Posts Tagged ‘Nurses’

h1

Addressing Nurses’ Urgent Concerns About Ebola and Protective Equipment

October 15, 2014

By Betsy Todd, MPH, RN, CIC, AJN clinical editor. (See also her earlier post, “Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective.”)

This is not a time to panic. It is a time to get things right.—John Nichols, blogging for the Nation, 10/12/2014

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

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

For years, nurses have tolerated increasingly cheap, poorly made protective gear—one result of health care’s “race to the bottom” cost-cutting. Now the safety of personal protective equipment (PPE) is being hotly debated as the Ebola epidemic spills over into the U.S.

If all nurses had access to impermeable gowns that extended well below the knee (and could be securely closed in back, had real cuffs, and didn’t tear easily); faceguards that completely shielded; N95 respirator masks that could be properly molded to the face; and disposable leg and shoe covers, we might not be having the same conversation. Yet how much protection can we count on from the garb we now have available, especially considering the minimal donning and doffing training given to most nurses?

While there is more to be learned about possible “outlier” modes of Ebola transmission, it’s pretty clear from past experience (including recent Ebola hospitalizations at Emory University Hospital and the University of Nebraska Medical Center, where no transmission has occurred) that standard, contact, and droplet precautions will virtually always prevent Ebola virus transmission. Because of the theoretical possibility that the virus could be aerosolized during procedures like intubation or suctioning, airborne precautions are usually added. (And from what we’ve seen, they’re being followed routinely, and not used only during aerosolizing procedures.)

Many organizations, including National Nurses United, are calling for hazmat-type gear and PAPR hoods (powered air-purifying respirators, which are HEPA-filtered) for staff who care for Ebola patients. Because most nurses have not used these, this more complex gear presents new challenges, especially because of the potential for self-contamination when worn and removed by untrained staff.

Specific techniques for donning and doffing PPE are not new, but many nurses have never been taught to pay attention to these details. One has only to look at staff in a contact precautions room, only half covered by their untied gowns, to understand why resistant organisms continue to spread within hospitals. Many clinicians may not have believed that their cavalier attitude towards PPE had anything to do with the next patient’s nosocomial MRSA pneumonia. During this Ebola epidemic, though, we are quickly learning that the proper use of PPE is a matter of life and death—ours. Read the rest of this entry ?

h1

If You Want to Write, Do It (and Skip the ‘Weaseling Qualifiers’)

September 26, 2014
Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

Are you one of those people—nurse or otherwise—who daydreams about writing (a personal essay about a formative experience, an article about a quality improvement project you took part in, a blog post about some aspect of nursing) but can’t seem to find the proper way to get started?

Since the weekend is coming and the October issue of AJN is now live on our Web site, it seems a good time to draw attention to “On Writing: Just Do It,” the editorial by Shawn Kennedy, AJN‘s editor-in-chief. Kennedy points out the one idea common to most writing advice: you have to start somewhere. You have to do it, and learn from doing it, and then keep doing it. Or, as she puts it:

One key to becoming a good writer—or a good anything—is persistence.

But the editorial also gives a range of other excellent tips from Kennedy and several experts in the field, and quotes writing advice found in AJN issues through the decades. My favorite bit is from a 1977 editorial by former AJN editor Thelma Schorr:

“[the writer] will use the active voice and not shirk his [or her] responsibility by introducing a statement with such weaseling qualifiers as ‘It is considered that…’ or ‘It is generally believed that…’”

What a great word: “weaseling.” It’s about as far as you can get from the jargon that afflicts so much academic writing. So if you’ve got some free time this weekend, take 15 minutes and see what happens. Netflix will wait.—Jacob Molyneux, senior editor

 

h1

Ebola: Infection Control Resources Make All the Difference

September 16, 2014

This post is follow-up to our widely shared post (“Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective”) by AJN clinical editor Betsy Todd. The author, Amanda Anderson, is a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. Her last post for this blog is here.

Ebola virus viron

By CDC microbiologist Cynthia Goldsmith, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. CDC image library.

I don’t know a single nurse who likes caring for multiple isolation patients. The process of donning a new gown, pair of gloves, and mask each time you enter an isolated patient’s room is arduous and time-consuming. Personal protective equipment (PPE) clogs the garbage cans and can be hot and confining.

PPE has been in the news quite a bit lately because of Ebola. An interview with Liberian nurses by Hunter College’s Diana Mason on her WBAI radio show Healthstyles revealed that the Liberian Ministry of Health estimates 75% of virus victims are women—mostly nurses and caregivers. Nurses in West Africa might really love some of those pesky yellow isolation gowns.

Ebola can be a messy virus. Infected people have copious diarrhea and vomiting, often containing blood. The basics of care for Ebola patients should not be new to us; HIV and hepatitis can be spread in many of the same ways. We’ve got little to fear if we follow CDC guidelines for PPE and infection control. But in parts of Africa, where supplies we take for granted are scant, nurses and caregivers can’t even hold the hand of a dying patient or family member, much less clean them, without fearing for their lives.

