Posts Tagged ‘Nurses’

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AJN in February: Rapid Response Teams, Complications of CHD Repair, Managing Type 2 Diabetes, More

January 29, 2015

AJN0215 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Rapid response teams (RRTs) are teams of expert providers who can be called on in an emergency to treat patients before their condition deteriorates. The success of an RRT depends on whether it is activated properly, a task that often falls to staff nurses. The original research article, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis,” describes the factors affecting nurses’ decisions to activate RRTs. This CE feature offers 3 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Long-term complications after congenital heart defect (CHD) repair. Nurses often encounter patients with complications that occurred years after CHD repair. “Long-Term Outcomes After Repair of Congenital Heart Disease: Part 2” reviews four common CHDs, their repairs, common long-term outcomes, and implications for nurses in both cardiac and noncardiac settings. This article offers 2.5 CE credits to those who take the test that follows the article.

Making nurses full partners in reforming health care. The Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, suggests that nurses should be full partners in reforming health care in this country. “A Bold New Vision for America’s Health Care System” is the first in a series that will revisit the report’s recommendations and the progress that has been made toward making them realities. Read the rest of this entry ?

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Long-Term Complications After Congenital Heart Defect Repair

January 19, 2015

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

Even those of us who don’t work in peds or cardiology are familiar with the amazing surgeries done to repair congenital heart defects (CHDs). After surgery, kids with CHDs are literally transformed, their glowing good health a reminder that medical miracles really can happen.

Sometimes, though, health problems develop many years after CHD surgery. These can be consequences of the original defect itself, or of the specific type of repair that was employed.

In this month’s CE feature, “Long-Term Outcomes after Repair of Congenital Heart Defects (part 1),” Marion McRae, an NP in the Guerin Family Congenital Heart Program at Cedars-Sinai Medical Center, Los Angeles, discusses the anatomy, physiology, and repair options related to six common CHDs: bicuspid aortic valve, atrial septal defect, ventricular septal defect, atrioventricular septal defect, coarctation of the aorta, and pulmonic stenosis. One of the types of congenital heart defects covered in the article is shown in the illustration.

Figure 3. Secundum Atrial Septal Defect and Transcatheter Occlusion. Secundum atrial septal defect is located in the center of the atrial septum (A). Blood usually shunts across the defect from the left atrium to the right atrium. The Gore Helex septal occluder is shown in a partially deployed position across the atrial septum (B). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Illustration by Anne Rains.

Figure 3. Secundum Atrial Septal Defect and Transcatheter Occlusion. Secundum atrial septal defect is located in the center of the atrial septum (A). Blood usually shunts across the defect from the left atrium to the right atrium. The Gore Helex septal occluder is shown in a partially deployed position across the atrial septum (B). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Illustration by Anne Rains.

Because patients tend to do so well after surgical repair, many eventually discontinue cardiology follow-up. This means that when problems do develop in adulthood, nurses in nonspecialty settings may be the first to evaluate patients’ cardiac changes. McRae’s succinct summaries of common CHDs and their long-term outcomes is a “primer” that guides us in the initial assessment of these patients. (All CE articles in AJN are free.) Read the rest of this entry ?

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Calling All Nurses to Address Health Disparities

January 16, 2015

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.

The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.

The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.

The research on health disparities is stark and continues to increase. The Centers for Disease Control and Prevention’s Health Disparities and Inequalities Report–2013 found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.

But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way—lives that are often very different than our own.

I understand that it is human nature to be more comfortable with the familiar, but this is not what we are called to in nursing. More than 150 years ago, Florence Nightingale noted a strong link between a population’s health and its economic prosperity, and she called for all people to be treated equally.

My mother told me that when she first entered nurses’ training at New York City’s Bellevue Hospital School of Nursing in 1943, Director Blanche Edwards addressed the students on her conduct expectations for nurse trainees. Part of that lecture—and of the nursing culture absorbed by those being trained at Bellevue—addressed the equality of all human life and how she expected her nurses to treat everyone with equal care and attention. Read the rest of this entry ?

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A Brief Meditation on Love, Loss, and Nursing

January 14, 2015

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

Manicure, by Julianna Paradisi, 2014

Manicure, by Julianna Paradisi, 2014

As a child, I remember being afraid to fall in love, because I didn’t want to experience the pain of losing people I loved when they died. I don’t know why I thought about this; I only know that I did.

