End-of-Life Conversations at the 11th Hour

Illustration by Gingermoth

A problem all too familiar to nurses.

How often have we nurses talked to friends, family members, or each other about the importance of making end-of-life decisions well before that decision becomes critical? We see so many deaths that come only after extended and often avoidable suffering, it’s all many of us can do to keep from grabbing a family member’s hand and whispering, “Let her go!” At home, our families are used to hearing us say again and again, “Do not let me die like that!”

If we work in a hospital, chances are that we are confronted over and over again with trying to help families make “11th hour” decisions that will affect how their loved ones die. How do we broach the subject, when time is so short?

Trust prepares the ground.

This month’s Reflections article, “Difficult Conversations,” isn’t a primer to walk us through these conversations, but it offers an example of how we can take our cue from events or changes in the patient’s condition to raise the topic of the inevitable. Author Vanessa Arroyo illustrates how, after we’ve developed a relationship with patient and family and earned their trust, it may become possible to ask the […]

2019-08-19T09:59:07-04:00August 19th, 2019|Nursing, nursing stories|1 Comment

Should Adults Experiencing In-Hospital Cardiac Arrest Be Intubated?

Photo by A.J. Heightman / Journal of Emergency Medical Service / PennWell Corp.

Although it’s commonly practiced, results from a large new study call into question the effectiveness of intubating adults who experience in-hospital cardiac arrest.

As we report in a May news article, researchers analyzed data for 108,079 adult patients who experienced cardiac arrest in the hospital between 2000 and 2014—and found that patients who were intubated within the first 15 minutes of arresting were less likely to survive than patients who were not.

Among other findings, intubated patients were less likely to experience a return of spontaneous circulation and had a lower rate of good functional outcome (defined as either mild or no neurological deficit, or only moderate cerebral disability).

The researchers concluded that the study results do not support early intubation for adults who experience cardiac arrest. However, they noted that their analysis was unable to eliminate potential confounders like the skills and experience of health care professionals, the underlying cause of the cardiac arrest, and the quality of chest compressions. Additional clinical trials are needed to yield useful results and to better understand the influence of confounding factors. […]

2017-05-15T09:13:26-04:00May 15th, 2017|Nursing|2 Comments

Cochrane Reviews: An Oft-Overlooked Evidence Source for Nurses at the Bedside

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

“Research holding the torch of knowledge” (1896) by Olin Levi Warner. Library of Congress, Thomas Jefferson Building, Washington, D.C./Photo by Carol Highsmith, via Wikipedia

Long ago, in an ICU far away, I picked up the habit of saying, during rounds, “Well, you know, research suggests the practice…” I have trouble remembering who taught me this tactic, but it has always been a highly effective way of advocating for my patients.

The eyes of doctors, never ones to be silenced by a nurse who reads research, usually light up at the challenge.

I’ll admit that, for a while, many of my conversational citations came from ‘clinical pearls’ or tidbits I read from certifying organizations via social media. While my knowledge was based on credible sources, my analysis was topical, at best.

Then I started graduate school. Although my program isn’t a clinical one, the need to seek out evidence for class assignments intensified my practice of trying to apply research evidence at the bedside.

It’s tricky to find and discuss credible research as a bedside nurse. Services like Lexicomp and UpToDate, which most hospitals hold subscriptions to, compile […]

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