As Mason’s interview reveals, many nurses are assigned 25 or more patients each shift in hospitals that lack electricity, running water, and gloves. (In an article for Buzzfeed, Jina Moore describes a nurse working in an Ebola ward who wears the isolation kit sent to her by the Liberian Ministry of Health. The kit includes a shower cap, gloves, and rubber bands for her wrists. Her ankles and neck are exposed, peeking out from her own short scrubs.) Read the rest of this entry ?

h1

Enterovirus D68: Precautions, Surveillance, Yes; Alarm, No

September 15, 2014

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

EV68-infographicAs news coverage focuses on the latest clusters of suspected—and, in some instances, confirmed—cases of human enterovirus D68 (EV-D68) as they occur in successive regions of the U.S., here’s a quick primer on what is known about EV-D68.

Is this a new, dangerous virus?
EV-D68, a non-polio enterovirus, is not a “novel” virus—the term used to describe emerging infections such as SARS and MERS. It’s more accurate to describe it as the CDC does: it is an “increasingly recognized” cause of respiratory infections, especially in children.

EV-D68 was first isolated in 1962. While reports of EV-D68 since then have been sporadic, the CDC in 2011 reported on clusters of this viral infection in Georgia, Pennsylvania, and Arizona as well as in Asia and Europe. It’s likely that there are hundreds or even thousands of EV-D68 infections every year in the U.S. But as with many other viral infections, they will range in severity, and an infection that looks like “a cold” isn’t usually brought to the attention of a health care provider.

According to the CDC, most enterovirus infections are actually asymptomatic; this may be the case with EV-D68 as well.

Diagnostic testing for EV-D68 involves RT-PCR and gene sequencing. Most hospital labs therefore are unable to test for it. Some readily available diagnostic tests do identify “enterovirus” but don’t type the virus further; some tests misidentify EV-D68 as a rhinovirus. (Specimens from suspect cases in the U.S. therefore almost always are handled by CDC labs.)

Because treatment is symptomatic, the lack of a widely available test for EV-D68 is not an issue for the patient. But as more sensitive and specific tests become more widely available, more cases will be correctly identified, and we can learn more about the course of the disease.

Genetically similar to cause of common cold.
EV-D68 belongs to a genus of viruses that includes polioviruses, rhinoviruses, coxsackieviruses, and echoviruses. It is not “polio-like.” Biologically and epidemiologically, it is most similar to human rhinoviruses, which cause the common cold.

Severe respiratory infections in children? Visitor restrictions?
While we are seeing reports of severe respiratory illness in patients with suspected or confirmed EV-D68, it should be noted, as the CDC points out, that many/most of those hospitalized with this and other respiratory infections are people with chronic conditions such as asthma or other health issues. Visitor restriction is a routine response in any hospital when there is a cluster of respiratory infections in the community. Read the rest of this entry ?

h1

End-of-Life Discussions and the Uneasy Role of Nurses

September 11, 2014

Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and 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 is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.

Evelyn Simak/ via Wikimedia Commons

Evelyn Simak/ via Wikimedia Commons

Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).

Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)

Have you ever disagreed with a physician’s choice to continue treatments in a situation where you thought these treatments were against a patient’s real desires or best interests? Have you felt cornered in your care? What conversations did you start—or want to start but maybe felt you couldn’t?

Many times, we nurses at the bedside are afraid to speak openly with our patients about end of life, especially when physicians have different views on what should be the patient’s treatment goals. The situation feels thorny, fraught. Moral distress—when you know the right thing to do for your patient but don’t feel you have the ability to do it—can lead to burnout, high turnover rates, and many emotional stressors among nurses. Often, we simply can’t say what we want to say, despite a duty to our patients to accurately educate them on their care and conditions. Read the rest of this entry ?

h1

Blogging: As Many Voices as There Are Nurses

August 20, 2014

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile.  I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat.

Nurse-midwifery. A post on At Your Cervix: Tales of a New CNM, First Year gives a short nuts-and-bolts glimpse of the author’s daily work life as a certified nurse-midwife. Those considering this specialty may benefit from one person’s experience of the pros and cons of one workplace:

I thought (as I was taught) that I would have more autonomy in practice . . . the two physicians are truly the “bosses.” Everything needs to be run by them . . . I definitely have more autonomy in the office setting. There was a big difference in reading/learning about prenatal care and GYN care, versus doing it. I didn’t learn (or have clinical experience in) nearly enough GYN clients! I think the number of GYN clients for clinicals was only about 35.

For the ‘research-minded nurse.’ At the INQRI blog—that is, the blog of the Interdisciplinary Nursing Quality Research Initiative, which has a stated goal “to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care”—you will find even-handed and brief summaries of recent nursing research on topics such as the potential for hourly nursing rounds to improve patient care.

Renewal. If you’re taking a vacation and going somewhere more peaceful this summer, sometime AJN blogger Amanda Anderson has a contemplative post, “The Place Where Noise Becomes Sound,” at her blog This Nurse Wonders. It starts like this:

Summer has finally found me. Somewhere in the long train ride west, between naps and riders and minutes of staring at passing trees, I listened.

Read the rest of this entry ?

h1

The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

Follow

Get every new post delivered to your Inbox.

Join 951 other followers

%d bloggers like this: