Posts Tagged ‘Nurses’

h1

Family Caregivers Increasing in Age, Numbers: How Can Nurses Help?

June 10, 2015

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

AJNFamilyCaregiverSupplementLast week, a new report from the National Alliance for Caregiving and AARP detailed the landscape of family caregiving in the United States. The majority (60%) of caregivers remain female (40% are men, a percentage that continues to rise). They average 49 years of age. In most cases, they are caring for a relative (typically, a 69-year-old female). On average, the caregiver spends 24 hours each week helping with daily activities and has been doing so for four years; one-third of caregivers still maintain a full-time job.

An estimated 34.2 million adults provided unpaid care to an adult 50 years or older in the previous 12 months; nearly one in 10 caregivers is 75 years or older—a typical example given in the report was a 79-year-old female caring for a 77-year-old spouse with Alzheimer’s disease, aging issues, or heart disease. Half of caregivers were thrust into caregiving and felt that they had no choice about taking on the responsibility of a loved one’s care; 22% of caregivers feel that their own health has suffered.

To raise awareness of their needs, in recent years AARP has championed the plight of family caregivers, collaborating with government and consumer organizations, and health care professionals. AJN, too, has worked with AARP on several projects to provide nurses with information to support family caregivers, as noted below.

The needs of family caregivers will only increase, according to the data on aging in a report from the U.S. Administration on Aging, A Profile of Older Americans: 2014. According to this report, “The 85+ population is projected to triple from 6 million in 2013 to 14.6 million in 2040.”

This means more people in the “oldest old” category—the group that typically needs assistance with daily living.

We’d like to offer some resources from AJN to help nurses support family caregivers, who often get overlooked by health care professionals and are unprepared for all the caregiving tasks they may need to do (see, for example, Carol Levine’s guest editorial in our September 2008 issue, which details her personal experiences and eloquently describes the problems caregivers often face). Read the rest of this entry ?

h1

A Nurse Epidemiologist’s Notes on Issues Raised by a Recent Death from Lassa Fever

June 5, 2015

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

Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a post-mortem diagnosis.

Some aspects of last month’s case of Lassa fever in New Jersey seemed to parallel the story of Thomas Duncan, who died last October in Dallas after contracting Ebola virus disease in Liberia.

A man arrived in the U.S. from Western Africa. He was screened for Ebola at the airport and instructed to monitor his temperature for 21 days. The next day, he developed a fever. Instead of calling the county health department, he headed to a hospital. He reportedly didn’t mention his travel history to staff, and was sent home on antibiotics. His condition worsened, and three days later he returned to the ED. When clinicians learned that he had recently arrived from Liberia, he was isolated, admitted, and tested for Ebola and Lassa. Positive for Lassa fever, he died soon afterwards.

Like Ebola, Lassa is a zoonotic hemorrhagic fever endemic to Western Africa. As with Ebola, the early symptoms of Lassa fever are nonspecific: fever, headache, malaise, nausea, vomiting . . .

But here the similarities end. Unlike Ebola, 80% of Lassa fever cases are mild or asymptomatic, and the overall case fatality rate is just 1%. (The risk of dying rises to 15%–20% if the disease progresses and requires hospitalization.) The most common complication of Lassa fever is deafness—one-third of those infected experience some degree of hearing loss—which occurs in both mild as well as severe cases.

Missed opportunities? This recent and upsetting story once again highlights the limitations of communicable disease follow-up based on self-monitoring and accurate individual reporting. Airport temperature screening of passengers arriving from certain geographical areas (which appears to be of questionable value) is supposed to result in the isolation and testing of anyone with a fever. But the vast majority of disembarking passengers are afebrile. They are instructed to monitor their temperature for a prescribed period of time (depending upon the disease of concern), and to call their local health department if they develop symptoms.

There are, of course, many holes in this surveillance “safety net.” Passengers may not reveal their connection to an epidemic area because of fear of reprisal, denial of their own at-risk status, or language-related misunderstandings at the point of screening. They may or may not subsequently monitor their health. When fever develops and becomes undeniable, they may not know how to contact their local health department, or if they do call, may quickly become impatient if met with a busy signal or no answer. Panic about what symptoms might mean will cause some people to run to the nearest ED for medical care; health department notification is not a high priority when you think you’re fighting for your life. Read the rest of this entry ?

h1

Nurses Aren’t Just Healers, They’re Teachers Too: A Patient’s View

June 3, 2015
Illustration by Jennifer Rodgers. All rights reserved.

Illustration by Jennifer Rodgers. All rights reserved.

A teeny red bump had mysteriously appeared on my left index finger. It hurt when I pressed on it. I figured it was nothing. . . .

