Posts Tagged ‘nurses’

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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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Preventing Delirium, The Luxury of Time, Things We Get Right, More: Nursing Blog Roundup

March 7, 2014

By Jacob Molyneux, senior editor

Here are a few recent posts of interest at various nursing blogs:

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

In the throes of nursing school: An intriguing little pastiche of a poem (does it qualify as a ‘found word’ poem?) can be found at a newish blog, adrienne, {student} nurse, in a short post called anatomy of a bath. In another post, she makes the following observations: “In nursing school, you are not driving the train…You absolutely must keep telling yourself that there is nothing wrong with you.”

Preventing delirium in the ICU: At the INQRI blog (the blog of the Interdisciplinary Nursing Quality Research Institute), a post summarizes some recent research on implementing a “bundle” of practices to increase mobility and reduce sedation in the ICU, all in order to prevent patient delirium, which is known to have many short- and long-term negative effects.

The luxury of time. At Love and Ladybits, the author gets a tantalizing glimpse of the quality of care she’d be able to provide if she had more time to spend with each patient. Of course, this “alternative reality” can’t last, but perhaps it can serve as a touchstone of sorts during more hectic times.

The past is present. At Head Nurse, there’s a somewhat rueful post about an unexpected encounter, years later, with the author’s least favorite nursing professor (“Everybody has one of those instructors–the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia”). Read the rest of this entry ?

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NPR Syndrome

February 21, 2014

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

calligraphy, 36" x 24," mixed media on vellum, 2007,  by julianna paradisi

calligraphy, 36″ x 24,” mixed media on vellum, 2007, by julianna paradisi

Compassion fatigue is a syndrome commonly known to nurses and other professionals involved in patient care. It is the result of constant exposure to traumatic events occurring to others. Its effects on the psyche of nurses are widely studied, recognized as a factor in burnout and self-medication, and sometimes result in nurses leaving the profession.

My clinical practicum as a nursing student, nearly 30 years ago, was in oncology. There I saw patients succumb to cancer. Many were young adults. One left behind a grieving husband, and an infant. It was heartbreaking. I asked my preceptor, a skilled, compassionate, and uncannily jolly nurse, how did she avoid burnout? I did not know about compassion fatigue yet.

She wisely replied, “You need to develop a happy, fulfilling personal life outside of nursing. You have to shut it off when you leave the hospital.” It was good advice.

I took it to heart, and over the years developed a happy, fulfilling personal life. However, turning it off when leaving the hospital is more of a challenge lately. In a similar way that an opportunistic, secondary infection makes the flu lethal, the rapid influx of news by way of our digital culture is a secondary infiltration into our lives, making it difficult for sensitive souls to “shut it off” after leaving the hospital. For lack of a better term, I’ve dubbed this digital age barrage “NPR Syndrome.”

Before going further, I want to state that NPR (National Public Radio) is a respected source of news. As more and more broadcast news reports are indistinguishable from infomercials, NPR plays an important role in bringing serious news from around the world to our attention. I coined the term “NPR Syndrome” simply because I was listening to NPR when it occurred to me how challenging it is to escape compassion fatigue outside of the hospital.

The amount of suffering in the world is overwhelming to nurses.

There is not enough time to volunteer for all of the projects close to our hearts. There is not enough cash in our wallets to hand out to every homeless person we meet, or fill the shelves of food banks. There are not enough blankets to donate to shelters for the cold and displaced. Resources for brave souls traveling to developing countries to provide vaccinations and drinking water are too few. And then there are the refugees of war we see in flight every night on the evening news. It feels like we are using a Band-Aid to stop the flow of a bleeding artery.

The result is that many nurses feel guilty over having happy, fulfilled personal lives, lives that sustain us to go back to our jobs providing skilled and compassionate nursing care to our patients, where we again encounter compassion fatigue.

A lot of nurses have stopped reading, listening to, or watching the news altogether, and at over three million strong in the United States, this is a lot of political power gone to waste through being uninformed. Read the rest of this entry ?

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Take a Walk: American Heart Month, for Nurses and Everyone Else

February 3, 2014

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

By Eric Hunt/via Wikimedia Commons

By Eric Hunt/via Wikimedia Commons

So we all know what we need to do to prevent heart disease: eat a healthy diet (such as the highly touted Mediterranean diet, which has been “consistently effective with regard to cardiovascular risk”), get regular exercise, and don’t smoke. But most of us—and I’m guilty—don’t quite follow the advice we may give our patients or family members. It’s difficult to carve out time for oneself in addition to working all day (and for most nurses, we’re not talking a nine to five day—many work 12-hour shifts, or at least a 10-hour day if in administrative positions), plus commuting and then spending time with family. If you have school-age children in activities, there are also car pools and homework.

We need to find 30 minutes—or even 20 minutes—daily to jump-start our own engines. According to the National Heart, Lung, and Blood Institute, heart disease kills one in four women and is the leading cause of death for both women and men in the United States. And while genetics certainly plays a part, cardiovascular health is mostly about prevention. So make a 30-minute appointment with yourself and stick to it.