Becoming a nurse has done absolutely nothing to alleviate this fear, but life experience has, to some degree.

Nursing is hard not only because we are there for the dying, but also because we are there for the illnesses and deaths of our own, the people we love, too. Making a living by caring for the sick and dying does not exempt us from personal loss. We grieve and mourn like everyone else.

Recently, I sat in a chair in an emergency department, noticing the sparkly red polish of a woman’s holiday manicure as she rolled past on a gurney. Clearly, she hadn’t anticipated an ER visit as part of her holiday celebrations either. On another gurney, next to my chair, lay my husband, getting an EKG, labs, and IV fluids. The prayer, “Please, don’t let it be a heart attack or a brain tumor,” wove silently through my thoughts.

We were lucky. There was no heart disease, no brain tumor. It was viral, just a touch of the flu. Two liters of IV normal saline did the trick.

“Thank you.”

I wish everything could be cured with a couple of liters of normal saline. There are nurses reading this post who recently grieved for loved ones absent from their places around the holiday meal table. No one mentions that all love stories eventually end. The most enduring conclude at death, and there’s the burn. Nurses know there’s no such thing as love without loss. Read the rest of this entry ?

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Are Nurses Ready for Retirement? Apparently Not

January 5, 2015

By Shawn Kennedy, AJN editor-in-chief

Photo by Judy Schmidt/CDC

Photo by Judy Schmidt/CDC

If you ask many nurses in their sixties if they’re ready to retire, they may heartily say, “Yes, can’t wait.” But if the question is whether they are financially ready to retire, the answer may be quite different.

In their article in this month’s issue of AJN, “Preparing for Retirement in Uncertain Times” (free until the end of January), authors Shanna Keele and Patricia Alpert note that surveys reveal nurses to be unsure of how to begin preparing for retirement. A 2011 survey reported that “71% felt they were not saving enough for retirement”; another survey revealed that “59% of nurses do not know how to begin the retirement planning process” and most do not feel knowledgeable about investing and other related financial processes.

Keele and Alpert, who’ve conducted research around nurses’ readiness to retire, “explore the obstacles that nurses, especially female nurses, confront in planning and preparing for retirement. We outline steps nurses can take to begin the process; discuss various types of retirement accounts; and refer readers to helpful, free online resources.” There’s also a box that lists crucial steps to take if you’re getting a late start on retirement planning. Read the rest of this entry ?

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Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

December 17, 2014

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

Photo copyright Thinkstock.

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results. Read the rest of this entry ?

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Nurses at Center Stage: AJN’s Top 10 Blog Posts of 2014

December 12, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

It’s unsurprising that some of our top blog posts this past year were about Ebola virus disease. But it’s worth noting that our clinical editor Betsy Todd, who is also an epidemiologist, cut through the misinformation and noise about Ebola very early on—at a time when many thoughtful people still seemed ill informed about the illness and its likely spread in the U.S.

Ebola is scary in itself, but fear was also spread by media coverage, some politicians, and, for a while, a tone-deaf CDC too reliant on absolutes in its attempts to reassure the public.

While the most dire predictions have not come true here in the U.S., it’s also true that a lot of work has gone into keeping Ebola from getting a foothold. A lot of people in health care have put themselves at risk to make this happen, doing so at first in an atmosphere of radical uncertainty about possible modes of transmission (uncertainty stoked in part by successive explanations offered as to how the nurses treating Thomas Eric Duncan at a Dallas hospital might have become infected).

And while, relative to the situation in Africa, a lot of knowledge and resources were readily available to support nurses and physicians who treated Ebola patients, the crisis has focused much-needed attention on the quality of the personal protective equipment (PPE) hospitals have been providing to health care workers.

Meanwhile, the suffering continues in Sierra Leone and other countries. Time magazine this week made the Ebola fighters here and overseas its collective Person of the Year for 2014. (See our recent post by Debbie Wilson, a Massachusetts nurse who worked in an Ebola treatment center in Liberia this fall. She will be visiting our offices next week for lunch with the staff.) Read the rest of this entry ?

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