Posts Tagged ‘nurses’

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Dispatch #2 from Melbourne: Dues, Election Results, Nursing at the WHO

May 21, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

There’s lots happening at the International Council of Nurses (ICN) meeting and I’ve logged more walking miles here in Melbourne in the last two days than I do in a week at home.

Judith Shamian

Judith Shamian

On Monday, the Council of National Representatives (CNR), the ICN’s governing body, announced election results. Judith Shamian, a well-known Canadian nursing leader, was elected the 27th president of the ICN. (For more information about Judith and other election results, read this press release.)

The CNR also agreed to address issues related to membership models and will move forward with a plan designed to support inclusiveness and membership growth in national associations. The plan also includes a tiered voting model that takes membership and percentage of membership into account. (The final vote will take place at the 2015 Congress).

Bryant

Rosemary Bryant

New dues scheme: will RCN return? The CNR approved a new scheme for dues that should address the issue that led the Royal College of Nursing (RCN) to withhold dues, resulting in its suspension from the ICN and its recent vote to withdraw from the ICN. According to ICN president Rosemary Bryant, Norway and Japan, who were also unhappy with their dues payments, were pleased with the new model. She is hopeful that the RCN will be as well. (A podcast interview with Bryant is forthcoming.)

I spoke with David Benton, chief executive officer of the ICN, about the RCN’s two-year suspension. According to Benton, the ICN had no choice. “The RCN made a unilateral decision in 2010 with no attempt to negotiate another resolution,” he said. He added that as a long-time member and a fellow of the RCN, he’s personally saddened by its decision to withdraw from the ICN. He noted that only a small portion of RCN’s dues goes to ICN membership and that other countries with far less resources continue to support the ICN’s work. He, too, is hopeful that the changes recently approved by the CNR will prompt the RCN to reconsider its position.

Meanwhile, two new associations were admitted to the ICN: the Chinese Nurses Association and the Palestinian Nursing and Midwifery Association (read more here).

Invisible nurses at the WHO. Another issue, not new but perhaps one that is coming to a head, is the “eradication of nursing expertise at the WHO.” Nursing positions, especially leadership posts, have been disappearing from the WHO headquarters and regional offices and are now at an all-time low of 0.6% (down from 2.6% in 2000).  (See AJN‘s July 2011 editorial and July 2012 report on this.) According to a document issued Monday, the CNR “calls upon the WHO Director General to urgently reinstate the vacant positions of WHO Chief Nursing Scientist  at WHO headquarters and urges regional directors to retain and strengthen senior nursing advisor positions in their regions.”

I also attended several interesting sessions: Read the rest of this entry ?

Posted in international nursing, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 1 Comment »

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Where Medicine Leaves Off

May 17, 2013

Long before we see the face, we hear the crying. Mournful, broken, it expresses general discomfort more than acute pain. In it lies the anxiety of all those children brought here against their will, made to submit to the probing of pale strangers who speak an alien tongue.

AftertheScienceIllustrationThat’s the start of the May Reflections essay, “After the Science,” by Charlie Geer, about working as a medical translator on an Episcopal church–sponsored team in the Dominican Republic. Geer, who published a comic novel in 2005, writes with sensitivity about the limits of medicine and the way the “nurses gather round, the compassion that brought them to medicine picking up where medicine leaves off.”—JM, senior editor

Posted in writing and nursing | Tagged , , , , | 1 Comment »

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Telling Patients About Staffing Levels: Transparency or Self-Interest?

May 9, 2013

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is the ethical quandary posed by nurse ethicist Doug Olsen in his latest article, in the May issue of AJN (free until the first week of June). Having posed the situation described above, he goes on to pinpoint the ethical principles that come into play when making such a decision, explore the pros and cons of disclosing certain information to patients in various related situations, and emphasize both the need for awareness of the patient’s perspective and the necessity for nurses of engaging in honest self-examination.

As with many such situations, there’s not always a right answer; every situation is different, and gray areas do exist. What’s your take?—Jacob Molyneux, senior editor

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Posted in ethical issues, patient safety | Tagged , , , , , , | 5 Comments »

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The Nuts and Bolts of Fluid Therapy in Critically Ill Patients

May 1, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the day when I was a bedside nurse, hemodynamic monitoring was just coming into play, and then only in coronary care. In the ER, we relied on a combination of vital signs (pulse and BP), urine output, and central venous pressure (CVP) to guide fluid administration. Later, patients in need of close monitoring received arterial lines to monitor pulmonary arterial pressures; monitors and stopcocks were everywhere (and soon after, infections, but that’s another story . . . ).