The American Heart Association (AHA) initiative highlighting heart disease in February is a good reminder to us all, especially in the harsh winter weather when it can be so much nicer to stay indoors. The AHA has designated Friday, February 7, as “National Wear Red Day” in order to raise awareness of heart disease in women.

I know some people who religiously go for a walk or run as soon as they get home from work. Others I know get up a half hour earlier to exercise. I walk on the treadmill while I watch the news, but rarely manage to do so every day of the week. So I forgive myself and start again. I have to—my parents and grandparents all died from heart disease and my siblings and I have other risk factors, such as hypertension or elevated cholesterol levels. Read the rest of this entry ?

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Smoking, Nurses, Knowledge: We’ve Come a Long Way, But Not Far Enough

January 22, 2014

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

"Smoke break"/by sylvar, via Flickr

“Smoke break”/by sylvar, via Flickr

Back in the day, I remember riding in the car with my parents, both of whom smoked. My siblings and I used to jockey for the window seats so we could be near the fresh air streaming in.  And I recall holidays with visiting relatives when all the adults would sit in the living room smoking cigarettes. (Kent filter-tips for the women; Camels for the men.) And as kids, we used to “smoke” candy cigarettes. The ones that “puffed” when you blew into them were our favorites.

But I also recall getting older and not wanting to visit my Uncle Joe, a once tough New York City police detective, because he would just sit on the edge of his chair, leaning over a table and struggling to breathe. This made my dad quit cold turkey after he had a heart attack at age 48 and our family physician told him he could either keep smoking or quit and see his children get married. My mom quit when she was pregnant with my youngest sister, after the surgeon general’s report said smoking could harm the fetus.

Our parents were constantly telling us that they wished they’d never started (my dad began in the army, when cigarettes were standard issue for GIs), that it was a “dirty habit” and an expensive one—and “don’t forget Uncle Joe.” Their efforts paid off—neither I nor any of my six siblings smoke today. Ironically, while I repeated those same messages (bolstered with more clinical information) to my three sons, two of them took up smoking during adolescence. Fortunately, they did stop, but not from my efforts—their girlfriends (who later became wives) pushed them into quitting . Read the rest of this entry ?

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For Nurses, on Slowing Down, Unplugging, Career Change, and Serendipity

December 30, 2013
Photo by James Russo, via Flickr

Photo by James Russo, via Flickr

Here are a few year-end posts from recent years that seem to me pretty much as relevant and timely as ever.

“Career Change in 2011 [or 2014]? Ask the God of Gates, Doors, and Beginnings”
A good source of inspiration for any nurse who feels the need of a change.

“Year-End Reindeer Dreams”
A meditation on serendipity and working holiday shifts as a nurse. It got a lot of responses from readers when we first posted it.

“The Slow Old Days”
A short, thought-provoking post by AJN editor-in-chief Shawn Kennedy, about unplugging over the holidays.

—Jacob Molyneux, senior editor/blog editor

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Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the U.S.: An IOM Report

December 2, 2013


By Natalie McClain, PhD, RN, CPNP, clinical associate professor, William F. Connell School of Nursing, Boston College, and Barbara Guthrie, PhD, RN, FAAN, Independence Foundation Professor of Nursing, Yale University School of Nursing. The above educational video was created by the Institute of Medicine and is available on YouTube.

Each day in the United States, minors experience abuse and violence that is overlooked and unidentified. In some cases, recognition of the abuse makes these minors subject to arrest rather than assistance and care. These children and adolescents are the victims and survivors of commercial sexual exploitation and sex trafficking. A recent report from the Institute of Medicine (IOM) and the National Research Council sheds light on this serious domestic problem and underscores the critical role that nurses must play in preventing, identifying, and responding to these crimes.

Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States is the culmination of a two-year study conducted by an independent panel of experts appointed by the National Academies of Science and funded by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. The report states that commercial sexual exploitation and sex trafficking of minors are acts of abuse and violence against children and adolescents. However, the response to these victims is often starkly different from that experienced by other victims of child abuse and neglect. In most states, for example, underage victims of commercial sexual exploitation and sex trafficking can be arrested and prosecuted.

Long-term consequences; inadequate services. The report also notes that the consequences of commercial sexual exploitation and sex trafficking are far-reaching and long lasting and include a range of mental and physical health problems. The committee found that there are too few services available to meet current needs of victims of commercial sexual exploitation and sex trafficking of minors. In addition, “services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of these crimes” (IOM and NRC, 2013, p. 260).

This form of abuse and violence against children and adolescents is largely underreported. This is because identification of victims can be challenging. Once victims are identified, there are few service providers who are adequately prepared to assist and care for them. The report describes this and numerous other challenges faced by professionals in law enforcement, education, victim and support services, and health care who seek to prevent and identify these crimes and to assist their victims. It also provides clear guidance on and examples of strategies to increase awareness, strengthen laws, and advance knowledge and understanding.

Nurses are essential partners in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. Two of the report chapters—Health and Health Care and The Education Sector—underscore the critical role of nurses as first responders in prevention, detection, and care of victims. Victims may seek out health care, thereby providing an opportunity for nurses in a range of settings to identify victims and survivors of this abuse. Read the rest of this entry ?