That’s the start of the June Reflections essay in AJN, “Ms. Lisa and Ms. MRSA,” a patient experience narrative by freelance writer Shannon Harris. As luck would have it, the bump on her finger, it turns out, is not nothing. It’s MRSA.

The diagnosis takes a while. Finally the situation worsens, and surgery is needed. The author takes it all in stride, at least in retrospect:

The third physician stood out to me most. He asked to take a picture of my green and black, staph-infected finger with his iPhone. “Sure. Look at it! I thought this only happened to pirates,” I told him as he snapped away. He glanced at the young, button-nosed nurse standing beside him. “Don’t you want a picture? For your records?” he asked.

She shook her head, squinting and gritting her teeth. “I know. Yuck,” I said. I later shared photos of my infection journey online, to the great wonder and disgust of my friends and family. Before that, though, came surgery.

The author’s tone is light, but the situation is a scary one for any patient. Read the rest of this entry ?

h1

AJN EIC Talks Priorities With Leaders of Critical Care Nurses Organization

May 26, 2015
Karen McQuillan and Teri Lynn Kiss

AACN president-elect Karen McQuillan (left) and president Teri Lynn Kiss

By Shawn Kennedy, AJN editor-in-chief

Last week at the American Association of Critical-Care Nurses (AACN) annual meeting (see this post), I interviewed the association’s president, Teri Lynn Kiss, or “TK,” and the current president-elect, Karen McQuillan, who will officially take office after this month. After days of rushing from session to session (and there must be 300+ sessions to choose from) and wandering through exhibits, I always enjoy sitting down with leaders of this organization and hearing what they think is important in critical care nursing.

Teri Lynn Kiss, MS, MSSW, RN, CNML, CMSRN, director of Medical Unit-2South and case management services at Alaska-based Fairbanks Memorial Hospital, has led this growing organization of over 104,000 members for the last year. I asked her what she felt she’d accomplished. She said that one of the most valuable things the association had done in the past year was to provide clear and credible information about Ebola to its members, the health care community, and to policy makers in Washington. She also believes the association’s work on creating healthy work environments is important not just for nurses but will translate to better care for patients. Her presidency, she said, enabled her to fulfill her own personal mission of service to others—one she will continue with the association in different capacities.

Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, a clinical nurse specialist at R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, announced that her theme would be “Courageous Care.” As she noted in her keynote address, “For us as nurses, courageous care means doing what is necessary to provide the best possible care for our patients and their families. Period.”

But you can listen to them speak for themselves in this podcast recording of our conversation.

.

Bookmark and Share

h1

Critical Care Nursing in San Diego (or was it Las Vegas?)

May 20, 2015

FullSizeRenderBy Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

I’ve written before about the American Association of Critical-Care Nurses (AACN) annual meeting, the National Teaching Institute (NTI). As a former critical care and emergency nurse, I’ve attended it almost annually. And I’m always amazed at how each year they step it up with new twists. One year, it was the helicopter and full MASH unit in the exhibit hall. Then AACN went to the TED talk style of keynote presentations. Last year, they had a contest for members to apply to be the guest co-master of ceremonies. So, what might possibly be a new twist in this year’s opening session?

I was sitting with leaders of the Canadian Critical Care Nurses Association, one of whom had never been to NTI before and had been told by her colleague that it would be unlike anything she had seen before. She couldn’t have been more on target—even by NTI standards. The session opened with a DJ and loud techno-rock music, followed by a very fit and energetic dance troupe and pop singers. Then, down from the ceiling came four acrobats and a bare-chested man spinning above the stage, along with a dozen or so men and women running up and down the aisles with large, lighted balls that the audience began batting around, all to the techno music. Was I really at a nursing meeting? Everyone was certainly awake and energized!

San Diego

San Diego

Awards. Pioneering Spirit awards were given to Paul Batalden (for his work with the Institute for Healthcare Improvement and at Dartmouth) and researcher Ann Rogers, and the Marguerite Rogers Kinney Award for a Distinguished Career was given to Joanne Disch (educator and former American Academy of Nursing president and AARP board chair). Some notable moments: Batalden said one piece of advice he would give is to “avoid working with jerks”; Disch received a rousing ovation when she told how she almost didn’t get into graduate school “because she partied too much as an undergraduate.”

‘Focus the flame.’ On a more serious note, AACN president Teri Lynn Kiss addressed the “growing community of exceptional nurses” (AACN membership is at a new record high of 104,000), speaking about her experiences over the past year as president, during which her theme, “Focus the Flame,” guided her work. Read the rest of this entry ?

h1

Good Jokes, Bad Jokes: The Ethics of Nurses’ Use of Humor

April 29, 2015

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Humor has real benefits. But when does nurses’ joking about patients, each other, and the care they provide cross a line?

