Posts Tagged ‘Nurses’


No Longer Alone: Nurses Supporting Family Caregivers

November 13, 2015

By Susan C. Reinhard, PhD, RN, FAAN, senior vice president and director, AARP Public Policy Institute, chief strategist, Center to Champion Nursing in America; Elaine Ryan, MPA, vice president of state advocacy and strategy integration, AARP government affairs; and Trish O’Keefe, PhD, RN, NE-BC, interim president, Morristown Medical Center, New Jersey

Teaching a daughter to help her mother with range-of-motion exercises.

Teaching a daughter to help her mother with range-of-motion exercises

The public trusts nurses to care for them and to teach them how to care for themselves and for those they love. But a 2012 AARP/United Hospital Fund report funded by the John A. Hartford Foundation, Home Alone: Family Caregivers Providing Complex Chronic Care, shows there is a big disconnect. In this first nationally representative study of families providing complex care activities, almost half reported that they had provided medical/nursing treatments, including injections, wound care, administering multiple medications, managing colostomies, and giving tube feedings and nebulizer treatments—among many other tasks that nursing students find daunting when they are first learning how to do them.

Family caregivers are expected to step right in, with little to no instruction or support. Most (nearly 7 out of 10) of those they cared for did not get a home visit by a health care professional, despite multiple encounters with the health care system. Many of these family caregivers said they had to learn how to do complex tasks on their own. For example, close to 60% had to learn about at least some medications on their own. More than a third performed wound care on their own, but only 36% said a nurse or physician in a hospital had taught them, and only 25% had received teaching from a home care nurse. Many were worried about making a mistake or harming the person they were trying to help.

Family caregivers need more support. Recent research shows that in 2013 there were 40 million family caregivers who provided $470 billion in unpaid care to an adult with limitations in daily activities. About 50% to 60% of family caregivers have a full- or part-time job. One in three provides an average of 62 hours of care a week—and eight out of 10 of these “intense caregivers” perform complex medical/nursing tasks.

How can nurses help? No doubt many nurses are trying to meet this critical need to teach family caregivers. But we need a more comprehensive, fully supported approach. One step in that direction is the Caregiver Advise, Record and Enable (CARE) Act, which focuses on hospital admissions and discharges and has been described as a “commonsense solution to help family caregivers.” There are three parts that respond to requests from people around the country.

  • First, the CARE Act requires hospitals to permit the patient to designate a family caregiver who will be recorded in the hospital record (and hopefully engaged in the care team, including the discharge planning).
  • Second, the hospital must notify that caregiver when the patient is to be moved or discharged.
  • Third, the hospital must offer instructions on the medical/nursing tasks that are part of the discharge plan.

As of October, 33 state offices (OK, NJ, PR, ND, MS, NY, IN, VA, NM, MN, KS, CT, HI, NH, WV, MA, WI, MD, IA, IL, NV, CO, RI, OR, ME, TX, AR, AK, CA, AL, MI, DC, PA) had introduced the CARE Act; it has been signed into law in 15 states (the states in italics). In many of these states, nurses testified or provided letters of support to advance this legislation.

One health system’s efforts to better meet caregiver needs. New Jersey was one of the first to pass the CARE Act, in November 2014. Nurse leaders in the Atlantic Health System embraced this policy and went to work quickly to prepare for implementation in May 2015. Read the rest of this entry ?


Ebola, One Year Later: What We Learned for the Next Big Epidemic

November 6, 2015

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

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

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

Read the rest of this entry ?


Practical Steps for Nurses to Reduce Prescription Opioid Diversion

October 28, 2015

By Shawn Kennedy, AJN editor-in-chief

“Opioids diverted from friends and family members who have legitimate prescriptions are a major source of abused prescription opioids.”

More than 800 lbs. of drugs have been collected in Lycoming County, PA, since drug collection boxes were placed in law enforcement agencies over a year ago, allowing residents to safely dispose of unwanted drugs. Here the drugs are separated from their containers before incineration. Photo courtesy of Karen Vibert-Kennedy / Williamsport Sun-Gazette.

More than 800 lbs. of drugs have been collected in Lycoming County, PA, since collection boxes were placed in law enforcement agencies over a year ago, allowing residents to safely dispose of unwanted drugs. Here the drugs are separated from their containers before incineration. Photo courtesy of Karen Vibert-Kennedy / Williamsport Sun-Gazette.

Amid recent reports from the CDC drawing attention to a prescription painkiller and heroin overdose epidemic, last week President Obama announced an initiative to address both prescription drug and heroin abuse in the United States. In addition to a PR campaign involving sports figures and celebrities, the initiative mandates education and training for those who prescribe controlled substances and steps to improve access to treatment for drug addiction.

This epidemic can’t be blamed on a single cause, and as the CDC points out, any meaningful solution must also address such crucial issues as significant state by state variations in prescribing patterns.

Another crucial contributor is the diversion of legitimately prescribed opioid medications, which we addressed in our August issue with a CE article by Renee Manworren and Aaron Gilson: “Nurses’ Role in Preventing Prescription Opioid Diversion.” The article is free. Here’s an excerpt from the overview: Read the rest of this entry ?


Violence Against Women: Old Stories Repeat, But Some Progress

October 19, 2015

By Maureen Shawn Kennedy, AJN editor-in-chief

Emergency lights #5, by DrStarbuck via Flickr

Emergency lights #5, by DrStarbuck via Flickr

It seemed ironic that, during this month of domestic violence awareness, a Florida judge showed little awareness of the fear that intimate partner violence can instill. Judge Jerri Collins came under attack from victim advocacy groups after she jailed a young mother who was a victim of domestic violence for failing to show up in court to press charges against her husband. According to various news reports, the distraught woman was afraid to face her husband in court for his sentencing to 16 days for choking and threatening her with a knife. Advocates say the judge’s action sends a message that may result in many women not bringing charges against abusers.

According to the CDC report Intimate Partner Violence Surveillance: Uniform Definitions And Recommended Data Elements (version 2.0; 2015), “over 1 in 5 women (22.3%) and nearly 1 in 7 men (14.0%) have experienced severe physical violence by an intimate partner at some point in their lifetime.” The real numbers are almost certainly higher, as many victims are afraid to report their partners for fear of retaliation once the abuser is released from jail. There are too many cases where that has happened, many ending in a woman’s death. Judge Collins’ actions seem heartless; she appears to be woefully misinformed about the dynamics and psychological effects of abuse.

At the recent Association for Women in Communications meeting in Kansas City, Nanette Braun of UN Women talked about several programs to raise awareness about women’s rights and reducing violence against women. The UNiTE to End Violence Against Women campaign has proclaimed the 25th of every month “Orange Day,” a call to action day to end violence against women and girls; Braun reported that over 60 countries have signed on to promote the campaign.

Another initiative that seems to have taken off, with the help of actress Emma Watson, is the HeForShe campaign, which aims to engage young men to end discrimination and violence against women and promote gender equality.

And here are some resources in AJN that you might find helpful: Read the rest of this entry ?


One Nurse’s Ode to Fragility

October 7, 2015
Illustration by Lisa Dietrich for AJN.

Illustration by Lisa Dietrich for AJN.

For nurses, the world outside work may from time to time seem as fragile and tenuous as the health of patients. Natural disasters threaten homes, illnesses afflict family members, the reminders of impermanence become too insistent. This month’s Reflections essay, “The Robin,” explores such emotional terrain with sensitivity and honesty.

Gentle warning: This is not an essay that neatly delivers a pearl of take-home wisdom at the end. But that’s what we liked about it. Sometimes the best we can do is hang in there and pay close attention. And, if we’re able and willing, write about it. Here are the opening few paragraphs of this short essay: Read the rest of this entry ?


Nursing Ethics: Helping Out on the Unit vs. Teaching Nursing Students Crucial Skills

September 23, 2015

By Jacob Molyneux, AJN senior editor

scalesJust as no two hospital units are exactly alike, rarely are two ethical conflicts exactly alike. There are too many variables, too many human and situational differences. This month’s Ethical Issues column, “Teaching Crucial Knowledge vs. Helping Out on the Unit,” explores potential ethical and practical issues faced by a clinical instructor who must balance the duty to teach essential skills to nursing students against the staff’s need for help in meeting patient care needs.

Will there be an easy, cut-and-dried answer? Probably not. In the course of their analysis of a hypothetical scenario, the authors make the following point:

Because new situations arise all the time, and every situation varies in its ethically relevant aspects, rigid rules often cannot guide ethical action. Instead, analytic skills and transparent negotiation are crucial for resolving conflicts between values as they arise in day-to-day interaction—and for supporting the solutions we choose.

While people skills may be as important as abstract ethical analysis in dealing with real world situations, determining which ethical principles or priorities are coming into conflict may provide us with a certain measure of clarity in our approach. The authors frame the conflict described in the article in the following way:

Read the rest of this entry ?


Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

September 21, 2015

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

by luke andrew scowen/flickr creative commons

luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for thought in the midst of our high-tech workplaces and death-denying culture. Read the rest of the article in this month’s AJN.

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