Posts Tagged ‘Nurses’

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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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Counting Your Blessings

November 26, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

A perhaps idealized past: 'Home for Thanksgiving,' Currier and Ives lithograph/Wikimedia Commons

A perhaps idealized past: ‘Home for Thanksgiving,’ Currier and Ives lithograph/Wikimedia Commons

At the Thanksgiving holiday in the U.S., it’s customary to take some time to reflect on our good fortune—to give thanks for what we have. For many of us, it means being thankful for family and good health. But what about all the other people who may make a difference in how we live our lives, who make the world in which we live better or in some indirect way have had an impact on what we do, how we do it, how we feel about life or our work?

Here are some folks I’d like to thank:

  • The incredibly talented team here at AJN who are committed to fulfilling AJN’s mission to provide accurate, evidence-based content with high journalistic standards, and the publishing team that provides the resources it takes to deliver on our mission.
  • AJN’s editorial boards, contributing editors, and peer reviewers, who contribute their expertise and wisdom to keep AJN on track.
  • Organizations like the Robert Wood Johnson Foundation, AARP, Johnson & Johnson, the Jonas Foundation, the John Hartford Foundation, the Macy Foundation, and others who believe in the value of nursing and provide support to further the profession.
  • Carolyn Jones, the photographer and filmmaker, for her wonderful book and film project, The American Nurse, which portrays the incredible work of nurses across settings and makes it visible to the public.
  • Brave people like nurses Kaci Hickox and Debbi Wilson and physician Craig Spencer and their colleagues at Doctors without Borders/MSF and at other relief agencies who volunteer (often with considerable risk to themselves) to provide care and compassion to those who need it (read about Wilson’s experience in a Liberian Ebola-treatment center in her recent blog post).
  • Nurses who make the hard decisions and are examples to us all, like the U.S. Navy nurse who has refused to force-feed detainees at Guantanamo Bay because it violates professional ethics.
  • Nursing faculty, who pursue teaching careers because they are committed to educating the next generation of nurses.
  • Nurses who stand up for colleagues, new and old, and work to promote teamwork and unity in the workplace.
  • And the nurses who, every day, show up and do whatever it takes to meet the needs of the patients in their care.

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As the VA Regroups and Recruits, The Words of Nurses Who Served

November 14, 2014

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. The AJN articles linked to in this post will be free until the end of December.

Vietnam Women's Memorial, courtesy of Kay Schwebke

Vietnam Women’s Memorial, courtesy of Kay Schwebke

A scandal earlier this year about suppressed data related to long wait times for appointments tainted the credibility of the Department of Veterans Affairs. On this Veterans Day week, the new secretary of Veterans Affairs has been using incentives and promises of culture change to promote new hiring initiatives for physicians and nurses. The focus as always should be on the removal of the barriers many veterans face in obtaining timely, high quality care. Naturally, a number of these veterans are nurses themselves.

To commemorate those who have bravely cared for our country, and who deserve the best of care in return, we’ve compiled a few quotations from nurse veterans who’ve written for or been quoted in AJN about their experiences in successive conflicts through the decades. Thank you for all your service, and for what you carry daily—as nurses, veterans, and patients.

World War II
“I remember walking through cities leveled by bombs, looking at the hollow eyes and haunted faces of a devastated civilian population. Since September 11, I see those same hollow eyes and haunted faces on the nightly news.”
—Mary O’Neill Williams, RN, “A World War II Army Nurse Remembers,” as told to her daughter. Published September 2002

Korea
“The challenges and responsibilities of combat nursing far exceeded the normal scope of nursing practice. Army nurses independently triaged casualties, started blood transfusions, initiated penicillin therapy, and sutured wounds. They monitored supplies and improvised when necessary. . .They often cared for 200 or more critically wounded soldiers in a standard 60-bed MASH; off duty, they provided food and nursing care to the local populace. Some managed to be innovators on the cutting edge of nursing practice. The nurses of the 11th Evacuation Hospital helped to pioneer the use of renal dialysis nursing and were among the first to support patients who had hemorrhagic fever using a first-generation artificial kidney machine.”
—Mary T. Sarnecky, DNSc, RN, CS, FNP, “Army Nurses in ‘The Forgotten War,’” November 2001

Nurse Lynne Kohl during Vietnam War. For more information, see article link to right.

Nurse Lynne Kohl during Vietnam War. For more information, see article link below.

Vietnam
“The guys loved the helicopters because, whenever the helicopter was coming in, their lives were going to be saved. . . But helicopters to the nurses meant, ‘Oh my God, how many are coming in?’. . . That’s when we had to run to the ER, get them out of the chopper, get them triaged, get them to where they needed to be. So for us, helicopters meant that people’s lives were at stake. We needed to move fast.”
—Diane Carlson Evans, RN, as told to Kay E. Schwebke, MD, MPH, in “The Vietnam Women’s Memorial: Better Late Than Never,” May 2009. (See also a collection of free podcasts on AJNonline.com that include short poems written and read aloud by nurses who served in Vietnam and an author interview about the creation of the Vietnam Women’s Memorial.) Read the rest of this entry ?