Photo from otisarchives4, via Flickr.

otisarchives4/Flickr

“Nurses make fun of their dying patients. That’s okay.” That was the provocative title of an op-ed by Alexandra Robbins in the Washington Post on April 16. The author’s treatment of the topic was more complex than the title suggested, but some examples of humor given in the article were troubling.

For ethical practice, nurses must consider if it is ever appropriate to discuss the clinical care of patients for humorous purposes. An easy answer would be—never. If patient care is never joked about, then no one’s feelings are ever hurt and nothing inappropriate is said as a joke. However, my experience as a nurse in psychiatric emergency and with human nature suggests two arguments against this approach:

  • Jokes will be made despite any prohibition.
  • Considerable good comes from such humor.

If jokes are going to be told anyway, it’s better to provide an ethical framework than to turn a blind eye. If joking about patient care is sometimes acceptable and sometimes not, nurses’ jokes are more likely to stay ethical if they consider in advance under what conditions it’s ethical to joke and how one distinguishes ethical from unethical humor.

According to Vaillant (1992), humor is among the most mature of the defenses. “Like hope, humor permits one to bear and yet to focus upon what is too terrible to be borne” (Vaillant, 1977). Those who have experienced the stress of intense clinical practice know the value of finding humor in life’s tragedies. In addition, patients who are able to cope with their physical and emotional pain are often those who find the humor in tragedy.

Still, some attempts to make people laugh are unkind, and it hurts to be the subject of others’ laughter. Vaillant distinguishes humor from wit, noting that humor never excludes (1977). It may help nurses to enjoy the beneficial effects of humor and avoid the effects of harmful humor if we attempt to identify some characteristics of appropriate humor. Watson (2011) offers some useful suggestions for self-examination to determine the acceptability of clinical humor:

  • Is the joke about the patient, the situation, or the clinicians themselves?
  • Does the joke reveal disdain or contempt for the patient?
  • Could the joke affect care? An example might be jokes suggesting that a patient deserves pain or disability. Wear et al. (2006) demonstrated that medical students treated patients considered responsible for their pathology as “fair game” for derogatory humor. And nurses have more difficulty empathizing with patients they consider responsible for their pathology (Olsen, 1997). Therefore, jokes enhancing this perception could erode a nurse’s relationship with that patient.
  • What is the underlying intent of the joke—is the motive to influence clinician behavior or attitude? This includes both harmful and helpful intent. Some jokes could be used to gently chide a clinician toward more empathy. Upon hearing a nurse refer to drug-seeking patients in a derogatory tone, I may retort, “Of course they’re lying about their pain. What would happen if she told the triage nurse that she has a five-bag-a-day habit and her dealer is out of town?” The comment generally gets a laugh, and my goal is to give the nurse a chance to consider the patient’s perspective and perhaps see the situation less as despicable deception and more as the desperation of unmet needs.
  • Is it true humor—that is, is it inclusive, a clever juxtaposition, insightful—or is it simply mean-spirited mockery of another’s misfortune? This distinction is subtle and is often dependent on personal intuitive reaction: Does it feel cruel, callous or uncaring? Do you feel shame at saying or hearing it? Does laughing at the joke make you uncomfortable? These reactions vary widely, as can be seen in the public debate regarding what is called “political correctness.”

Filter yourself when thinking to tell a joke and reacting to another’s humor. Pause a moment before telling the joke or reacting to another’s comment; let your intuition and values weigh in. Then, speak—or don’t.

A more difficult ethical issue is whether it is acceptable to make potentially hurtful jokes if one can reasonably ensure that the joke remains within the clinical circle. Read the rest of this entry ?

h1

Recent End-of-Life Care Links of Note, by Nurses and Others

April 13, 2015
nature's own tightrope/marie and alistair knock/flickr creative commons

nature’s own tightrope/marie and alistair knock/flickr creative commons

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

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent NPR story, a Honolulu hospital offers patients and their family members instructive videos on the sometimes gruesome realities of some end-of-life treatment options. Starting with the no-sugar-coating-it statement, “You’re being shown this video because you have an illness that cannot be cured,” these videos explain intubation, CPR, and the different care options available.

I really liked this piece because the physician admitted that he was ill prepared to talk to a patient running out of options who he had never met before. Then he remembered the counsel of other professionals to give patient-specific care (“What are your goals for your care?”).

And some recent coverage in AJN or on this blog
Joy Jacobson’s short end-of-life and palliative care overview from 2013. Read the rest of this entry ?

Follow

Get every new post delivered to your Inbox.

Join 1,714 other followers

%d bloggers like this: