Posts Tagged ‘Nurses’

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Medicare Turns 50: Familiar Opposition in 1965, Essential and Continuing to Evolve Now

July 30, 2015
President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

On this date in 1965, exactly 50 years ago, Medicare (part of the Social Security Amendments of 1965) was signed into law by President Johnson. The debate over government-sponsored health insurance is not new, and opposition to the creation of Medicare was similar to the opposition to the Affordable Care Act and driven by many of the same organizations and arguments.

According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article in the May 1958 issue after a health insurance bill was introduced in 1957. Yet again, one of the staunchest opponents was the AMA. In the September 1958 issue, “at the request of the American Medical Association,” AJN published an article by the AMA’s general manager explaining the AMA’s opposition. Then (as in recent years we continue to see from opponents of both Medicare and the ACA), the alternative plans proposed by the AMA and others were weak and lacked comprehensiveness. By contrast to the AMA’s position, in 1958 the American Nurses Association (ANA) formally expressed support for federal health insurance for older Americans.

Medicare continues to evolve in numerous ways, and will face unprecedented challenges in the coming years as the number of seniors continues to increase. Medicare has its flaws and waste and inefficiencies, and some of the quality measures it uses to decide compensation rates for hospitals are controversial with nurses and others. There is always room for improvement, always negotiation among competing parties, never enough money.

But some very positive news came out this week about steep reductions in Medicare patients’ mortality and hospitalization rates and in costs for hospitalized “fee-for-service” Medicare patients.

So it’s complicated, as might be expected. But where would be without Medicare? It might not be pretty.—By Shawn Kennedy, editor-in-chief, and Jacob Molyneux, senior editor

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Working a Shift with Theresa Brown

July 20, 2015

bookBy Maureen Shawn Kennedy, AJN editor-in-chief

Many of you may be familiar with Theresa Brown, nurse and author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between, as well as a blogger for the New York Times. Brown also writes a quarterly column for AJN called What I’m Reading (her latest column, which will be free until August 15, is in the July issue). Her new book, The Shift: One Nurse, Twelve Hours, Four Patients Lives, will come out in September, and I was able to read a prepublication copy. (You can pre-order it.)

I don’t usually write book reviews. I think of most books like food: what one person finds delicious may be less savory to another. But I’m making an exception because this book is an accurate and well-written portrayal of nursing (at last!).

Anyone who wants to know what it’s like to be a nurse in a hospital today should read this book. Patients, families, and non-nurse colleagues tend to see nurses as ever-present yet often in the background, quietly moving from room to room, attending to patients, and distributing medications or charting at computers. But what they don’t understand about what nurses do is what Brown so deftly describes—the cognitive multitasking and constant reordering of priorities that occur in the course of one shift as Brown manages the needs of four very different patients (she was working in a stem cell transplant unit at the time); completes admissions and discharges; and communicates with families, colleagues, and administrators. Read the rest of this entry ?

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Family Caregivers Increasing in Age, Numbers: How Can Nurses Help?

June 10, 2015

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

AJNFamilyCaregiverSupplementLast week, a new report from the National Alliance for Caregiving and AARP detailed the landscape of family caregiving in the United States. The majority (60%) of caregivers remain female (40% are men, a percentage that continues to rise). They average 49 years of age. In most cases, they are caring for a relative (typically, a 69-year-old female). On average, the caregiver spends 24 hours each week helping with daily activities and has been doing so for four years; one-third of caregivers still maintain a full-time job.

An estimated 34.2 million adults provided unpaid care to an adult 50 years or older in the previous 12 months; nearly one in 10 caregivers is 75 years or older—a typical example given in the report was a 79-year-old female caring for a 77-year-old spouse with Alzheimer’s disease, aging issues, or heart disease. Half of caregivers were thrust into caregiving and felt that they had no choice about taking on the responsibility of a loved one’s care; 22% of caregivers feel that their own health has suffered.

