Archive for the ‘Social media’ Category

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Remembering Nurses Who Served the Wounded and Dying and Those Who Died Themselves

May 22, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Normandy American Cemetery, France. Photo by Karen Roush

Normandy American Cemetery, France. Photo by Karen Roush

So many of us look forward to Memorial Day weekend as a welcome long weekend and official start of summer. But there are many for whom Memorial Day (the last Monday in May) is a reminder of loved ones who died in military service—and that includes a significant number of military nurses who cared for the wounded in various wars.

We’d like to take this occasion to remind us all of the real meaning of this day and to honor the sacrifices of our colleagues. While it’s hard to find specific numbers of nurses who died in wars, one can extrapolate from what’s known about women who died, since most women who served in combat areas from the start of the 20th century through the Vietnam War were nurses.* Read the rest of this entry ?

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A Found Poem For Nurses Week

May 11, 2015
Badruddeen, via Flickr

Badruddeen, via Flickr

The poem below, originally published in our May 2005 issue, is by Veneta Masson, MA, RN. It’s a “found poem,” a form of poetry in which the poet assembles phrases selected from a source or sources. The lines here come “from actual posts to an Internet bulletin board,” but they could as easily be comments on AJN‘s Facebook page! The author is a nurse and writer living in Washington, DC (more about her work can be found here).—Jacob Molyneux, senior editor

Nurses Week—What Did You Get?
Hi, everyone! Just curious to see what you received for Nurses Week.

Denim shirts with the company logo

Swiss Army–type knives with fourteen blades

Carnations in dollar-shop vases

One wilted rose

Soap on a rope

I think I’m worth more than this

A live band at the Holiday Inn

A potato bar luncheon

If you weren’t there, you got nada

Nothing

Not a thing

A PA announcement thanking the nurses

We dug out our caps & wore them all day
our VP of Nursing came to the unit and stayed for an hour
we sat with her & shared our stories of why we went into nursing

We got pizza one day (if you were there) and ice cream one day (if you were there)

Rolos, Skittles and M&Ms—give me the tools to do my job
instead of tote bags and candy

A drawing for some pretty cool prizes—movies, massages, a month off call

A bonus

We got to work overtime!

I presented my findings to the Executive Team and found out Tuesday
that they had approved another nurse . . . the best thing I   could have gotten

One of my patients agreed to an interview with a local paper
and our story made the front page

Read the rest of this entry ?

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Nurses Week: An Annual Occasion for Mixed Feelings and a Little Reflection

May 4, 2015

By Shawn Kennedy, AJN editor-in-chief

by rosmary/via Flickr

by rosmary/via Flickr

It’s here again, that week set aside to remember the accomplishments of Florence Nightingale and the good work all nurses do. Many nurses I speak with don’t like this annual event and feel it represents a patriarchal tradition that diminishes our professionalism. One nurse recently said to me, “Do they have a Neuroscientists Week, or an Attorneys Day?” (Actually, a Google search reveals there’s a “Be Kind to Lawyers Day”! But you get the point.)

Others say that Nurses Week provides an opportunity to promote our profession and gain recognition for what we do, even if only for a week—and that’s better than nothing. Organizations do seem to have evolved from the “Love a nurse prn” shoelaces to more substantial recognition, like a lunch with a noted speaker, or better yet, recognizing the achievements of their own staff.

On the other hand, I was surprised last year when I asked on AJN‘s Facebook page what nurses’ workplaces were doing for Nurses Week and many nurses replied, “nothing.” That word was often followed by some derogatory remarks about the facility.

I have mixed feelings, but I guess I fall more into the camp of using Nurses Week to remind everyone—including ourselves, colleagues, employers, and the public—of the complex and vital work nurses do. Without nurses, there is no health care system. Nurses Week is an opportunity to honor those among us who have achieved excellence and gone “above and beyond” in their work. Still, as a blog post from a few years back (“Superlatives: An Alternate List for Nurses Week”) gently suggests, honoring needs to be appropriate to the seriousness of the work we do and not be trivialized with meaningless trinkets and goodie bags. Read the rest of this entry ?

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Good Jokes, Bad Jokes: The Ethics of Nurses’ Use of Humor

April 29, 2015

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Humor has real benefits. But when does nurses’ joking about patients, each other, and the care they provide cross a line?

