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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me…

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

Read the rest of this entry »

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The Power of Imagination: Helping Kids with Sickle Cell Disease to Cope with Pain

April 2, 2014

By Sylvia Foley, AJN senior editor

Many people with sickle cell disease suffer from both acute and chronic pain, which can be severe. Although the exact mechanism isn’t known, the pain is believed to result when sickled erythrocytes occlude the vascular beds, causing tissue ischemia. Such pain, which often begins in early childhood, arises unpredictably. Although some pain crises may require ED visits, hos­pitalization, opioid treatment, or a combination of these, most are managed at home. Yet little is known about at-home pain management in people with sickle cell disease, especially children.

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Cognitive behavioral therapy (CBT) has shown promise in helping patients with other chronic illnesses to cope with pain. Cassandra Elaine Dobson and Mary Woods Byrne decided to test guided imagery, a form of CBT, among children enrolled at one sickle cell treatment clinic in New York City. They report on their findings in this month’s original research CE, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease.” The abstract below offers a quick overview; if you click the image above, you’ll see an enlarged view of one table showing key results.

Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training.
Methods: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.
Results: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well.
Conclusions: Guided imagery is an effective technique for managing and limiting sickle cell disease–related pain in a pediatric population.

The technique was easily taught in training sessions lasting 15 to 45 minutes, with no child needing more than one session. The authors concluded that “the use of guided imagery in this population assumes that a child’s imagination has the potential to affect health, and our findings support that assumption.” Because this was a small study, they urged further large-scale clinical trials.

To learn more, read the article, which is free online. As always—and especially if you have experience caring for children with sickle cell disease—we welcome your comments.

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AJN’s April Issue: Sickle Cell Anemia, Telehealth, Systematic Reviews, FOAMed, More

March 28, 2014

AJN0414.Cover.OnlineAJN‘s April issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Coping with pain in sickle cell anemia. Our April cover features a painting of red flowers in a vase. But on closer inspection, you might notice that the flowers are actually red blood cells, painted by a young girl who suffers from sickle cell anemia. Afflicting about 90,000 to 100,000 people in the United States, sickle cell disease often causes acute and chronic pain syndromes described as being on par with cancer-related pain. Cognitive behavioral therapies, such as the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. April’s original research CE article, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” suggests that this technique can be effective for managing pain in school-age children with the disease.

Implementing advances in telehealth. New technologies such as remote monitoring and videoconferencing often emerge before a facility is ready to efficiently integrate them. Sometimes referred to as disruptive innovations, these technologies, while convenient and easy to use, may not be readily accepted. “Telehealth: A Case Study in Disruptive Innovation” discusses the many applications of telehealth, a means of delivering care that is likely to be a part of every nurse’s skill set. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New installment on systematic reviews. Last month, we debuted our new series from the Joanna Briggs Institute on the systematic review. This second installment, “Developing the Review Question and Inclusion Criteria,” provides an overview of the first steps taken when conducting such a review, starting with forming the perfect review question.

#FOAMed. The April iNurse column, “Have You FOAMed?” delves into the new and still evolving social media concept called FOAM, or Free Open Access Meducation. FOAM is an umbrella concept that refers to online media that students and professionals can use to educate themselves and to share and discuss new knowledge and ideas. It spans many social media platforms and is a fast, free way to keep up with the latest in medical knowledge. Read the rest of this entry »

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Hard to Resist, They Come With Health Benefits

March 28, 2014

By Shawn Kennedy, AJN editor-in-chief

ForestWe used to have a dog, a black Lab named Sam. We thought he was especially smart, though a bit of a character. He was a wonderful pet and when he died, we were heartbroken.

We didn’t want another dog right away, but it took a while to stop looking for him to greet us each time we walked in. And he wasn’t there to eat the pizza crusts or a Chinese fortune cookie (he’d sit patiently to hear one of us read his fortune to him—and yes, our kids thought we were crazy).

But as my friend Helga said, “The longer you go without a dog, the easier it is not to have one.” Eventually we got used to being in a non-pet household—we could make spur-of-the-moment decisions about going to dinner right from work or away for a weekend without a second thought of “What about Sam?” There was no need to negotiate who would do the morning walk or the evening walk when it was raining or bitterly cold out.

(How many nurses working full time have dogs, I wonder? Given the responsibilities, owning one can be a scheduling challenge, or a budget challenge for those who hire dog walkers. But then, seeing a dog at the end of the day may also be a nice change from seeing patients and colleagues, and research suggests that owning a dog is good for one’s health—petting is associated with lower blood pressure, and of course, long walks are good too.)

Read the rest of this entry »

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Don’t Write Off Community College to Start a Nursing Career

March 26, 2014

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

KarenRoushMy daughter is about to start her nursing career. She’s got all her prereqs out of the way and she’s waiting to hear from the half-dozen colleges she applied to. Among them is the community college where I started my career 35 years ago. That’s right—a community college that confers an associate degree.

I hope she gets in.

Community colleges are seen by many as the bottom of the ladder of desired schools of nursing. Not only do they offer only a two-year degree, but they’re not seen as being as selective as four-year colleges and they don’t have the big name professors.

But community colleges can and do produce great nurses. Programs are rigorous, so a more liberal admission standard at the onset doesn’t necessarily change the caliber of student who graduates at the end. And once they graduate, they must meet the same standards as students from four-year schools to attain licensure as an RN—everyone takes the same NCLEX. At the time of my graduation, my school had a 98% pass rate, one of the highest in the country.

Community colleges even have some advantages over a lot of four-year programs. They may not have the big names—but really, how many of those big name professors actually teach full courses? At community colleges, teaching is the focus. Community colleges are affordable; students don’t leave burdened with astronomical debt to start a career that, while setting them down firmly, and often permanently, in the middle class, can also saddle them with a burden of debt on top of all the expected financial struggles. And in many places, community colleges are truly embedded in their community; this can provide a level of support and open up opportunities for students that is not possible at larger detached universities.

I agree that all nurses should have a BSN, eventually. There is a lot of evidence that it improves patient outcomes. But the two-year community college can be a great place to start—two years of reasonably priced education that gives you a solid base of skills and knowledge to practice while you continue to take courses toward a bachelor degree. I remember when I returned to school for my bachelor’s: the wonderful sense of discovery that I was not just a nurse but a professional, and part of a profession with its own history and body of knowledge.

We need more nurses. All the experts agree that there is a shortage just waiting for the rest of the Baby Boomer nurses to hang up their stethoscopes. An education that starts at a community college can take a nurse far. I know mine has, from acute care staff nurse to long-term care educator, from oncology to urgent care to the IV team. Here in the U.S. and in India and Africa. As a nurse scholar at the WHO in Geneva, Switzerland, and as an NP in the Adirondacks of upstate New York.

Read the rest of this entry »

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Three Nurses and a Doctor Go Sailing – Some Notes on Communication Style

March 24, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Untitled from the series, Pareidolia. Charcoal and graphite on paper, 12" x 9," by julianna paradisi

Untitled from the series, Pareidolia. Charcoal and graphite on paper,
12″ x 9,” by julianna paradisi

There’s an old joke about the personality differences among nurses of different specialties. It goes like this:

A medical–surgical nurse, an ICU nurse, an ER nurse, and a doctor go sailing. The doctor stands at the bow of the boat and shouts to the nurses, “Trim the sail!”

The med–surg nurse asks, “How do you want it?”

The ICU nurse replies, “I’ll trim, okay. But I’m doing it my way.”

The ER nurse shouts back at the doctor, “Trim the sail yourself!”

ICU style. The joke is a generalization, of course. However, I was a pediatric intensive care nurse once upon a time, and I have to admit that the ICU nurse characterization resonates with my own experience. Like the nurse in the joke, I always have an opinion, and rarely mind sharing it. In the ICU, if another nurse, a physician, a pharmacist, or respiratory therapist didn’t agree, conversation ensued. My colleague, equally opinionated, would state her or his position. Data was consulted, and then, more often than not, consensus occurred.

And I often learned something from sharing information. It made me a better nurse. I learned to dig in on a position only if patient safety or my license was at risk. Everything else was pretty much negotiable, face-to-face. From this perspective, our ICU team was similar to a marriage—it would have been unrealistic to expect there would never be disagreement within our team. In fact, if there was never disagreement, someone probably wasn’t being honest about her or his feelings—an approach that can lead to passive-aggressive behavior.

I don’t know if it’s because I no longer work in ICU, or if nursing culture in general has changed, but lately I’ve noticed some confusion about the difference between open, honest communication and bullying. There’s a difference. Read the rest of this entry »

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Working Out the Bugs: Old and Alone in the City

March 19, 2014

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She tweets at @12hourRN.

Old Woman Dozing/Nicolas Maes

Old Woman Dozing/Nicolas Maes

At work the other day, after almost seven years as a nurse, I had an experience that completely floored me. While connecting a bag of cefepime to my tiny, elderly, blind patient’s IV, I spotted a cockroach making its way across her pillow. And then another on her lap. And then they were on the wall behind the bed, coming out of the closet where her belongings were stored. Another nurse had just handed her the pocketbook she’d requested, and the host of insects that apparently called it home were now scurrying quickly around the room, and around me.

I consider myself a fairly brave woman. I can kill a bug if I need to, I see rats quite frequently, and come on, I’m a nurse—there have been some pretty gory things to pass these eyeballs and touch these fingers. But this was different; it was not the hospital grossness that I am a seasoned veteran of. This was a glimpse into my patient’s dirty home. I ran like a little child.

When the situation had calmed down, I talked to my patient about her home, an apartment in Manhattan. How did she get around? How did she get food? She told me that her quest for survival had grown more challenging—that, with no family to care for her, she depends solely on Meals on Wheels, and that she might, after so many years, need to cave in to the pressure and move into an assisted living facility. Although, based on my assessment, she clearly qualified, no doctor had ever offered her a home health aide or visiting nurse.

Cockroaches aside, she is not the first elderly New Yorker I’ve cared for who has no web of support. Living precariously between the poles of health and complete collapse, many of them walk through the city streets for groceries, live on next to no money, and have very little reserve when sickness finally overturns their delicate homeostasis. Read the rest of this entry »

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