Color-Coded Wristbands and Patient DNR Status: Can We Do Better?

March 16, 2015

In the Viewpoint column in the March issue of AJN, a staff nurse at an oncology center argues that we can improve our use of color-coded wristbands to communicate patient DNR status. There’s also a short podcast interview with the author below, in which she explains that her motivation for writing this article was “a near-miss” on her unit several years ago.

A lot of attention has been paid lately to the reasons why clinicians don’t follow end-of-life preferences in advance directives. Overaggressive care by some physicians is one reason, as is the vagueness of the language used in advance directives to express treatment preferences.


Author Blima Marcus

Another major reason advance directives are ignored is lack of immediate access to a patient’s end-of-life preferences at critical moments, such as during a code. This month’s Viewpoint column, “Communicating Patient DNR Status Using Color-Coded Wristbands,” is by Blima Marcus, a doctoral student at the Hunter-Bellevue School of Nursing in New York City as well as an RN at the NYU Langone–Perlmutter Cancer Center. Marcus points out that a “patient’s choice of do-not-resuscitate (DNR) status is a major one, and communicating this status in the hospital is often the responsibility of nurses.”

However, she argues, paper and/or electronic chart documentation of patient end-of-life preferences isn’t always adequate, given clinical realities, and can leave “communication gaps that can lead to wrongful resuscitations and mistaken fatalities.” Read the rest of this entry »


Drive for Show, Putt for Dough: A Cliche With Some Truth for Nursing

March 13, 2015

By Clint Lange, BSN, RN, a MICU nurse at University Hospital, San Antonio, Texas.

Wikimedia Commons

Wikimedia Commons

Before becoming a registered nurse, I was a resident in the wonderful world of professional athletics, where cliches are fed to you almost as much as protein shakes and supplements.

I was a golfer, and golfers are the worst in terms of cliches. I sprained my eyes rolling them so much while listening to desperate golfers try to rationalize their poor performances or give themselves some hope. “I gave it 110%.” Ever take a math class? Because what you are saying isn’t possible. “It ain’t over till it’s over.” After that abysmal last hole, you are, in truth, officially mathematically eliminated from this tournament. For you, it’s over.

I’ll admit it, I’m cynical. I didn’t see the merit in cliches then and to a great extent I still don’t. But I have something else to admit; I’m kind of missing cliches. It seems one can’t quit them cold turkey without having withdrawal.

Or it could simply be that I played in a golf tournament recently for the first time in years, and I couldn’t help thinking about one of golf’s most-used phrases: Drive for show, putt for dough. It simply means that driving the ball is very flashy and fun to watch, but it is generally the guys or gals who are making putts who win the events and the most prize money. In the tournament, I drove it fine but didn’t make enough putts, thus finishing low in the prize money.

What’s alarming to me is that I’m finding it hard not to retrofit the aforementioned cliche into nursing, as I see many similarities. There are aspects of nursing that are flashy and make us seem better than our colleagues, while the other more mundane aspects that are more likely to be overlooked by our peers are really what make us successful and valuable nurses to our facilities—and more importantly, to our patients.

For the nongolfers, further explanation of components of the cliche is warranted. Driving is the first shot one takes on the longer golf holes using what is called a driver. The driver is the club in the golfer’s arsenal that they spent the most money on, produces the longest shot, loudest noise, and the most oohs and aahs from the gallery. There are even long drive contests where musclebound men get all medieval on the ball, to the delight of onlookers for prize money.

These are truly the “protein shake” professional golfers. In comparison, putting is anemic. It is in some cases a tap of the ball to finish out a hole. It doesn’t take much strength to do it, but each putt counts for as many strokes as a ball that was crushed 315 yards with a driver.

What it does take is repetition, discipline, and courage. We’ve all been exposed to “drive for show” nurses. These may be the ones who point out perceived flaws in care during bedside report in order to look good to the patient and family. These are also the ones who make the patient nice and pretty at the end of the shift while practically neglecting the patient for the previous 11 and a half hours. In the same vein, they are the ones who have checked the boxes for all of the duties that were completed on the task list while, in fact, not completing them. Read the rest of this entry »


Women’s History Month: Nurses Started What?

March 11, 2015

Lillian Wald and other notable nurse pioneers, 1923The first paragraph of Maureen Shawn Kennedy’s editorial in the March issue of AJN, “Securing Our Place in History,” ends with a thought-provoking suggestion:

In 1980, after realizing that women were largely missing from the history books, a group of women formed the National Women’s History Project . . . and, in 1987, were successful in getting Congress to designate the month of March as Women’s History Month. . . .This year’s theme, “Weaving the Stories of Women’s Lives,” reflects the . . . tenet that “[k]nowing women’s achievements challenges stereotypes and upends social assumptions about who women are and what women can accomplish today.” One might substitute the word nurses for women in this statement.

Public health nursing, school nurses, hospice, and many other crucial areas of health care today began with the efforts of nurses. Noting the many accomplishments of Lillian Wald, Lavinia Dock, Annie Goodrich, M. Adelaide Nutting, and the other nurses in the 1923 group photo on our March cover, shown as they gathered to celebrate the opening of the new headquarters of the Henry Street Visiting Nurse Service, Kennedy urges nurses today to learn about this tradition and to envision how they can carry it forward:

“The story of nursing continues to be one of social commitment, innovation, and problem solving. It legitimizes and supports our inclusion on governing boards and our presence at policymaking tables. It can infuse each of us with pride and energy for the work we do. Let it infuse you.”

Click here to read the entire short editorial.—Jacob Molyneux, senior editor/social media

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Telling the Truth, Keeping a Patient’s Trust

March 9, 2015

“Am I going to be okay?” Ami gasps. Her breath hitches, her chest rising and falling in spasms. One of my hands holds a mask to her face; the other hand holds hers. Pain has made her strong—my fingers are almost as white as her pale face, radiant with fear.

Illustration by McClain Moore for AJN.

Illustration by McClain Moore for AJN.

That’s the start of the Reflections essay in AJN‘s February issue, “Am I Going to Be Okay?” Nurses tell patients ‘it’s going to be okay’ because the words can keep them calm, because no one can tell the future, because it’s comforting to hear ritualized phrases from a caregiver—even when they’re not, strictly speaking, true.

But are there times when more honesty is desirable? The author of this short Reflections essay delves into one such situation where the patient needs, above all, to feel trust for her nurse. Read the rest of this entry »


Maximizing the Recovery of ICU Survivors: An Innovative Collaborative Care Model

March 5, 2015

By Sylvia Foley, AJN senior editor

Photo courtesy of the Muscular Dystrophy Association (MDA).

Photo courtesy of the Muscular Dystrophy Association (MDA).

ICU stays are inherently stressful, and can result in various unique morbidities that adversely affect ICU survivors’ quality of life. To better care for such patients, providers at one Indiana facility decided to create a new care model. Authors Babar Khan and colleagues report on their efforts in one of this month’s CE features, “Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors.” Here’s a brief overview.

Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed.

To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post–critical illness morbidities and improving the ICU survivor’s quality of life.

The CCRC model also incorporates four more follow-up visits for additional patient monitoring and reassessment, as well as evaluation of the designated caregiver’s stress and burden. Preliminary data suggest that the CCRC model can indeed enhance the cognitive, physical, and psychological recovery of ICU survivors. The authors are continuing to gather data. Read the rest of this entry »


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