specific to patients undergoing this procedure.

Read the article (it’s open access)—you can earn 2.3 hours of CE credit.—Shawn Kennedy, AJN editor-in-chief

Bookmark and Share

Posted in continuing education, nurse practitioners, nurses, patient safety, practice tips, Shawn Kennedy, AJN editor-in-chief, Uncategorized | Tagged , , , , , | 1 Comment »

h1

When It’s Not Just Heavy Menses: A Nurse’s Guide to Recognizing von Willebrand Disease

June 11, 2012

By Sylvia Foley, AJN senior editor

Blood red sky by Micky Zlimen, via Flickr

Quick, what’s the most common inherited bleeding disorder? As you might have guessed from the giveaway title, it’s not hemophilia. It’s von Willebrand disease, and it affects about 1.3% of the U.S. population.

Yet many nurses and other clinicians, as well as the public, are unaware of this disease, its symptoms, and the associated risks. Sequelae can include complications during pregnancy and childbirth, chronic joint disease, even death. In girls and women, menorrhagia is the most common symptom; while the disease is equally prevalent in both sexes, it can be more problematic for menstruating females. In our June CE article, “Just Heavy Menses or Something More? Raising Awareness of von Willebrand Disease,” author Josie Weiss seeks to improve the odds that nurses will know when to suspect that a patient has the disorder and what to do once diagnosis is confirmed.

Simply put, von Willebrand disease is caused by “genetic defects in the concentration, structure, or function of von Willebrand factor,” which is a protein essential to blood clotting. These defects result in episodes of excessive or prolonged bleeding, which can be mild to severe in intensity. Weiss describes the three main types of the disease (which are distinguished by their pathophysiologic mechanisms) and lists suggestive signs and symptoms, which include the following: Read the rest of this entry ?

Posted in continuing education, practice tips, school nurses, women's health | Tagged , , | Leave a Comment »

Older Entries »
Follow

Get every new post delivered to your Inbox.

Join 456 other followers