To raise awareness of their needs, in recent years AARP has championed the plight of family caregivers, collaborating with government and consumer organizations, and health care professionals. AJN, too, has worked with AARP on several projects to provide nurses with information to support family caregivers, as noted below.

The needs of family caregivers will only increase, according to the data on aging in a report from the U.S. Administration on Aging, A Profile of Older Americans: 2014. According to this report, “The 85+ population is projected to triple from 6 million in 2013 to 14.6 million in 2040.”

This means more people in the “oldest old” category—the group that typically needs assistance with daily living.

We’d like to offer some resources from AJN to help nurses support family caregivers, who often get overlooked by health care professionals and are unprepared for all the caregiving tasks they may need to do (see, for example, Carol Levine’s guest editorial in our September 2008 issue, which details her personal experiences and eloquently describes the problems caregivers often face). Read the rest of this entry ?

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A Nurse Epidemiologist’s Notes on Issues Raised by a Recent Death from Lassa Fever

June 5, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a post-mortem diagnosis.

Some aspects of last month’s case of Lassa fever in New Jersey seemed to parallel the story of Thomas Duncan, who died last October in Dallas after contracting Ebola virus disease in Liberia.

A man arrived in the U.S. from Western Africa. He was screened for Ebola at the airport and instructed to monitor his temperature for 21 days. The next day, he developed a fever. Instead of calling the county health department, he headed to a hospital. He reportedly didn’t mention his travel history to staff, and was sent home on antibiotics. His condition worsened, and three days later he returned to the ED. When clinicians learned that he had recently arrived from Liberia, he was isolated, admitted, and tested for Ebola and Lassa. Positive for Lassa fever, he died soon afterwards.

Like Ebola, Lassa is a zoonotic hemorrhagic fever endemic to Western Africa. As with Ebola, the early symptoms of Lassa fever are nonspecific: fever, headache, malaise, nausea, vomiting . . .

But here the similarities end. Unlike Ebola, 80% of Lassa fever cases are mild or asymptomatic, and the overall case fatality rate is just 1%. (The risk of dying rises to 15%–20% if the disease progresses and requires hospitalization.) The most common complication of Lassa fever is deafness—one-third of those infected experience some degree of hearing loss—which occurs in both mild as well as severe cases.

Missed opportunities? This recent and upsetting story once again highlights the limitations of communicable disease follow-up based on self-monitoring and accurate individual reporting. Airport temperature screening of passengers arriving from certain geographical areas (which appears to be of questionable value) is supposed to result in the isolation and testing of anyone with a fever. But the vast majority of disembarking passengers are afebrile. They are instructed to monitor their temperature for a prescribed period of time (depending upon the disease of concern), and to call their local health department if they develop symptoms.

There are, of course, many holes in this surveillance “safety net.” Passengers may not reveal their connection to an epidemic area because of fear of reprisal, denial of their own at-risk status, or language-related misunderstandings at the point of screening. They may or may not subsequently monitor their health. When fever develops and becomes undeniable, they may not know how to contact their local health department, or if they do call, may quickly become impatient if met with a busy signal or no answer. Panic about what symptoms might mean will cause some people to run to the nearest ED for medical care; health department notification is not a high priority when you think you’re fighting for your life. Read the rest of this entry ?

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Nurses Aren’t Just Healers, They’re Teachers Too: A Patient’s View

June 3, 2015
Illustration by Jennifer Rodgers. All rights reserved.

Illustration by Jennifer Rodgers. All rights reserved.

A teeny red bump had mysteriously appeared on my left index finger. It hurt when I pressed on it. I figured it was nothing. . . .

That’s the start of the June Reflections essay in AJN, “Ms. Lisa and Ms. MRSA,” a patient experience narrative by freelance writer Shannon Harris. As luck would have it, the bump on her finger, it turns out, is not nothing. It’s MRSA.

The diagnosis takes a while. Finally the situation worsens, and surgery is needed. The author takes it all in stride, at least in retrospect:

The third physician stood out to me most. He asked to take a picture of my green and black, staph-infected finger with his iPhone. “Sure. Look at it! I thought this only happened to pirates,” I told him as he snapped away. He glanced at the young, button-nosed nurse standing beside him. “Don’t you want a picture? For your records?” he asked.

She shook her head, squinting and gritting her teeth. “I know. Yuck,” I said. I later shared photos of my infection journey online, to the great wonder and disgust of my friends and family. Before that, though, came surgery.

The author’s tone is light, but the situation is a scary one for any patient. Read the rest of this entry ?

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AJN EIC Talks Priorities With Leaders of Critical Care Nurses Organization

May 26, 2015
Karen McQuillan and Teri Lynn Kiss

AACN president-elect Karen McQuillan (left) and president Teri Lynn Kiss

By Shawn Kennedy, AJN editor-in-chief

Last week at the American Association of Critical-Care Nurses (AACN) annual meeting (see this post), I interviewed the association’s president, Teri Lynn Kiss, or “TK,” and the current president-elect, Karen McQuillan, who will officially take office after this month. After days of rushing from session to session (and there must be 300+ sessions to choose from) and wandering through exhibits, I always enjoy sitting down with leaders of this organization and hearing what they think is important in critical care nursing.

Teri Lynn Kiss, MS, MSSW, RN, CNML, CMSRN, director of Medical Unit-2South and case management services at Alaska-based Fairbanks Memorial Hospital, has led this growing organization of over 104,000 members for the last year. I asked her what she felt she’d accomplished. She said that one of the most valuable things the association had done in the past year was to provide clear and credible information about Ebola to its members, the health care community, and to policy makers in Washington. She also believes the association’s work on creating healthy work environments is important not just for nurses but will translate to better care for patients. Her presidency, she said, enabled her to fulfill her own personal mission of service to others—one she will continue with the association in different capacities.

Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, a clinical nurse specialist at R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, announced that her theme would be “Courageous Care.” As she noted in her keynote address, “For us as nurses, courageous care means doing what is necessary to provide the best possible care for our patients and their families. Period.”

But you can listen to them speak for themselves in this podcast recording of our conversation.

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Critical Care Nursing in San Diego (or was it Las Vegas?)

May 20, 2015

FullSizeRenderBy Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

I’ve written before about the American Association of Critical-Care Nurses (AACN) annual meeting, the National Teaching Institute (NTI). As a former critical care and emergency nurse, I’ve attended it almost annually. And I’m always amazed at how each year they step it up with new twists. One year, it was the helicopter and full MASH unit in the exhibit hall. Then AACN went to the TED talk style of keynote presentations. Last year, they had a contest for members to apply to be the guest co-master of ceremonies. So, what might possibly be a new twist in this year’s opening session?

I was sitting with leaders of the Canadian Critical Care Nurses Association, one of whom had never been to NTI before and had been told by her colleague that it would be unlike anything she had seen before. She couldn’t have been more on target—even by NTI standards. The session opened with a DJ and loud techno-rock music, followed by a very fit and energetic dance troupe and pop singers. Then, down from the ceiling came four acrobats and a bare-chested man spinning above the stage, along with a dozen or so men and women running up and down the aisles with large, lighted balls that the audience began batting around, all to the techno music. Was I really at a nursing meeting? Everyone was certainly awake and energized!

San Diego

San Diego

Awards. Pioneering Spirit awards were given to Paul Batalden (for his work with the Institute for Healthcare Improvement and at Dartmouth) and researcher Ann Rogers, and the Marguerite Rogers Kinney Award for a Distinguished Career was given to Joanne Disch (educator and former American Academy of Nursing president and AARP board chair). Some notable moments: Batalden said one piece of advice he would give is to “avoid working with jerks”; Disch received a rousing ovation when she told how she almost didn’t get into graduate school “because she partied too much as an undergraduate.”

‘Focus the flame.’ On a more serious note, AACN president Teri Lynn Kiss addressed the “growing community of exceptional nurses” (AACN membership is at a new record high of 104,000), speaking about her experiences over the past year as president, during which her theme, “Focus the Flame,” guided her work. Read the rest of this entry ?

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