Photo from otisarchives4, via Flickr.

otisarchives4/Flickr

“Nurses make fun of their dying patients. That’s okay.” That was the provocative title of an op-ed by Alexandra Robbins in the Washington Post on April 16. The author’s treatment of the topic was more complex than the title suggested, but some examples of humor given in the article were troubling.

For ethical practice, nurses must consider if it is ever appropriate to discuss the clinical care of patients for humorous purposes. An easy answer would be—never. If patient care is never joked about, then no one’s feelings are ever hurt and nothing inappropriate is said as a joke. However, my experience as a nurse in psychiatric emergency and with human nature suggests two arguments against this approach:

  • Jokes will be made despite any prohibition.
  • Considerable good comes from such humor.

If jokes are going to be told anyway, it’s better to provide an ethical framework than to turn a blind eye. If joking about patient care is sometimes acceptable and sometimes not, nurses’ jokes are more likely to stay ethical if they consider in advance under what conditions it’s ethical to joke and how one distinguishes ethical from unethical humor.

According to Vaillant (1992), humor is among the most mature of the defenses. “Like hope, humor permits one to bear and yet to focus upon what is too terrible to be borne” (Vaillant, 1977). Those who have experienced the stress of intense clinical practice know the value of finding humor in life’s tragedies. In addition, patients who are able to cope with their physical and emotional pain are often those who find the humor in tragedy.

Still, some attempts to make people laugh are unkind, and it hurts to be the subject of others’ laughter. Vaillant distinguishes humor from wit, noting that humor never excludes (1977). It may help nurses to enjoy the beneficial effects of humor and avoid the effects of harmful humor if we attempt to identify some characteristics of appropriate humor. Watson (2011) offers some useful suggestions for self-examination to determine the acceptability of clinical humor:

  • Is the joke about the patient, the situation, or the clinicians themselves?
  • Does the joke reveal disdain or contempt for the patient?
  • Could the joke affect care? An example might be jokes suggesting that a patient deserves pain or disability. Wear et al. (2006) demonstrated that medical students treated patients considered responsible for their pathology as “fair game” for derogatory humor. And nurses have more difficulty empathizing with patients they consider responsible for their pathology (Olsen, 1997). Therefore, jokes enhancing this perception could erode a nurse’s relationship with that patient.
  • What is the underlying intent of the joke—is the motive to influence clinician behavior or attitude? This includes both harmful and helpful intent. Some jokes could be used to gently chide a clinician toward more empathy. Upon hearing a nurse refer to drug-seeking patients in a derogatory tone, I may retort, “Of course they’re lying about their pain. What would happen if she told the triage nurse that she has a five-bag-a-day habit and her dealer is out of town?” The comment generally gets a laugh, and my goal is to give the nurse a chance to consider the patient’s perspective and perhaps see the situation less as despicable deception and more as the desperation of unmet needs.
  • Is it true humor—that is, is it inclusive, a clever juxtaposition, insightful—or is it simply mean-spirited mockery of another’s misfortune? This distinction is subtle and is often dependent on personal intuitive reaction: Does it feel cruel, callous or uncaring? Do you feel shame at saying or hearing it? Does laughing at the joke make you uncomfortable? These reactions vary widely, as can be seen in the public debate regarding what is called “political correctness.”

Filter yourself when thinking to tell a joke and reacting to another’s humor. Pause a moment before telling the joke or reacting to another’s comment; let your intuition and values weigh in. Then, speak—or don’t.

A more difficult ethical issue is whether it is acceptable to make potentially hurtful jokes if one can reasonably ensure that the joke remains within the clinical circle. Read the rest of this entry ?

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AJN’s Spring Break with the Student Nurses in Phoenix: Sunnier Job Outlook for New Graduates?

April 17, 2015

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

PhoenixSkylineAfter a long winter in the Northeast, it was wonderful to visit Phoenix last week for the 63rd annual convention of the National Student Nurses’ Association (NSNA).

Like other meetings, this one was packed from morning to late evening with educational sessions, exhibits, resume-writing consultation, and for some, deliberating over 60 resolutions at the House of Delegates. Keynotes addressed:

  • health care reform (Gerri Lamb).
  • progress on implementing recommendations from the Future of Nursing report (Susan Hassmiller).
  • clinical ethics and moral distress (Veronica Feeg and Cynda Rushton).
  • and, the closing speech, a charge to continue nursing’s legacy into the future (yours truly).