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Measuring Dyspnea Upon Unit Admission: Is It Feasible?

November 4, 2013

Do You Ask Your Patients about Dyspnea?

Photo by Thomas Northcut.

Photo by Thomas Northcut.

As a CE article this month, we feature a report of a pilot study on routine assessment of dyspnea on admission to a patient unit. It’s routine to take vital signs on all patients on admission, but really, how many nurses actually stand there and count respirations for all patients? And even if you are the exceptional nurse who does, that doesn’t necessarily tell you if the patient actually feels any shortness of breath. And then, of course, there’s the issue of whether it’s a good idea to add to the burden of documentation that many nurses are already concerned about.

This article reports on one group’s experience piloting a short dyspnea assessment tool for all admissions on several units. Here’s the abstract:

The assessment of dyspnea, like that of pain, depends on patient self-report. Expert consensus panels have called for dyspnea to be measured quantitatively and documented on a routine basis, as is the practice with pain. But little information is available on how to measure and record dyspnea ratings systematically. Consequently, the prevalence of dyspnea in hospital settings may be greater than is generally recognized, and dyspnea may be insufficiently managed. This article describes a pilot study that sought to test the feasibility of measuring dyspnea as part of the initial patient assessment performed by nurses within several inpatient units of a large urban hospital.

While most nurses in the pilot felt that assessing for dyspnea was important, a number felt that quantifying it and documenting it was less so. The article provides a revealing snapshot of some ways implementing an assessment can work and not work so well, according to unit type, patient condition, and the format of the required documentation.

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Guess Who’s Wearing Housekeeping Garb Now? Surprise! It’s Your Nurse

October 28, 2013

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

Catch-all: noun [usu. as modifier]

a term or category that includes a variety of different possibilities: ex. the stigmatizing catch-all term “schizophrenia”

American Hospital/by J. Paradisi

American Hospital/by J. Paradisi

The first thought that came to mind after I heard that Vanderbilt University Medical Center had laid off its housekeeping staff and assigned cleaning patient rooms to nursing was this: Has anyone from the hospital’s administration ever looked inside the nursing staff’s refrigerators, microwaves, or sinks?

Universally, nurses’ staff lounge kitchens nearly rank biohazard status. In every unit a single nurse, but often it’s the unit secretary, martyrs herself (or himself) by emptying these refrigerators of forgotten food. She washes the moldy containers and places them on a nearby countertop, with this message scrawled in Sharpie:

CONTAINERS NOT TAKEN HOME BY WEDNESDAY WILL BE THROWN OUT! (Caps intended)

Another sign commonly posted above the staff lounge sink or microwave by this same nurse or unit secretary reads:

CLEAN UP AFTER YOURSELF! YOUR MOTHER DOESN’T LIVE HERE!

Fact: Nurses know a lot about infection control, but this does not automatically make us good housekeepers. Besides, nurses already have a job: keeping hospitalized patients safe while assessing their needs and administering their care.

While Vanderbilt’s decision to lay off its housekeeping staff and assign cleaning patient rooms to nurses may be unprecedented, it is not innovative. Using nurses as catch-alls for various jobs not designated to specific departments is an established tradition of hospital administrations. Obtaining patient meal choices, handing out food trays, distributing patient satisfaction surveys, and wiping down used equipment (including toys in pediatric units) are a few examples of nonnursing tasks I have been assigned during my career. No doubt other nurses can add more to this list.

It is not, however, the purpose of this post to call out a single institution. Hospitals around the country are struggling financially. Many are millions of dollars over budget. All are seeking ways to trim their budgets. But why were nurses singled out for shouldering the burden? Read the rest of this entry ?

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AJN’s October Issue: Reducing VAP, Decreasing Patient Agitation, Bedbugs, Helping Transgender Kids, More

September 30, 2013

AJN1013.Cover.OnlineAJN‘s October issue is now available on our Web site. Here’s a selection of what not to miss.

Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections and a leading cause of death in ICUs. The authors of “Mouth Care to Reduce Ventilator-Associated Pneumonia” discuss the importance of oral care in infection control and offer an evidence-based, step-by-step guide to providing optimal mouth care for intubated patients. You can earn 2.3 CE credits with this article. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

The stress of hospitalization can lead to anxiety or agitation, especially in patients with psychiatric or cognitive disorders, putting them at increased risk for falls and self-harm.Decreasing Patient Agitation Using Individualized Therapeutic Activities” describes a nurse-led quality improvement project that reduced agitation in patients suffering from cognitive impairment, delirium, and other behavior-altering conditions who were receiving continuous observation on a nonpsychiatric unit. Earn 2.4 CE credits by reading this article and taking the test that follows. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

Increasing patient satisfaction has become a critical goal for hospitals in the U.S. “Nursing Staff Innovations Result in Improved Patient Satisfaction” describes how nurses at one facility implemented and tested a variety of care practices to improve patients’ hospital experience and outcomes. Read the rest of this entry ?

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