Archive for the ‘Uncategorized’ Category

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How Good Are Your CPR Skills? Research Shows Monthly Practice Is Crucial

May 11, 2012

A nurse practices CPR on a voice advisory manikin. Photo courtesy of Laerdal Medical.

By Maureen Shawn Kennedy, AJN editor-in-chief

Most of you are probably aware of the AHA’s revised CPR guidelines that were issued in 2010. They include a major change in the resuscitation sequence—which now begins with chest compressions rather than ventilation—and emphasize the importance of achieving adequate compression of the chest—“at least two inches (5 cm)”—to achieve adequate blood flow. (You can see a video by the AHA demonstrating the new guidelines here.)  This change is especially important in light of recent research on CPR skills.

In 2011, Marilyn H. Oermann and colleagues conducted research with nursing students to determine how often one needs to practice CPR skills to maintain competence. 

As she explains in an article in the May issue of AJN, students who practiced briefly each month not only maintained their skills, but improved them significantly by the end of 12 months.

In comparison, the skills of those who only  had an initial training session deteriorated after three months; by 12 months, few could perform CPR adequately, especially in terms of achieving adequate depth for chest compressions. And although these were students, Oermann describes studies showing similar results with paramedics, non-ICU nurses, and nurse anesthetists. 

Most hospitals and agencies only require an annual review or demonstration of skills to be recertified in CPR; few, I bet, measure the depth of compressions. Sounds like it’s time to revisit this practice.

You can hear Oermann discuss her article in a podcast with Jo Haag, director of global training, ECC Programs, AHA, and Vanderbilt nursing professor Mary Fran Hazinski, a clinical specialist in pediatric critical care at Monroe Carell Jr. Children’s Hospital at Vanderbilt and a senior science editor at the AHA.

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Say It Ain’t So: Another ‘No’ on the Cookie Dough

December 12, 2011

Photo by AlexiUeltzen, via Flickr.

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

I admit it. For me, the best part of baking chocolate chip cookies is eating the raw dough. I know there’s a risk for a food-borne illness, but it’s hard to resist at least one mouthful—well, maybe two—of that combination of brown sugar, butter, and chocolate chips. Now, just in time for the holiday baking season, there’s even more evidence that taking that bite is not such a great idea.

A recent study by Neil and colleagues found that a 2009 outbreak of Escherichia coli was associated with eating raw cookie dough: 77 people across multiple states came down with an E. coli O157:H7 infection. The researchers found the common exposure was to a  ready-to-bake, prepackaged cookie dough that the patients had eaten raw. They believe the most likely culprit in the dough was contaminated flour. (The researchers note that flour has been implicated in food-borne Salmonella and E. coli outbreaks in the past.)

So, when educating patients about safety this holiday season, remind them that food products meant to be cooked or baked should never be eaten raw. As for me, this holiday I think I’ll head to the bakery and stay out of temptation’s way.

What other holiday safety tips have you got for patients?

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Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

November 30, 2011

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

Marilyn Tavenner

When Donald Berwick steps down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) on December 2, he’ll turn the reins over to Marilyn Tavenner, MHA, BSN, RN. Tavenner is not a new face at CMS—she served as acting administrator prior to Berwick’s July 2010 appointment by President Obama and has been principal deputy administrator at CMS since February 2010.

As noted by an article in The Washington Post, Berwick is stepping down in the face of organized opposition to his nomination by Republicans in Congress, who have vowed to block the confirmation he’d need to continue after his recess appointment expires on December 31.

On November 23, President Obama announced his intent to nominate Tavenner for the top post. In her e-mail to CMS staff (carried on the Kaiser Health News site), Kathy Sebelius, secretary of  Health and Human Resources, says of Tavenner, “Her career as a nurse, hospital administrator, and Virginia Secretary of Health and Human Resources give her unique insights that position her well to serve as Administrator.”

I certainly hope so. Berwick’s reputation and track record for pinpointing problems in our health system—and more importantly, working to do something about them through the Institute for Healthcare Improvement—was stellar, and he carried this zeal into his government position as he grappled with the daunting task of implementing reforms in the Affordable Care Act. Read the rest of this entry ?

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On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

March 8, 2011
President Barack Obama speaks to a joint sessi...

Obama Speaks to Congress on Health Care/Image via Wikipedia

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful [health] system on the planet. Its fiscal future would be transformed if Congress passed reforms that emphasized control of costs as much as the expansion of coverage that Barack Obama rightly wants.”

Why should any of this matter to nurses? Here’s a post reminding us why nurses have a stake in health care reform

But back to nursing proper, nursing in the trenches, nursing not in the abstract but in its inescapable dailiness. Read the rest of this entry ?

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Psychiatrists as Therapists: A Vanishing Breed

March 7, 2011

By Maureen Shawn Kennedy, AJN editor-in-chief

Freud's couch, Freud Museum, London/Sacha Pohflepp, via Flickr

In an article in the New York Times on Sunday, writer Gardiner Harris described how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy; if patients want to discuss their problems, they are referred to a therapist. The main driver of this trend is money—with other, cheaper professionals available to provide therapy with comparable results, insurance companies won’t pay the higher fees most psychiatrists charge. So, instead of seeing 50 to 60 patients a week for the traditional 45-minute session on the psychiatrist’s couch, the psychiatrist can see 1,000 or more patients in a 15-minute, “what’s happening? do you need a medication adjustment? see you next week” check-up. As the wife and business manager of the psychiatrist profiled in the article says, “It’s all about volume.” One only hopes that most of the patients take his advice to see a therapist.

In fact, there is a growing body of evidence favoring psychotherapy over medications in mental health, notably in depression. In a recent meta-analysis in the Journal of Nervous and Mental Disease comparing psychotherapy with second-generation antidepressants (SGAs), researchers found that “[b]ona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.” 

And in the March issue of AJN, we report on a study published in the Archives of General Psychiatry, which found that “cognitive therapy combined with daily practice of meditation, yoga, and other health-enhancing behaviors can be as effective as long-term antidepressant medication alone in preventing relapse in patients who have had several bouts of major depression.” 

It’s a shame that so many psychiatrists are abandoning an effective treatment method for financial reasons. According to the National Institute of Mental Health, in a given year over 26% of Americans over age 18 suffer from a mental disorder, and “major depressive disorder is the leading cause of disability in the U.S. for ages 15–44.” With these numbers, we need all hands on deck.

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Treating Kids With Asthma in the ED Means More Than Just Putting Out Fires

February 15, 2011

EDs play an important role in the care of children with asthma. ED clinicians often treat families who don’t have a consistent relationship with a primary care provider. Given this opportunity, it’s essential that all members of the pediatric ED health care team be informed, educated, and updated on the latest asthma treatment guidelines to ensure best practice and high quality outcomes.

by noii/via Flickr

In this month’s Emergency column, “Managing Pediatric Asthma Exacerbations in the ED” (which will be free for the next six months), three nurses at Children’s Hospital Boston present a composite case, review the evidence regarding treatment options, describe practices at their own hospital and asthma treatment guidelines, and emphasize the crucial importance ED nurses can play in making sure these children don’t end up back in the ED because of lack of follow-up care or poor care in the home.

Have a look and let us know what you’re doing to make sure you’re not just putting out fires when you treat a child with asthma in the ED.—JM, senior editor

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Next Post

December 23, 2010

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Parting Thoughts: 10 Lessons Learned from Florence Nightingale’s Life

July 22, 2010

The final post in a series by Susan Hassmiller, Robert Wood Johnson Foundation (RWJF) Senior Adviser for Nursing, sent to us as dispatches from her summer vacation spent retracing Florence Nightingale’s influential career. The full series can be found by clicking here.  

My husband has called this trip a “game changer” for me, and indeed it has been.  I see things differently now, including our health care system . . . and the critical contributions that nurses are making, and need to continue making, to improve care for patients. Of course, I always knew this, but somehow this ups the ante for me—and I will use my new education to up the ante for nurses. I have learned so much, but let me share these 10 lessons I gleaned from Ms. Nightingale.

1. Never, ever stop learning. 
A broad education in the arts and sciences helps with critical thinking and making important connections that lead to action. I saw how Florence used her knowledge of math, statistics, sanitation, religion, and architecture to put a holistic plan together to improve the systems that care for patients. 

2. Ground yourself and your work in facts and evidence. Make your case indisputable.  Everyone should do this . . . not just those who call themselves “researchers.”

3. Muster the courage to follow your convictions. Step beyond what you think you can do. 

4. Treat every person holistically. Every person has a spiritual, mental, and physical side that must be nurtured for complete healing to occur. 

5. Know your strengths and know your weaknesses. If you don’t know what they are, ask someone. Choose a job where you can make the most of your strengths. Contribute, contribute, and then contribute some more.

6. Use your network to accomplish what you think you might be unable to accomplish on your own. Don’t be afraid to ask important people to help you finish important jobs and make needed improvements. Likewise, say yes to helping others when you are asked.

7. Speak and write often about the lessons/learnings that you would like to share with others.

8. If you see something that needs to be changed, change it! Nightingale said, “Deed, not creed.” 

9. Don’t blame others for how things are, if you are not willing to change them yourself. Or at least solicit help from others to make needed changes.

10. Keep your standards high. Lack of time, fatigue, and ambivalence all undermine high standards. Our patients deserve more.

Sue Hassmiller at statue of Florence Nightingale, London*

* Note on photo: Of the many statues in London, there are only two that depict women who are not members of the royal family, and both are of nurses! The other nurse statue is of Edith Louisa Cavell, described by Wikipedia as “a British nurse and humanitarian. She is celebrated for helping some 200 Allied soldiers escape from German-occupied Belgium during World War I, for which she was executed.”

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Searching for the Evidence? AJN Series Demystifies EBP

July 21, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Trying to get evidence-based practice (EBP) implemented in your hospital or nursing home? Running into problems or just not quite sure how to proceed? Well, AJN has the answer.


EBP should be the basis for any clinical practice. Since last November, AJN has published a series of articles by the faculty at Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Articles are published every other month and are designed to take the reader, step-by-step, towards implementing EBP. The current article describes the beginning steps to appraising the evidence; or go here to read the first article and follow in sequence.

Listen to a podcast with series leaders Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, and Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, the authors of Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. And we’ll have a second “Ask the Authors” call in November (check our home page for details after November 1).

If you’ve had problems or hit snags on your journey to EBP, e-mail me (shawn.kennedy@wolterskluwer.com) so we can address these issues on our next call.

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Tooting Our Horn

May 3, 2010

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

I know some people think it’s crass and self-serving to announce awards.  Sometimes I agree, especially if it’s the “I” award – I did this, I did that, I’ve been named to this or that commission.

But I have to announce these awards because not to do it is unfair to the many  people who work very hard behind the scenes to get each issue of AJN out the door and in your hands. Every reference and every fact is checked; articles are edited, second-edited, copyedited, and then proofread multiple times. There’s a pre-edit meeting with the author; there’s an art meeting; there are weekly editorial meetings. It takes editors, freelancers, clinical editors, knowledgeable authors with great stories, copyeditors, a librarian, our talented design and production teams, and our editorial and department coordinators to work together to develop each article, each issue. Some of the people who took part in working on these pieces are no longer here and I will be sure they learn about these awards, as it is truly a team effort.

So it’s with pride and thanks to those who made it happen that I share our news about the six (count ‘em – six!) awards to AJN announced by the American Society of Healthcare Publication Editors (ASHPE):

GOLD award – Feature Article

Vietnam Women's Memorial, Washington, DC. Courtesy of Kay Schwebke.

The Vietnam Women’s Memorial: Better Late Than Never

Kay E. Schwebke; May 2009;


SILVER
award – Signed Editorial 

Who’s Watching?

Diana J. Mason; March 2009 


SILVER award –
Cover Photo

Street Nurse 

Nettie Wild; July 2009

 
SILVER award – Opening Page, Computer Generated

Stopping Eating and Drinking

Judith K. Schwarz; September 2009


BRONZE award –
Blog Post [!] 

Is it Ethical for a Nurse to Decline the H1N1 Vaccine?

Douglas Olsen; August 2009

 
SILVER award – Special Supplement

Transforming Care at the Bedside: Paving the Wave for Change

November 2009

Click on the links and check out our award winners. Don’t forget to listen to podcasts that may be associated with the articles (my favorite: the poems written by nurses who served in Vietnam).  And you can see all the winners of ASHPE awards here. Or maybe just browse our current issue, entirely free until May 15, after which time only certain departments and selected articles will be free (as they usually are).

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