But things are changing again, and the trend is toward less-invasive monitoring. In our May issue, we’re pleased to bring you a comprehensive CE article (worth 2.6 contact hours), “Using Functional Hemodynamic Indicators to Guide Fluid Therapy.” The author is Elizabeth Bridges, PhD, RN, CCNS, an associate professor in biobehavioral nursing and health systems at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center in Seattle. Many critical care nurses will know her from her “standing room only” research sessions at the American Association of Critical Care Nurses National Teaching Institute (this year it will be in Boston, May 20–23), in my view one of the best annual national nursing meetings.

Here’s the article abstract:

Hemodynamic monitoring has traditionally relied on such static pressure measurements as pulmonary artery occlusion pressure and central venous pressure to guide fluid therapy. Over the past 15 years, however, there’s been a shift toward less invasive or noninvasive monitoring methods, which use “functional” hemodynamic indicators that reflect ventilator-induced changes in preload and thereby more accurately predict fluid responsiveness. The author reviews the physiologic principles underlying functional hemodynamic indicators, describes how the indicators are calculated, and discusses when and how to use them to guide fluid resuscitation in critically ill patients.


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Good Medicine

April 22, 2013

musichospitalroomBy Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped cold by the slow drawing of a wide-toothed comb through someone’s hair, seen someone instantly relax when provided pictures of a beloved pet, and have witnessed music provide relief more than once.

Small measures, perhaps, but sometimes little things matter a lot, and good medicine doesn’t always come from a vial.

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Posted in healing/holistic, nursing perspective | Tagged , , , , , , | 4 Comments »

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Friday Nursing Blogs Roundup, More or Less

April 19, 2013

By Jacob Molyneux, AJN senior editor/blog editor

BostonAnother Friday in New York, and it’s time to do a quick tour of the nursing blogosphere after a grueling week in which the city I will always think of as home, Boston, took a major hit on a holiday that always marks the end of a long winter, the first stirrings of spring, the Red Sox playing in the morning, no one at work, glimpses of marathoners passing in the distance up still salt-stained avenues under barely budding trees, usually in bright sun and a gusty breeze with an underside of chill.

I have noted ad nauseam in the past that blogs have life cycles, wax and wane, flourish or fade out. And that’s okay. Though maybe blogs should go to a blog graveyard at some point, or be given a proper burial, or demolished like old buildings in a great controlled cinematic whoosh of collapsing pixels and pixel-dust. Or, in some cases, put in a museum to mark a moment in Web history or preserve particularly lively voices and experiences for posterity.

Enough throat clearing. There isn’t much out there to report this week. We try to collect links to sane, more or less active blogs on our nursing blogs page. A few nurse bloggers are perennially engaging and active, and a couple of these excellent bloggers even write occasional posts for this blog, so for once I won’t draw attention to them. But here’s what else I could find:

We the people. Many nurse blogs and Twitter streams and Facebook pages have been posting links to a petition to the White House to remove barriers preventing advanced practice nurses from practicing to their full scope. The petition has until just April 22 to reach the required 100,000 signatures; the last time I checked, admittedly about a week ago, it was only about a quarter of the way there. If you happen to know Justin Bieber, please ask him to publicize this. In lieu of that, consider sending it to your social media connections, and take a moment to sign yourself.

A brief note on the readability of blogs. By “readability,” I’m not talking about style, as you’d expect, but more about how easy and pleasant the blog is to read in an actual physical sense. The right word might instead be “legibility.” Or, put another way, did you choose a green or black or red background for your text? Though it’s nice to be reminded of the early days of the Web and the idiosyncratic appearance of many blogs, I now find blogs with such colored backgrounds almost impossible to read. Consider making a change to something closer to the traditional black text on a whitish background. And consider avoiding flowery fonts.

More on nurse staffing and why it matters: at the INQRI (Interdisciplinary Nursing Quality Research Initiative) blog, further confirmation that “better nurse staffing, education and work environment contribute to patient outcomes”:

A new study in Medical Care, conducted by Matthew McHugh, an RWJF Nurse Faculty Scholar,
finds that the lower mortality rates at Magnet Hospitals are achieved
in part because of investments in nursing. This study reflects many of
the findings of INQRI studies into the impact of nurse staffing, work environment and education on quality of patient care.

Conference tips. At In the Round, the blog at Nursing Center, a short post lists “tips and time-savers” for those of you who from time to time attend professional conferences. I used to go to a lot of them, and they really do take practice and some strategy.

Already sick of Nurses Week and Nurses Day (and still wondering about whether to use an apostrophe s or just an apostrophe or nothing with them)? At Impacted Nurse, there’s a strangely heartwarming yet appropriately skeptical piece called “Note to Nurse Day: I don’t need to write some silly note.”

And that’s really it for today. Have a great weekend, and let us know if you find a really good nursing blog we don’t know about yet.
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Posted in nursing perspective, social media, writing and nursing | Tagged , , , , , , , | 2 Comments »

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The Hands of Strangers

April 16, 2013

By Karen Roush, AJN clinical managing editor

Boston MarathonA marathon is a triumph of spirit and endurance. It is a solitary endeavor carried along by a hundred thousand strangers. Anyone who has run a marathon knows that the spectators are not merely spectators. They are participants—they give their energy, their encouragement, their voices; they become part of your will, your perseverance; they carry you forward. Some part of every voice, every hand touched, crosses that finish line with you.

A marathon takes place in a particular city but it belongs to the world. For months, even years, someone in Sydney, in Kampala, in Seoul, in Cedar Rapids, in Damascus, in some small unknown village and in every great city, prepared for those same 26.2 miles ending yesterday at Boylston Street in Boston.

When I think about the marathons I’ve run, it is not crossing the finish line that I remember. What I took away, and what stays with me to this day, is a powerful and joyful sense of our shared humanity. That is what the bomber tried to shatter yesterday.

I have no doubt that in time investigators will find answers to who did this and why. But the greater questions will remain. How do we live with the certainty of our vulnerability? How do we come together freely and joyfully, knowing the threat that walks in our midst? How do we stay open enough to reach our hands out to strangers?

As we grieve the terrible losses suffered in Boston and face an uncertain future, we need to be like those participants lining the route, sharing our energy and voices to carry each other forward. We need to refuse to allow anyone to shatter our shared humanity.

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Posted in Karen Roush, nursing perspective | Tagged , , , , , , | 1 Comment »

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Finding Future Leaders – and a NICHE in Nursing

April 15, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

It has been a hectic few weeks, as I’ve been traveling to the early spring nursing meetings (with still more to come).

With John Gransbach at NSNA meeting

With John Gransbach at NSNA meeting

First I went to Charlotte, North Carolina, to attend the National Student Nurses Association (NSNA) annual meeting (April 3–7). AJN has had a long association with the NSNA, supporting it in various ways since its 1952 founding, from hosting board meetings at AJN offices to producing the convention newsletter to convention scholarships for key contributors. In recent years, we’ve sponsored travel expenses to the annual meeting for the winner of Project InTouch, the member incentive plan. This year, the winner was John Gransbach, who graduated from the Goldfarb School of Nursing at Barnes-Jewish College in St Louis. He recruited 228 new NSNA members—an achievement certainly worth recognizing.

Future leaders. As I told the audience when I presented the plaque to Mr. Gransbach, this award isn’t just about growing membership in the NSNA—it’s about contributing to the future of the profession. Students who join the NSNA are already demonstrating a commitment to nursing by going beyond what’s required of them. They’ve joined an organization that provides considerable resources to help them begin their careers. Not only does it provide practical help with passing the NCLEX exam, writing a resume, and finding a job, but it informs them about what it means to be a nurse. NSNA members are the future of nursing and likely the future leaders of nursing. We’re pleased to support this award and NSNA.

NICHE. And this past week I was in Philadelphia for a meeting of the Nurses Improving Care for Healthsystem Elders (NICHE) initiative, a program based at New York University College of Nursing that seeks to provide education and resources to improve care for hospitalized older adults. It provides training curricula and tools to the 450 hospitals that are members of the NICHE network. Much of the agenda focuses on initiatives that NICHE members have successfully implemented to improve care.

NichePhotoAJN partnered with NICHE in a joint initiative, “Professional Partners Supporting Diverse Family Caregivers Across Settings,” funded by the Jacob and Valeria Langeloth Foundation in collaboration with the AARP Foundation. (Pictured in the photo are, from left: Liz Capezuti, director, NICHE; Susan Reinhard, senior VP, AARP Public Policy Institute; Rita Choula, program manager, strategic initiatives, AARP; myself.)

Helping family caregivers. We worked with NICHE to develop a series of articles and videos designed to teach nurses concepts and skills to help them better support family caregivers in assuming care for loved ones after hospital discharge. These materials were used in training staff and as a basis for developing family-centered practices, which were then piloted in five NICHE hospitals. Dennise Lavrenz, the NICHE coordinator on the project, presented some initial results that were encouraging. Overall, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores, caregivers showed increased satisfaction with their experience and with staff communication and felt more prepared to care for family members.

At the meeting, presenters from Carolinas Medical Center-Mercy in Charlotte, North Carolina, discussed their success in improving caregivers’ experience through employing a caregiver assessment tool, paying closer attention to caregivers’ information needs, and providing the caregiver with a tote bag of personal items for their use when their family member was admitted to the hospital. What started as a nurse-driven pilot on two units was now being rolled out hospital-wide—certainly a success story for the nurses who spearheaded the project and and the hospital, but most of all, a win for the caregivers.

The NICHE Web site offers a wealth of information; you can also find AJN-produced, foundation-funded resources for caring for older adults at this Web page; or access AJN’s family caregiver videos here.

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Sustainable Health Care Environments

April 8, 2013

By Shawn Kennedy, AJN editor-in-chief

Laura Anderko

Laura Anderko

In our April issue, we give a nod to Earth Day (April 22) and its focus on the environment. The article, “Greening the ‘Proclamation for Change’: Healing Through Sustainable Health Care Environments” (free until May 8), by Laura Anderko and colleagues Stephanie Chalupka, Whitney Austin Gray, and Karen Kesten, highlights how hospitals can incorporate design elements and practices not only to reduce energy consumption and garbage, but to provide a healing environment for patients and staff. There is ample evidence in support of the use of natural light, noise-reducing materials for floors and walls, and other design elements in improving rest and healing. And the evidence also shows the benefit to staff AJN0413.Cover.2nd.inddin terms of reducing stress, fatigue, and errors.

Denise Choiniere

Denise Choiniere

Anderko put me in touch with Denise Choiniere, MS, RN, a former critical care nurse who is now director of sustainability, materials management, and in-house construction at the University of Maryland Medical Center in Baltimore. So how does one go from being a bedside nurse to overseeing construction and environmental efforts? Choiniere says she had “an ‘aha’ moment” when she realized that the chemicals being used to clean hospitals could make people ill. Listen to my podcast with Anderko and Choiniere to learn more about how nurses can help their facilities go green.

As the authors point out,

In the past three decades, researchers have learned a great deal about environmental effects on health, including the ways in which the design and operation of health care facilities can negatively affect the health of patients and employees, communities, and the environment at large. From health care–associated infections and medical errors to pollution caused by the incineration of hospital waste, health care institutions have much to rectify before they can become truly healing environments.

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AJN’s February Issue: COPD, Fungal Meningitis Outbreak, SIDs, Nursing Leadership

February 1, 2013

AJN0213 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Last month, we published findings from a quantitative study exploring antiparkinson medication–withholding times during hospitalization and symptom management. This month you can catch part two of this series, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with Parkinson’s disease. Participants’ comments in this study made it clear that the actions of nurses could affect the perioperative experience for better or worse. The article is open access and can earn you 2.1 continuing education (CE) credits.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the U.S. Our CE feature “COPD Exacerbations” outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations. The article is open access and can earn you 2.6 CE credits.

This month we introduce our new series, Perspectives on Leadership, which is coordinated by the American Organization of Nurse Executives. This first article, “Partnering for Change,” describes how one hospital’s nurse leaders and staff worked together to change the way nurses conduct shift report.

Matthews_BillboardEach year in the U.S., more than 4,500 infants die suddenly and unexpectedly. February’s In Our Community article, “Babies Are Still Dying of SIDS,” describes how a nurse’s advocacy and activism resulted in safe-sleep legislation. A podcast with the authors of the article is also available.

Want to learn how hospitals, clinics, and the public health system responded to the recent fungal meningitis outbreak? Read this month’s Emerging Infections article for more.

There is plenty more in this issue, including a report on the recovery of health care facilities following Hurricane Sandy, so stop by and have a look. Feel free to tell us what you think on Facebook, or here on our blog.

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