Concurrent sessions, most of them well attended by Starbucks-fueled students, covered nursing specialties, exam help, licensure and legal/ethical issues, and clinical topics. (Betsy Todd, AJN‘s clinical editor, who is also an epidemiologist, led a session called “Is It Safe: Protecting Ourselves and Our Patients from Infectious Diseases.”)

Changing job climate? Several students I spoke with who were graduating at the end of the semester didn’t seem to have the anxiety of previous years’ students over securing a job. Maybe this is because things are looking up in the job market for new graduate nurses, at least according to recent figures in NSNA’s annual survey of graduates.

Reporting in the January issue of Dean’s Notes, researcher Veronica Feeg, associate dean of Molloy School of Nursing, and NSNA executive director Diana J. Mancino note that, in a September 2014 survey of NSNA members who were 2014 graduates, 78% reported they had secured an RN position by six months following graduation. This is an increase over the prior two years, when results were 76% for 2013 graduates and 66% for 2012 graduates. Read the rest of this entry ?

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Recent End-of-Life Care Links of Note, by Nurses and Others

April 13, 2015
nature's own tightrope/marie and alistair knock/flickr creative commons

nature’s own tightrope/marie and alistair knock/flickr creative commons

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent NPR story, a Honolulu hospital offers patients and their family members instructive videos on the sometimes gruesome realities of some end-of-life treatment options. Starting with the no-sugar-coating-it statement, “You’re being shown this video because you have an illness that cannot be cured,” these videos explain intubation, CPR, and the different care options available.

I really liked this piece because the physician admitted that he was ill prepared to talk to a patient running out of options who he had never met before. Then he remembered the counsel of other professionals to give patient-specific care (“What are your goals for your care?”).

And some recent coverage in AJN or on this blog
Joy Jacobson’s short end-of-life and palliative care overview from 2013. Read the rest of this entry ?

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More Than Competencies and Checklists: The Shadow Side of Nurse Orientation

March 30, 2015

‘Developing beneficial working relationships is part of a successful nursing orientation. If you’re lucky, your preceptor is explaining the nuances.’

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is hers.

Paradisi_Illustration_ShadowI led the first patient I had contact with as a nurse navigator to the hospital restrooms—this was her most pressing concern at the time. Building on this success, I now have a small number of patients to navigate through their cancer journeys, under advisement of my preceptors.

During this early stage, I’ve become aware that, running parallel to my orientation, a shadow orientation is also occurring.

This umbral orientation doesn’t come, like its more tangible counterpart, with a sheath of paperwork with competencies to perform or checklists to mark off. But it’s just as real. Awareness of shadow orientation develops on an intuitive level. While this experience is difficult to describe in words, it feels familiar.

Shadow orientations happen to everyone. Nearly 30 years and several nursing jobs since that first one, I’m acutely aware of the importance of a good first impression. Fortunately, this particular orientation of mine is going smoothly, but here are some observations based on past experiences.

Shadow orientation is present when you meet a staff member who makes it known this is her desk, her chair, her phone—maybe not in words, but with a look and a click of her tongue as she makes a great show of finding somewhere else to sit, despite your offer to give up the seat.

It’s happening when a physician won’t speak to you directly about your patient, instead giving his orders to the charge nurse, because you’re new. When you question it, she explains, “It takes him a long time to trust new nurses.” But she does nothing to facilitate an introduction between you.

Another example: There’s much discussion about working relationships between nurses and physicians, but little is said about the interactions between nurses and ancillary staff, such as respiratory therapists, X-ray technicians, phlebotomists, or unit secretaries. Each play important roles in patient care, but negotiating workflow can be a source of friction, depending on the individual’s level of professionalism.

I’m only partially joking when I advise striving for a good working relationship with the unit secretary. She or he knows who to call for a vacant bed, the phone and fax numbers you need, and how to make the office machines work. Even now, I can manage a patient safely on a ventilator, but am nearly helpless when the copier machine doesn’t work.

Developing beneficial working relationships is part of a successful nursing orientation. If you’re lucky, your preceptor is explaining the nuances. Read the rest of this entry ?

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