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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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Some Florida Inspiration for Nurse Admins and Execs

March 17, 2014

By Shawn Kennedy, AJN editor-in-chief

Zander

Zander

A pep talk on being open to possibility. While it was cold late last week in Orlando, Florida (ok, maybe not so bad at 64 degrees and sunny blue skies, but cold by their standards) the audience at the opening session of the annual meeting of the American Organization of Nurse Executives (AONE) was definitely warmed up after listening to the engaging keynote speaker, Benjamin Zander.

Zander is the conductor of the Boston Philharmonic and a professor at the New England Conservatory of Music. You may be thinking he was probably a bit stuffy and formal, but you couldn’t be more wrong. Zander is, at 75, a dynamo, strolling up and down aisles, exhorting the audience to be likewise expressive, waving arms, smiling and connecting.

His message was to be open to the notion that everything is subject to change depending on how one frames it. He challenged the 1500 listeners to “stand in the realm of possibility.” His message is that everything—the rules, perceptions, games we play—are invented and can be changed. He maintains that every situation can be dealt with three ways: resignation, anger, or recognizing the possibility. Read the rest of this entry »

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Sexual Assault Survivors, SANEs, and the Nonreport Option

March 14, 2014

Figure 1. Process in the nonreport optionBy Sylvia Foley, AJN senior editor

Until recently, survivors of sexual assault had to make quick decisions about whether to report the assault to law enforcement. Those who chose not to report it weren’t entitled to a free medical forensic examination, and many felt further traumatized by this situation.

The Violence Against Women and Department of Justice Reauthorization Act of 2005 changed this. It added a “nonreport” option, which mandates that survivors be given medical forensic examinations even if they choose not to cooperate with law enforcement or the criminal justice system; states must pay for these medical examinations, regardless. In order to receive certain federal funds, states had to comply by 2009. States have responded in various ways. (Click the image above for an enlarged view of the steps followed in Texas.) But there has been little investigation into the impact of the new provision.

An important question. How has the nonreport option affected survivors, sexual assault nurse examiners (SANEs), and victim advocates? To learn more, Laurie Cook Heffron and colleagues conducted a study in Texas. They report on their findings in this month’s original research CE, “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option.” The following abstract offers a quick overview. Read the rest of this entry »

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