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Nurses, Brittany Maynard, Methods of Hastening Dying: No Easy Options

November 5, 2014

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week.

Last weekend, 29-year-old Brittany Maynard died, in her bed, in her bedroom, with her husband and immediate family beside her. I learned of her death on Twitter, along with millions of other readers. Several weeks earlier, Maynard had publicly announced, in a YouTube video, the way she planned to end her own life: using a lethal dose of medications prescribed to her for that purpose.

Maynard, while a compelling public advocate, is not the first to choose to die this way. Compassion and Choices, the organization that worked with Maynard to publicize her choice, lobbies for the drafting and passage of “death with dignity” laws, which currently exist in some form only in Oregon, Washington, Vermont, New Mexico, and Montana. Arizona.

In Oregon, where Maynard moved in order to be able to legally end her life before she was incapacitated by the effects of terminal brain cancer, approximately 71 other people made the same choice in 2013, the most recent year of reported data—the peak of a gradual increase from the law’s inaugural year of 1998, when 16 people did so.

Illustration by Denny Bond for AJN. All rights reserved.

Illustration by Denny Bond for AJN. All rights reserved.

Much social media discussion has arisen from Maynard’s case, often influenced by strongly held religious and ethical principles. For nurses, the issue can be further complicated by our own clinical experiences with death. Some have argued that legalized aid in dying opens a door to hasty, emotionally fraught, irreversible decision making.

Yet few commentators discuss other practices associated with hastening dying that are commonly practiced in our health care system, as described in a 2009 CE article in AJN by Judith Schwarz, “Stopping Drinking and Eating” (free until December 1). These practices include “foregoing or discontinuing life-sustaining treatment, including medically provided nutrition and hydration (such as tube feeding),” “using high doses of opioids to treat intractable pain,” and “initiating palliative sedation.”

Schwarz’s article focuses on the case of 100-year-old Gertrude, whose progressive loss of hearing and vision and her inability to complete activities of daily living had convinced her that she needed a plan to end her own life while she still could. Because she lived in a state where physician-assisted death was not a legal choice, Gertrude and her family enlisted the counsel of Compassion and Choices for knowledge of further options. Through a series of home visits and consultations, Schwarz assisted Gertrude and her family as they considered their legal options and arrived at the voluntary decision to stop eating and drinking. Read the rest of this entry ?

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AJN in November: Palliative Care, Mild TBI, the Ethics of Force-Feeding Prisoners, More

October 31, 2014

AJN1114.Cover.OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

Palliative care versus hospice. For many seriously ill, hospitalized older adults, early implementation of palliative care is critical. These patients often require medically and ethically complex treatment decisions. This month’s original research article, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults,” found that staff nurses often confuse palliative and hospice care, a fact that suggests a need for increased understanding and knowledge in this area. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Mild traumatic brain injury (TBI) can have profoundly negative effects on quality of life and can negatively affect relationships with family and caretakers. This issue’s other CE feature, “Mild Traumatic Brain Injury,” reviews the most commonly reported signs and symp­toms of mild TBI, explores the condition’s effects on both patient and family, and provides direction for devel­oping nursing interventions that promote patient and family adjustment. Earn 2 CE credits by taking the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, in our iPad app, by tapping the icon on the first page of the article).

Medication safety. While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors. “Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit,” an article in our Cultivating Quality column, describes how nursing staff at one facility implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation. Read the rest of this entry ?

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Ebola: A Role for Nurses in Sharing the Facts

October 29, 2014

By Shawn Kennedy, AJN editor-in-chief

Screen Shot 2014-10-29 at 12.27.27 PMThe current Ebola crisis has everyone concerned over transmission, and rightly so. The public has been in a quandary as to who and what to believe. I can’t say I blame them. We should have been better prepared and anticipated that, given the situation in West Africa, we would eventually see a patient with Ebola present to a U.S. hospital ED (or clinic or urgent care center). What’s surprising is that it didn’t happen sooner.

I’d thought fears about widespread transmission of Ebola had abated after no more new cases arose from that of Thomas Eric Duncan in Dallas: his family, who were in the apartment with him during the time he was sick, did not contract Ebola and have since been released from quarantine; the two nurses who became ill treating Duncan have now been declared Ebola free and none of their contacts have become ill; no other nurses who provided care for him have fallen ill.

But with the onset of confirmed Ebola in a New York physician who had recently returned from caring for Ebola victims in West Africa, fears of widespread contagion resurfaced. Craig Spencer had been self-monitoring his symptoms while he went about his life; when he began to feel ill and developed a low-grade fever, he initiated a controlled transport in isolation to Bellevue Hospital.

And when nurse Kaci Hickox returned from volunteering in West Africa, she was caught in New Jersey’s new Ebola precautions and placed in mandatory quarantine in a tent outside a hospital in Newark. She protested, secured attorneys to advocate on her behalf (basing her protest on CDC recommendations that routine quarantine of nonsymptomatic health care workers is not justified), and was released to travel home to Maine, where she is now disputing Maine’s mandatory in-home quarantine and active monitoring requirement in favor of self-monitoring. Read the rest of this entry ?

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